Medication question if your child has ODD and ADHD

Discussion in 'General Parenting' started by PlainJane, Jan 12, 2013.

  1. PlainJane

    PlainJane Every dog has his day....

    We are finally going to start difficult child on medication, He's 5 years old. During his last doctor appointment we decided (against doctor recommendation) to wait one more period of time until the next visit (6 months). Anyway next visit is the end of Feb.

    difficult child official diagnosis is still "high funstioning autism" from when he was 2. It was never "updated' because the doctor said it really didn't matter what we call it as long as we are treating it right. difficult child DEFINITELY, no doubt in my mind and the doctor has agreed is ADHD and ODD. Also she feels there are some anxiety issues as well.

    My question is, I've heard that medications for ADHD can make ODD worse. And its really the ODD that's basically destroying our family environment. The agruing ALL THE TIME, about EVERYTHING. The aggressive outbursts, towards everyone...I don't need to preach to the choir here, but no one in this house is happy or at peace with difficult child here. The ADHD is much much less an issue. I mean, its there, but having to tell him 20 times to put his shoes on, does not cause the disruption that the ODD behavoirs cause.

    What is your experience with medications? Did it make the ODD worse?

    Also difficult child is not in therapy right now because we don't know what kind of therapy would even help this. What kind of therapy helps kids with ODD?

    Thanks or your help in advance. :)
  2. Tiapet

    Tiapet Old Hand

    Hi Jane! Others will come along with their experiences. I don't know that I would say the medications made then ODD worse. What I would say that sometimes, and we've over the years tried many different ones in finding the right one, the stimulants can do in the opposite direction and make it seem worse. Like their argumentativeness does increase, if they are aggressive, it will increase. We also found that it didn't necessarily start out being worse but as time wore on it did if it was a bad medication of choice (for example, dexadrine spansules - after about 6 weeks the behaviors started escalating). Sometimes it did nothing though too, like when we trialed Focalin or Strattera. It was like they hadn't taken any medications at all. Now they take Concerta and it doesn't make the ODD worse and it does control the ADHD symptoms.

    It really is just a matter of finding the right medication for your child and understanding that it will take time. Being willing to take that step knowing that, yes, if it's not right it might make it worse but then your doctor should work with you as well to change it and find the right one. If you have confidence in your doctor I think it's a good thing. I started out being against medications years ago but I learned the difference between my children being unmediacted and medicated.
  3. DownTheRabbitHole

    DownTheRabbitHole New Member

    I'm not sure what medications are prescribed if any for ODD. in my opinion, based solely on my personal experience, it is more a symptom of something else. That's why most people described as ODD usually always have another underlying diagnosis with the ODD.

    My son is definetly ODD as well, although he is not specifically diagnosed with this. I think it depends on the doctor.

    My son started medications at about the same age. In our experience he controlled the ODD behaviors much better on ADHD meditation which is all he was ever on until the last two years. If the medications work like they should for the ADHD, you should notice less impulsiveness, and more focused attention. The thing about most prescribed ADHD medications (Ritilan, Focalin etc.) they go through the system quickly so if you give a pill at 7 am by say 2 pm it's completely out of the system. Obviously the ODD are sometimes worse then other times but when he takes, Folcalin for us, it's like a switch is turned on and within say half an hour the arguring over everything kid suddenly turns into my helper.

    This has been my experience anyway and when starting medications it can sometimes be a trial an error phase till you get a good dosage and regimen. You might want to start with keeping a journal to note times and behavior changes it sometimes helps.
  4. DDD

    DDD Well-Known Member

    I have never met a parent who was eager to medicate their child. on the other hand your son obviously has issues that are setting him apart from the norm and I wish you well. The stims are "quick in quick out" so generally you can see improvement or undesirable side effects soon after beginning the medication. Like others we experimented until we found one that made the children best able to function. I suggest keeping a simple diary recording the time of dosage, the meal eaten before taking the pill and observations of behavioral changes...hopefully good but sometimes not. Don't try to "wing it" it in as easy scientific way. Fingers crossed that your son will benefit and, therefore, the family will benefit also. It's so easy to lose sight of how aware our difficult child little kids are of their differences. Sometimes I think that ODD results (in some children) as a means to fight back from the negative way their behaviors are received by peers and strangers. I hope your child is receptive and successful. Hugs DDD
  5. Hi, Jane.

    My son was diagnosed with ODD + ADHD after his first very thorough neuropsychologist exam at three years old. At that time he was on Trileptal for epilepsy and I think that drug helped stabilize his moods somewhat but he was still had daily meltdowns, aggression and irritability all day long even on Trileptal. During one of his 24hr EEG his violent behavior towards me and the nurses was captured on video so his neurologists started him on antipsychotic Risperdal. The combo of Trileptal and Risperdal worked pretty well.

