Does ADHD have to lead to Oppositional Defiant Disorder?
By Cindy Goldrich Ed.M., ACAC
Oppositional Defiant Disorder (ODD) is characterized by excessive anger, frustration, arguing, stubbornness and defiance. The correlation rate for being diagnosed with ADHD and ODD is staggering, ranging between 60% and 80%. It is the most common co-existing condition associated with ADHD and people with ADHD are 11 times more likely to be diagnosed with ODD than the general population. Anyone familiar with ADHD knows that its core components are Inattentiveness, Hyperactivity and Impulsivity. Yet, very often I receive calls from parents who are confused and concerned that the behavior of their child with ADHD is becoming combative and rebellious. Is there a connection between ADHD traits and the development of oppositional behavior?
According to Dr. Russell Barkley, world-renowned Clinical Scientist and Researcher in the field of ADHD, there absolutely is a link between having ADHD and developing ODD. In fact, Dr. Barkley believes that if you have ADHD you have a propensity for developing Oppositional Defiant Disorder from the start. Why? Because, he believes that ADHD involves one more vital component that has been left out of the Clinical diagnosis for ADHD – Emotional Dysregulation: deficits in inhibiting and regulating emotions.
During his Keynote Address at the recent National CHADD (Children and Adults with Attention Deficit Disorder) Conference, Dr. Barkley provided compelling evidence to suggest that, overwhelmingly, the difficulties people with ADHD have in both suppressing and regulating their emotions are not co-existing conditions of ADHD such as ODD or Bipolar Disorder … they are characteristics of ADHD itself. Simply stated, Emotional Dysregulation is as much a part of ADHD as are hyperactivity, impulsivity, and inattentiveness.
With the work being done now to rewrite the DSM-V, the manual physicians and clinicians use to diagnosis Mental Health Disorders and Insurers use to determine coverage, this vital and exciting new insight by Dr. Barkley could change the way ADHD is defined and treated. More importantly for most of us, it may change the way we understand and parent our children.
The Connection Between ADHD and Emotional Self-Regulation
Emotional Self-Regulation is the ability to manage your behavior in relation to the events that happen in your life. This can involve suppressing or inhibiting your response, self-soothing to calm or comfort yourself, prolonging your pleasurable experience, or refocusing your attention to a more positive goal directed activity. By providing compelling evidence where he analyzed neuro-anatomy, psychological evidence, and clinical research, Dr. Barkley found that children diagnosed with ADHD also exhibited difficulties in Emotional Self-Regulation.* He found that every rating scale that is given to children who have been diagnosed with ADHD that measures symptoms of emotions is elevated dramatically for hostility, anger, frustration and impatience. These children exhibited much stronger emotional reactions and had much greater difficulty in controlling their reactions once elicited.
What does this mean for Parenting the Child with ADHD?
So, if part of the experience of having ADHD for a child is having difficulty suppressing and regulating their emotions, how does this impact the way we parent these children? First and foremost, as I always say, you must Parent the Child You Have. If your child is having difficulty managing their emotions, you must understand, without judgment, that this is an inherent part of their disability. The tremendous social roll that the Emotional Dysregulation part of their ADHD plays cannot be understated. Dr. Barkley states: “The single biggest predictor of social rejection among children and adults with ADHD is not distractibility, inattentiveness, not completing their goals, [nor] their hyperactivity – it is their inability to regulate their frustration, impatience, hostility and anger.”
Dr. Barkley explains that the capacity to Self-Regulate is limited like a fuel. Teaching children what depletes their ability to Self-Regulate and the steps they can take to refuel their willpower can go a long way in helping them cope with the stressors they face in life. It is also important for parents to recognize and intervene when their children’s fuel may be tapped out, perhaps after a long and stressful day at school, rather than being surprised or agitated with them. Just as with hyperactivity, impulsivity and inattentiveness, you will need to learn the specific ADHD parenting skills needed to help your child develop the tools needed to manage their emotions.
In addition to helping children learn to regulate their emotions, there is a second implication in Dr. Barkley’s findings related to the strong link between ADHD and the development of Oppositional Defiant Disorder. He states, “The single best predictor of who will develop diagnosable ODD is parenting.” What does this mean for parents? We must recognize the tremendous stakes involved in how we parent our ADHD children. ODD has two main components: Emotional Regulation and Social Conflict. The Social Conflict component has to do with being argumentative, defiant, and stubborn. It seems that the Social Conflict component of oppositional behavior is a learned behavior. Dr. Barkley states: “The way parents manage the emotional gambits of the child may make the emotions of the child better or worse and may teach the child that emotions are a tool to use on others. This is known as coercion theory.” By being inconsistent, both emotionally and actionably, in how we react to a child’s emotions and actions, we leave the door open for children to use negative emotions to coerce others into doing conforming to the child’s desires.
It is not easy parenting a challenging child. Love and logic are not always enough when parenting kids with ADHD. Specific education, tips, tools and strategies are extremely valuable. Parents may benefit from parent training such as the workshop: Calm and Connected: Parenting Kids with ADHD. More than with other children, you must gain clarity on your rules and expectations, strengthen your resolve when you are secure in your decisions, and be consistent in your parenting. This must at all times be adjusted as your child matures and seeks greater need for independence and inclusion in decision-making. Helping kids gain the tools of collaboration and proper decision making will ultimately do more help them learn to regulate their emotions than punishment and restriction will.
* For more information on Dr. Barkley’s research and evidence discussed in this article, please refer to: Deficient Emotional Self-Regulation: A Core Component of Attention-Deficit/ Hyperactivity Disorder, Journal of ADHD & Related Disorders, Vol. 1, No. 2
Written by Cindy Goldrich, Ed.M., ACAC © 2013 PTS Coaching. All rights reserved. Articles may be reproduced or electronically distributed as long as attribution to PTS Coaching is maintained.
Read a related article about addressing Oppositional Behavior here.