ADHD and Defiance: Parenting “Difficult” Teens

“’Nightmare’ would be putting it mildly,” Christine said of raising her 22-year-old daughter Michelle, diagnosed with ADHD and Oppositional Defiant Disorder (ODD). “For a long time I wasn’t sure what would happen. I was afraid she was going to end up in jail or worse.” Molly faces a similar situation with her 15-year-old son Thomas, who also has ADHD and exhibits characteristics of ODD or a Conduct Disorder (CD). Parents of children and teens with ADHD already face additional challenges and hurdles, and defiant children with ADHD can make those challenges feel like a minefield. Michelle, age 22 For Christine, most of her struggles are in the past, as Michelle has gotten her life in order. The moment of truth for Michelle came when she was 16, and snuck out of the house to go to a party she had been forbidden from attending. She took her mother’s car keys and set out for a night of unbridled fun. Things did not go as planned. She was pulled over by the police during her trip, and several ounces of marijuana were found and seized. She was arrested and spent the night in jail. “I wanted to go and bail her out immediately,” recalls Christine. “I tried so hard to keep her from making those mistakes and to protect her from the consequences of her behaviors… and now my worst fears were happening.” While her mother tried to protect Michelle, her father took a different approach. He felt Michelle needed to be free to explore who she was and also to live with the consequences of her actions. When the call came that she was in jail, there was a heated disagreement over what to do. In the end, Michelle's parents decided that she would have to wait until morning to be bailed out. “It was the scariest night of my life,” Michelle sad of the experience. “There were really bad looking, scary people in there, and I was thinking ‘I’m just a kid! I don’t belong with these people, they’re REAL criminals!’” After that, she agreed to try working with her parents to rein herself in. Christine said that there were still a number of arguments, and the defiant behaviors did not disappear completely, but at least Michelle was making an effort and improving. Her parents agreed to allow her to transfer to a specialized school that matched Michelle's interest in the arts, on a trial basis. This set her on the path to where she is today, working as a graphics artist for an advertising firm. Thomas, age 15 Today, Molly is where Christine was seven years ago, and there’s no guarantee her story will have as happy an ending. Her 15-year-old son Thomas has ADHD and exhibits extremely defiant behaviors. The problems started as far back as Kindergarten, Molly said, but she spent many years with “the blinders” on and attributed his behavior problems to the school's failing to provide adequate accommodations. “Had I sought out help earlier, maybe things would not have escalated to where they are now,” Molly said. “For anyone else, I would tell them don’t just depend on medication and accommodations; if there is a problem that keeps happening, find help.” Thomas has struggled throughout his school career, and over the past couple of years has taken to cutting class. At one point during his last year in middle school, he physically assaulted and verbally threatened another student, resulting in his being placed in an alternative school. Molly said this is the only environment he seemed to succeed in. She wanted to transfer him to such a school on a permanent basis, but he refused, and threatened to run away if she tried. He has since done exactly that, on more than one occasion. He has also ended up in trouble with the law for shoplifting electronics and food. Currently, he is residing with his grandparents, who Molly feels are severely undercutting her efforts to get Thomas on track. “They think he just needs more love, and not a lot of structure,” Molly said. “He has no rules or consequences with them, so he is taking advantage.” Molly and her husband have recently sought help from a psychologist who specializes in working with defiant children, but her parents are unwilling to see this psychologist and buy in to the therapy he is offering. Molly does report that she is having success implementing the treatment with her daughter, who also exhibits defiance and is where Thomas was a few years ago at the same age. “My mother is enabling his behavior by not placing boundaries or consequences,” Molly said. “He’s been there for several weeks now, and continues to skip class when he goes to school at all. He’s also stopped taking his ADHD medications since living there.” Without having her family on the same page and working together, Molly does not see a resolution to this situation. And short of moving to another state, far from her parents, is not sure how to keep Thomas away from them and at home. As Molly’s experience so painfully demonstrates, it is absolutely essential for a teen like Thomas to get the same message from all important adults in his life. Defiant teens can be very skilled at finding weaknesses in even well-structured environments, so ensuring that parents and all caregivers are “on the same page” is essential. Hope and Help for Parents What can a parent do when faced with defiant behavior above and beyond what even most parents of children with ADHD must face? A starting point would be found in the NRC’s information sheet What We Know #5B: Coexisting Conditions: Disruptive Behavior Disorders. Basic advice offered includes: Obtaining parent training, family therapy and a system known as Collaborative Problem Solving. The fact sheet offers some resources for parents, and lists some books that can help parents take the first steps towards reducing such behaviors. One book that is of particular help is Your Defiant Teen, by Russell A. Barkley, PhD, Arthur L. Robin, PhD, with Christine M. Benton. This book speaks specifically towards teens, and has a narrower focus than many books which focus on defiance in children of various ages. Your Defiant Teen sets out a 10 step program for parents to institute, and recommends finding a professional familiar with the system who can work with parents to implement treatment. Tips for finding such a person can be found in the NRC’s FAQ Can you help me find a doctor or mental health professional? The NRC News article Adult, ADHD … and No Help in Sight, from the September 2011 edition, offers insight as to finding treatment in traditionally underserved areas. Finding a good professional to work with and implementing the proper course of treatment is vital if improvement is to be seen. In addition, families must be on the same page and act consistently for treatment to work. When these basic elements are not in place, treatments become very difficult and the situation can worsen. There are no easy answers for parents who live with defiant teens as Christine and Molly have, but as Michelle has shown, there is hope.

