Morwen made an excellent comment on my original ODD post which leads me to revise the post and also add new links:
Hello Doug, I feel as though the information you presented above lacks critical engagement with diagnosis or disorder. There are many important critiques of ODD, particularly in it’s overuse as a label for children of color. There is serious concern that ODD diagnoses also hide other struggles, such as trauma and neurodevelopmental conditions, making the focus behaviour rather than situation or neurology. Your line about feeling as though you should just say “May god bless you” and move on also plays into the narrative that these children (again disproportionately children of color) aren’t savable, and that they are inherently and irrevocably destined for violence or anti-social behaviour. Considering that less than 30% of diagnosed ODD children progress to having a conduct disorder, and only a minority of diagnosed CD children progress to APD, your glum, hopeless tone of your post is distressing to me. |
Note: CD conduct disorder; APD antisocial personality disorder
Revised Post:
“About forty percent of kids with ADHD have or will develop ODD, Oppositional Defiant Disorder. “
I think 40% is too high.
What is ODD?
“A disorder in a child marked by defiant and disobedient behavior to authority figures. The cause of oppositional defiant disorder is unknown but likely involves a combination of genetic and environmental factors. Symptoms generally begin before a child is eight years old. They include irritable mood, argumentative and defiant behavior, aggression, and vindictiveness that last more than six months and cause significant problems at home or school. Treatment involves individual and family therapy.”
When I see a post that starts, ” My son is diagnosed with ADHD and ODD, and —“, my heart sinks. The parents are having a hard time, as is the child, and I don’t have good advice to give and so I feel inadequate and helpless and unhelpful and pessimistic. I’m trying to get more information.
There is a support group, and the parents do need support. The parents need knowledgeable professional help, and to be consistent with a good behavior management program , and to stick with it for a while even when it doesn’t seem to be working. (This is different from most situations, where if what you’re doing isn’t working, try something else.)
There are successes, but these kids tend to develop serious problems – school drop out, drugs, incarcerations. The parents need to learn to protect themselves, and to avoid enabling. The worst outcomes I’ve seen were where parents kept bailing the kid out of the trouble they were in.
The main point from Morwen is that if the diagnosis of ODD is being considered, there needs to be a careful look at what else might be going on – truama, dyslexia, depression, etc. Also that we cannot just give up one these kids and write them off.
doug
Stimulants for ODD
“For co-occurring ODD and ADHD, clinicians often prescribe stimulants to treat ADHD first. Typically, the ADHD stimulant medications greatly reduce ODD symptom severity and frequency. One study also found that patients with ADHD who consistently took medication significantly lowered their risk of developing ODD or CD in later life compared to patients with lower drug adherence3. In practice, clinicians often use liquid formulations to avoid having the patient potentially dispose of tablets.”
Personal Notes O the Day:
- Did I have ODD too? Only a touch. I was too afraid of consequences, but I tended to automatically disobey any rule or direct order if I could, even when I realized it was in my best interest. But, I was a “bad kid.” A bully, lots of fights, and convicted of a serious offense I hadn’t done.
- Sometimes parents are, or were, fined if their kid was too much truant. But what if they were just not able to force the kid to go to school?
Quote O the Day:
“If you tell me I can’t do something, I’ll do it twice, video tape it, and post it on all the social media.”
ODDer? That was me.
Question O the Day:
Did you have ODD?
Links:
From NIMH
Mightier – commercial program for ODD?
#ADHD, #adultADHD, @dougmkpdp, @addstrategies, @adhdstrategies
ADHD Meds
You are stressing me.
ADDadultstrategies 
Yikes. The lack of sensitivity in this post is disturbing
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morwen- i’m sorry you found the post insensitive but I’m glad you told me. please explicate – how was it insensitive?
and thank you for commenting
best wishes
doug
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@Doug and Morwen
For what it’s worth: I don’t think the post is insensitive. I think Morwen stumbled upon this blog just now and is not fully aware of Doug’s expertise on the matter and what makes Doug say all this.
I kind of understand what Morwen means though, because knowing this blog for many years, my heart sunk too when reading this post. We always want to hear that there will be a solution, and it’s hard to swallow when there is no certain fix available.
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Ram
thank you for giving me an idea of what might be “insensitive.” just giving the facts when they are discouraging might be.in my negative view, the main issue is to support the parents. i am attaching a link about outcomes, pretty grim. but one study showed that with proper multi-faceted treatment, 75% of ODD kid (didnt say adhd plus ODD I’m afraid) can have normal behavior in two years. That’s great! so i wish i had been more sensitive and somehow presented a less pessimistic picture while still being factual.
as always, I’m very appreciative of your comments.
best wishes
doug
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ram
i forgot the link https://scholar.google.com/scholar?q=outcome+of+oppositional+defiant+disorder&hl=en&as_sdt=0&as_vis=1&oi=scholart
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Coo. I would really appreciate if you didn’t try to explain away my criticism with falsely presumed ignorance. I’m really not comfortable with that. Thanks.
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morwen
if you were referring to me? i assure you my ignorance is not falsely presumed. specifically, i don’t know a lot about child issues, learned early I wasn’t good with children, and also wasn’t trained for them, so didn’t take children as patients.hope everyone sees the new info related to ADHD, you’ve done a good job. thanks
best wishes
doug
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Hello, Morwen. I meant no offense. I’ve been a regular at this blog for many years and never “saw you” around, so thinking that you didn’t know Doug was what felt a natural conclusion to me. You seem to think I accused you of ignorance and think it offensive, and I neither see nor meant offense in that. But I do apologize if I came across as offending.
Without meaning to start a fight: I found the tone of your first message unnecessarily provocative and dismissive, and chimed in to try and “comfort” a friend. But I am glad you came back and cleared it up with him. Apparently, written messages make for a lot of misunderstandings. Have a good one!
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Hello Doug, I feel as though the information you presented above lacks critical engagement with diagnosis or disorder. There are many important critiques of ODD, particularly in it’s overuse as a label for children of color. There is serious concern that ODD diagnoses also hide other struggles, such as trauma and neurodevelopmental conditions, making the focus behaviour rather than situation or neurology.
Your line about feeling as though you should just say “May god bless you” and move on also plays into the narrative that these children (again disproportionately children of color) aren’t savable, and that they are inherently and irrevocably destined for violence or anti-social behaviour. Considering that less than 30% of diagnosed ODD children progress to having a conduct disorder, and only a minority of diagnosed CD children progress to APD, your glum, hopeless tone of your post is distressing to me.
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morwen
excellent informative explanation. I’m redoing the post. I have not found any good sites with information about outcomes, just the general negative stuff without statistics, nor information about ODD and ADHD comorbid. If you can send any links that would be very helpful.
thank you
doug
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