Child with ODD and ADHD

Question

I honestly am confused about what to do as a parent. I have a 4 year old child with severe ADHD symptoms and ODD and persistent impulse control issues. My child experiences level 10 tantrums multiple times a day over various things. Sometimes it's because we're following through on a punishment like turning off the TV or tablet when he is using foul language or being mean to his brother. Sometimes he randomly hits his brother or the dog and we remove privileges when he does. It's at the point where every attempt at anything remotely resembling discipline is met with extreme rage and violent tantrums for at least half an hour or more and this happens multiple times a day

During these episodes if we don't lock him in his room, he will continue to punch, kick, and bite at us and his brother. It doesn't end until he is a quivering exhausted mess or he ends up hurting himself in his fit of rage. There is no point at any negative or positive consequences or attempts to punish the behavior as communicating with him during this stage is impossible. I and his therapists are not sure how to calm him down. I have tried physically restraining him to keep him from constantly attacking us or his brother, but that is dangerous for both of us. I have two damaged teeth from random headbutts. The last time I have tried this he clocked me in the face and I saw red and unfortunately lost my cool and screamed at him in his face. The terror in his eyes was too much to bear, but he did stop. This cannot be the only way to snap him out of it, surely, because I cannot accept for him to not be violent that he must fear us?

My parents and in laws are disgusted with us as parents and make it known that they think we are raising a psychopath because we refuse to beat our children. They make it explicitly known that they think this is 110% our fault and that ODD and ADHD are made up diagnoses to sell therapy and drugs.

Any ideas on what we can do to bring the violence under control in our house? The doctor highly recommends we get him on ADHD medication soon but wants to wait a few more months when he is closer to 5.

Answer 1

Someone will probably comment that ODD and ADHD can't be diagnosed reliably in a preschooler. Not only is that unhelpful, it's also untrue. I can't speak to your child's ADHD, but it sure sounds like they have ODD. What can you do? It's hard to say, because you don't mention everything that you do try before the tantrums erupt.

You don't say what kind of therapist(s) your child has. The importance of a good, experienced child psychiatrist cannot be overstated here. If you don't have one, please start looking. If you do have one and they don't know how to help you, start looking for one who does. Positive interactions should precede tantrums (validate emotions - which does not mean agreeing with them - and try to understand why the child is upset, which requires emotional literacy on your part and theirs), and deescalation tactics are crucial, as is the ability to remain calm and to disengage. A good child psychiatrist can guide you here.

Sometimes he randomly hits his brother or the dog and we remove privileges when he does.

This strikes me (no pun intended) as strange. Removal of a privilege doesn't seem like an effective consequence for violence; removal of the child from the situation does. No being, child or dog, should be subjected to violence, and the consequence should be immediate, consistent, and significant: removal of the child to a safe place (not restraining him), done without emotion or discussion until the child is calm and shows evidence of ability to engage in meaningful discussion. ("...communicating with him during this stage is impossible." That's correct and completely normal.)

Since his behavior affects the entire family, Family Therapy should strongly be considered. Depression is common in those affected by the disruptive behavior. Family Therapy - with or (maybe better) without your ODD child can be a sanity-saver.

My parents and in laws... make it known that they think we are raising a psychopath... [and] they think this is 110% our fault and that ODD and ADHD are made up diagnoses to sell therapy and drugs.

It sounds like you can't count on your parents and in-laws for emotional support, so it might be beneficial to join a support group for people who are experiencing the same problems that you are. Your Psychiatrist or Family Therapist should be able to guide you here. Knowing that others are coping with the same problems and getting support are important. If the input from the grandparents is really bad, then learning about boundaries (and how to set them) might help a lot.

To end on a brighter note, hopefully someone has told you that a lot of preschoolers with ODD (some literature states up to 50%) outgrow it. So there is hope!

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Oppositional Defiant Disorder

Age 4 predictors of Oppositional Defiant Disorder in early grammar school

_{If you could get your library to borrow a copy of the Handbook of Preschool Mental Health: Development, Disorders, and Treatment, Joan L. Luby, editor, there is an entire chapter on ODD in preschoolers which might be helpful.}

Answer 2

Two of my three children have extreme behavior differences, although not exactly the same as yours (or each other). Some things I've learned:

• The idea that children's behavior is controlled or "molded" by parents is very deeply ingrained in our culture. Parents do have some effect, but much if not most of parent technique is a reaction to how kids behave, not the other way around.

• Parents who don't have a child like yours have no clue. Our normally-behaved child is our youngest. Having her was like, "Oh, this is why people think it's so simple."

• This is why I'm not very active with questions on this site anymore. No one ever offered anything that helped significantly. We mostly had to figure it out on our own.

• A lot of times, when you wish you could be choosing the best thing for your child, you're actually stuck choosing the lesser of two evils. The "snap out of it" thing you described is one such decision. You're trying to maximize the family's happiness over the entire day, and sometimes making it worse for a moment is worth it to avoid hours of misery.

• You need to base your decisions on how your own child reacts, not on how you think some hypothetical median child you don't have would react. My son who behaves the worst is also the quickest to forgive of anyone I know. Use your child's strengths.

Answer 3

We saw some improvement using Russel Barkley's The Defiant Child method. Not overnight, and not out of the woods, but improvement.

You set up a chart of daily expectations (basics such as get dressed, brush your teeth, get to school on time...) daily rewards (screen time, dessert) long-term rewards (saving up for a bike or a trip) and lose points for hitting, biting, cursing, etc. At the beginning the child resists, but if you are firm and consistent the child starts to cooperate and feels better about having predictable results to his behavior and choices. This takes work on the parent's part to remove emotion, blaming, threatening, and just using the chart.

If he has a meltdown, make sure he doesn't hurt siblings, then tell him with poker face "That's minus 50 points". And try to get past the meltdown as quickly as possible. With time they will become fewer and last less time.

In terms of grandparents we try to make sure there are only positive interactions. Would you like to spend time together? No? Ok no problem. Grandparents don't get involved in parenting the child in any way.

Answer 4

Sometimes its because were following through on a punishment like turning off the tv or tablet when he is using foul language or being mean to his brother. Sometimes he randomly hits his brother or the dog and we remove privileges when he does.

I think this is the problem here. I don't think punishment will make a child behave better in the future. If the child is a confident and self-determined one, he'll view your punishments as irrational and restrictive, and start disrespecting you instead of changing his behavior to not get punished.

I think you should try letting him be free, and explain to him why he should not attack other people.

I think ADHD and ODD is a made up term for kids who think a lot. ADHD generally means that the kid's mind is creative and is full of thoughts, and he views the world in a different way. So he may also tend to question traditional practices, and that's what they call ODD.

If anything, I believe the kid is strong and self-determined from a young age, so instead of punishing him, you should let him be free and explore his interests. Just make sure to let him know that other people's behavior are not within our control, and the consequences of getting violent at others. That ought to help him make a better decision and be socially calmer than punishments.

Punishments will only change someone who fears punishments.

Also, this can lead to people not accepting his behavior or blaming yourselves as spoiling the child. But it's up to you to decide whether you'd want to listen to others or let him find his own uniqueness. TV and fiction are not purely for entertainment, and children can often gather perspectives and ideas from it. Instead of cutting them off, try providing him with toys and more creative material he can invest his time in, and learn from. ADHD is also an indication of desire for adventure and change.