National Resource Center on AD/HD: A Program of CHADD

Your Holiday Home

Your Holiday Home

by Karen Sampson, MA

www.chadd.org

THE HOLIDAYS ARE HERE. The big questions, such as “which traditions does our family want to celebrate and continue?” have been answered. It’s the little things that are snowballing that need to be addressed now. Such as cleaning the house.

Develop routines

Maintaining a home is such a big project that a few generations ago, almost every family had a full-time home manager. Today, it is more common that single and partnered adults work outside the home. The challenge can still be met, even with AD/HD as part of the mix.

A secret resource for many CHADD members, keeping in mind that CHADD doesn’t endorse products or websites: FlyLady. So named for her love of fly fishing, FlyLady is all about “baby steps” and routines. She explains how to develop a routine to tackle the holiday season and the rest of the year, and her plans and control journals work well for anyone affected by AD/HD. Since you design your own routine with her guidance, it will fit the needs of your life. Other helpful websites include ServiceMaster and Queen of Clean.

Make a plan

Scout your dwelling and note what needs the most work, what needs the least work, and the best hiding places for stuff. (That includes cramming things under the bed—but only for quick cleanings during the holidays.)

Set the timer

Once there is a plan, set the kitchen timer for five, ten or fifteen minutes, and attack the first room. Pick up, stuff away, clear out of sight. When the timer dings, reset it for the next room, whether the first is done or not. Repeat the picking-up in the second room. Ding; same for the third. Set the timer again, grab something to drink or nibble and sit. Rest for the fourth round. Ding, and you’re back to the first room. Repeat until each room is picked up, dusted, and vacuumed, and any additional scrubbing is completed. Breaking it up over a couple days or a week is a good thing, too.

Handy tips

Leave a second garbage bag at the bottom of the pail, under the current one. That way you have one handy in a pinch without having to hunt for it.

Keep one extra of whatever—laundry soap, can of soup, package of paper towels—on hand. Don’t fill your cupboards with more than you need, but make sure you have a back-up at the ready so you don’t lose your stride.

Keep all cleaning supplies together—a mop bucket makes a great container to stick everything in so you can move from room to room quickly.

If you use it in that room, find a place for it to live in that room. That goes for brooms (kitchen pantry), vacuums (living room closet), laptop computers and accessories (family room entertainment center), and tablecloths (dining room china cabinet). This works well with cleaning supplies, too (though if there are small children in your life, perhaps up high in a cabinet).

Suggestions from CHADD members

Get out of having the celebration at your house. Consider co-hosting family events at another relative’s house.

Make running lists—notebooks and personal data assistants are great for this. Make a list for everything from groceries to library books, and keep lists in one place for easy reference.

Limit your number of guests. A dinner party of six is more manageable than twenty-six. Since this is a holiday season, make use of the time by having two small dinner parties with different guests or one intimate party and then making reservations for the larger group at a favorite restaurant.

Call your favorite grocery store and find out about its holiday meals. Many prepare the entire meal at a reasonable cost. Order ahead, pick it up the morning of your holiday meal—and serve in your own dishes!

Online shopping is good. If the online store includes gift-wrapping, go for it! Have gifts sent to their recipients rather than to you. One wise member pointed out that wrapping gifts as soon as you get them helps to avoid the 3 a.m. crunch before the big day.

As one CHADD member wrote to us, “Change the expectations so the holiday works for you, not the other way around.”

If all else fails…

One CHADD member wrote that he once had a stack of newspapers piling up in the dining room, evidently for a couple of years. As company was coming rather soon, he struck upon a plan: He placed a board across the tops of the piles and draped a holiday tablecloth over it. The piles were successfully hidden and the set-up “didn’t look bad, really.”

Except that it stayed that way for another four years before finally being cleared away.

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Karen Sampson, MA, writes from Hanover, Maryland.

Difficult Peer Relationships

ADHD can have many effects on a child's development. It can make childhood friendships, or peer relationships, very difficult. These relationships contribute to children's immediate happiness and may be very important to their long-term development.

Children with ADHD might have difficulty in their peer relationships, for example, being rejected by peers or not having close friends. In some cases, children with peer problems may also be at higher risk for anxiety, behavioral and mood disorders, substance abuse and delinquency as teenagers.

