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