Two of the most prevalent disorders we see in
clinical work with teens are Attention Deficit Disorder/Attention Deficit
Hyperactivity Disorder (ADD/ADHD) and Oppositional Defiant Disorder (ODD).
ADD/ADHD seems to be caused by a structural problem in the brain. People with
ADD/ADHD often have difficulty anticipating the long-term consequences of
their behavior and determining if their behavior is appropriate to the
situation. This is a lifelong condition that can be helped with medication and
behavior therapy.
In contrast, ODD occurs primarily in
adolescents and involves the willful neglect of what the child knows is
expected of them. It is important to stress that ODD involves an extremely
oppositional stance. Virtually all teenagers are defiant at times, but those
with this disorder are almost perpetually defiant and seldom back down in the
face of consequences. This defiance includes opposing things that are actually
in their best interest, simply because they do not want to listen to the adult
that is providing direction. ODD does not last into adulthood. This disorder
is not treated with medication but it can be effectively treated with behavior
therapy.
In reading the above paragraphs, one might
assume these disorders appear quite different. Unfortunately this is not the
case. Both disorders present with inappropriate behavior on the part of the
child. The difference in the disorders begins with the reasons for their
behavior. In ADD/ADHD their actions occur because they act without deciding if
their action is appropriate for the setting or situation they are in. With ODD
the child simply has no intention of following directions or doing anything
they find boring or distasteful.
To complicate matters even more, research has
shown that 40% of all ADD/ADHD children develop an ODD by the time they are in
their teens. In fact, there is some evidence to suggest they start becoming
oppositional several years before their peers, as early as eight or nine years
of age. In theory this occurs because the ADD/ADHD child develops a defiant
and oppositional stance in response to the frequent negative feedback they
receive. They are just as intelligent as others so they are aware that they
get in trouble more than others, and cope with this by openly acting that way.
It is their way of saying, “if you treat me this way then I’ll act this
way.” In essence, if they decide to act in defiance of the rules, they have
some measure of control, and others are not as likely to find out that they
are different from other kids.
So how do you determine if you are dealing
with their ADD/ADHD or with their ODD? Here are a few ideas:
If it is ADD/ADHD the problem behavior will
stop when it is confronted or consequences are given. It may recur within
several minutes but there will be gaps between the episodes of misbehavior.
Misbehavior is more constant with ODD
children. In the face of many negative consequences they will continue to
misbehave. ADD/ADHD misbehavior stops once it is redirected. It may
deteriorate again shortly thereafter, but the immediate response is to
cooperate and comply.
ADD/ADHD children respond in positive reward
systems, whereas their ODD counterparts rarely will. ADD/ADHD children will
work on proper behavior in order to gain simple rewards, such as praise. This
is why they will take redirection so well. They want to succeed. ODD
adolescents consider themselves successful when they have ruined your day. The
result is that positive rewards and praise are met with, at best,
indifference, and at worst they spark further defiance.
Consequences with ODD adolescents are usually
received with further opposition. This is essentially a “you can’t make me”
attitude. If grounded they will walk out the door in defiance of your
authority. Consequences with the ADD/ADHD child are most often met with
compliance or pleading. In other words they attempt to wriggle out of the
consequence by appealing to your sense of fairness or promising never to do it
again. Begrudgingly, they will accept their consequences, particularly if you
are consistent, do not get upset yourself, and never give in or give warnings.
There is reasoning and rationale behind an ODD
youth’s misbehavior. It is usually very poor reasoning, but they do have
reasons. Examples include, “I don’t want to do it”, “you can’t make
me do it”, and “I don’t see why I should have to do it.” By contrast
an ADD/ADHD child will not have reasons or rationale behind their actions. “I
don’t know” is actually the truth, because they acted without thinking.
Keep in mind that if an adolescent has both
disorders, they may be misbehaving for both reasons. For instance, initially
they may have been distracted from doing their homework (ADD/ADHD), but when
redirected to do their work they refuse (ODD). ADD/ADHD requires frequent
redirection, and when they respond appropriately to the redirection the
intervention has been successful and no long-term consequence is required.
Defiance, on the other hand, involves willful disregard for expected and
appropriate behavior, so they will not respond to redirection. Consequences
are needed every time defiance occurs so behavior is properly shaped.
Treatment for both conditions requires a
thorough assessment and coordination of strategies between home, school and
the treatment provider. In many cases social service or criminal justice
agencies are also involved, and must be included in the coordinated effort at
treatment.
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