• Parents of children with a history of ADHD report almost 3 times as many peer problems as those without a history of ADHD (21.1% vs. 7.3%).¹

• Parents report that children with a history of ADHD are almost 10 times as likely to have difficulties that interfere with friendships (20.6% vs. 2.0%).¹

How does ADHD interfere with peer relationships?

Exactly how ADHD contributes to social problems is not fully understood. Several studies have found that children with predominantly inattentive ADHD may be perceived as shy or withdrawn by their peers. Research strongly indicates that aggressive behavior in children with symptoms of impulsivity/hyperactivity may play a significant role in peer rejection. In addition, other behavioral disorders often occur along with ADHD. Children with ADHD and other disorders appear to face greater impairments in their relationships with peers.

Having ADHD does not mean a person has to have poor peer relationships.

Not everyone with ADHD has difficulty getting along with others. For those who do, many things can be done to improve the person's relationships. The earlier a child's difficulties with peers are noticed, the more successful intervention may be. Although researchers have not provided definitive answers, some things parents might consider as they help their child build and strengthen peer relationships are:

• Recognize the importance of healthy peer relationships for children. These relationships can be just as important as grades to school success.
• Maintain on-going communication with people who play important roles in your child's life (such as teachers, school counselors, after-school activity leaders, health care providers, etc.). Keep up-dated on your child's social development in community and school settings.
• Involve your child in activities with his or her peers. Communicate with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.
• Peer programs can be helpful, particularly for older children and teenagers. Schools and communities often have such programs available. You may want to discuss the possibility of your child's participation with program directors and your child's care providers.

Risk of Injuries

Children and adolescents with ADHD can have more frequent and severe injuries than peers without ADHD.

Research indicates that children with ADHD are significantly more likely to:

• Be injured as pedestrians or while riding a bicycle
• Receive head injuries
• Injure more than one part of the body
• Be hospitalized for accidental poisoning
• Be admitted to intensive care units or have an injury result in disability

Further research is needed to understand what role ADHD symptoms play in the risk of injuries and other disorders that may occur with ADHD. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may engage in high-risk physical activity without thinking of the possible consequences. Teenagers with ADHD who drive may have more traffic violations and accidents and twice as likely to have their driver’s licenses suspended than drivers without ADHD.

Much of what is already known about injury prevention may be particularly useful for people with ADHD.

• Ensure bicycle helmet use. Remind children as often as necessary to watch for cars and to avoid unsafe activities.
• Supervise children when they are involved in high-risk activities or are in risky settings, such as when climbing or when in or around a swimming pool.
• Keep potentially harmful household products, tools, equipment and objects out of the reach of young children.
• Teens with ADHD may need to limit the amount of music listened to in the car while driving, drive without passengers and/or keep the number of passengers to a chosen few, plan trips well ahead of time, avoid alcohol and drug use and cellular phone usage.
• Parents may want to enroll their teens in driving safety courses before they get their driver’s license.
• For more injury prevention tips, visit CDC’s Injury Center.

Oppositional Defiant Disorder

Oppositional Defiant Disorder (ODD) is one of the most common disorders occurring with ADHD. ODD usually starts before age eight, but no later than early adolescence. Symptoms may occur most often with people the individual knows well, such as family members or a regular care provider. These behaviors are present beyond what are expected for the child’s age, and result in significant difficulties in school, at home, and/or with peers.

Examples of ODD behaviors include:

• Losing one’s temper a lot
• Arguing with adults or refusing to comply with adults’ rules or requests
• Often getting angry or being resentful or vindictive
• Deliberately annoying others; easily becoming annoyed with others
• Often blaming other people for one’s own mistakes or misbehavior

Learning Disorder

Recently released data from the 1997-98 National Health Interview Survey suggests roughly half of those youth 6-11 years old diagnosed with ADHD may also have a Learning Disorder (LD). The combination of attention problems caused by ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is crucial. Appropriate and timely interventions to address ADHD and LD should follow diagnosis. The nature and course of treatment for ADHD and LD may be different, and different types of providers may be involved. Working with health care professionals to determine appropriate referrals and treatment is the best way to make informed decisions for an individual dealing with ADHD and a learning problem.

Conduct Disorder

Conduct Disorder (CD) is a behavioral pattern characterized by aggression toward others and serious violations of rules, laws, and social norms. These behaviors often lead to delinquency or incarceration. Increased injuries and strained peer relationships are also common in this population. The symptoms of CD are apparent in several settings in the person’s life (e.g., at home, in the community and at school).

While CD is less common than Oppositional Defiant Disorder, it is severe and highly disruptive to the person’s life and to others in his/her life. It is also very challenging to treat. A mental health professional should complete evaluations for CD where warranted, and a plan for intervention should be implemented as early as possible.

Read more at http://www.cdc.gov/ncbddd/adhd/conditions.html#peer. From Centers for Disease Control and Prevention

Are you Impulsive, Impatient or Losing Your Temper?

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