    Fast forward a few years and by this time my marriage had fallen apart and I was divorced with the kids splitting time between homes. difficult child outgrows seizures so is taken off Trileptal. Did ok on Risperdal alone but still lots of meltdowns, arguing, and started being depressed and talking about suicide at the age of 5 1/2. He had another neuropsychologist evaluation and this time primary diagnosis was ADHD. The psychiatrists took him off of Risperdal due to high prolactin levels and started him on a long list of ADHD stimulants. None of them helped and some made him worse but his docs and his father wanted to continue them on the stimulants. My life really became a nightmare after that. My ex and rarely agreed about difficult child or anything else. Four long years later and another psychiatric evaluation this summer after my son was having super serious problems resulted in a change of diagnosis to Mood disorder and just this week changed officially to bipolar disorder + ADHD. He is finally on a medication combo that works for him.

    Stimulants alone made my son's "ODD" worse in my opinion. His fuse was even shorter, and as they wore off he would become super hyper, and his mania would go on for hours at time. Laughing hysterically alternating with violent meltdowns. It was no fun at all.

    Many here do not believe that ODD is a real diagnosis but a place holder until a true diagnosis becomes evident. But for those of us with young children diagnosed with ODD via neuropsychologist evaluations hearing that ODD is not a "real" diagnosis doesn't help us does it? It is so frustrating and I feel your pain. All I wanted was a peaceful home and I finally have that most of the time now. Well, maybe not compared to some homes but definitely compared to the last eight years. We were desperate to help our son and his behaviors not only interfered with family life but also school. So we trialed many medications in attempt to help him. But, I always contended that the ADHD medications (alone without a mood stabilizer) made him worse. I am not telling you not to try them but with every medicine you try make sure you keep a journal and good notes about what is going on with your son.

    As far as therapy goes, there was a program that helped my son a little bit when he was three but the hospital we were at discontinued it. We tried in vain to find therapy for him over the years and found many obstacles and little help. That has been so unfortunate as I believe that therapy would really help my son. There just are so few therapists out there that will work with kids like ours. If you can find one most don't take insurance. If you have insurance...but that is an entirely different problem.

    Hang in there. There are no easy answers.

  6. buddy

    buddy New Member

    Hi Jane. I love what everyone here has to say. I wish I had you all when I first started with Q on the whole medication journey.

    To me, it really depends on what is driving the ODD and frustratingly, it is often a combination of issues.

    So, if not being able to slow thinking down enough to make more considered choices is part of the issue (definately my son's issue) then the adhd medication can be really helpful because he does not just do what he wants the instant he wants it as much of the time on the adhd stimulant. BUT when he is on too much it for sure causes him to be more crabby and more ODD-like and for sure more aggressive so using the lowest possible effective dose of course is the goal!

    My son for sure, 100% could qualify for an ODD plus ADHD diagnosis but he is also autistic and has a brain injury. But using those labels (odd especially) works against him so much. Autism Spectrum Disorders (ASD) has as symptoms for many, ODD like behavior, and adhd symptoms, as well as anxiety and without using that umbrella label (like Autism Spectrum Disorders (ASD)), people WILL treat him as if he is making more of a choice just to be stubborn and rude. I wish that wasn't so because it is not fair to those that are struggling with those disorders (and not on the spectrum). But, I have seen it so many times and it is super frustrating. I have tried to advocate for students but still people just really respond differently (not everyone of course, but administration in schools and general ed. teachers are often in that group) so just mho to try to describe symptoms and behaviors rather than using those terms if you have the option to do so. Everyone has a different take on this, so if this fits for you great but if not just ignore

    I noticed you said you have to give directions over and over and I can so relate to that! I am wondering if you have ever used visual organizers and task boards to help take some of the auditory directions out of the loop.

    If you have a check list or velcro laminated symbols/pics on a board that he can take down as each step of a task is done (or a flip book or however works for your family) it often helps a child with Autism Spectrum Disorders (ASD) organize and get a task done. Verbal directions often do not process well and even if they can verbally echo the direction a million times, it doesn't process into action.

    That took a ton of stress out of our lives and I have seen it work in schools and other families too. Not all though, so it of course depends on your own child's learning style.

    Figuring out if things like language/auditory processing issues, visual processing, memory etc. are a part of a child's not following directions (which sure as heck looks like oppositional and defiant behavior because they can't say to you, but mom, I am not processing all of the words or I am forgetting half of the direction or I am not able to deal with all the noise while I am trying to think....etc.....) is a BIG part of figuring out if medications will be the answer. And to complicate things, medications can help him concentrate enough to use methods that help with all of those other issues OR they can make things worse of course if they are not the right medications or right doses.

    SO, the trick is to keep really detailed notes. If you start a new intervention of any kind, medications or visual supports, or behavior plans, it ONE at a time. Keep notes on how things are going and then you can start intervention number two.

    My best to you, I have to say medications are what make my son able to live in the community, but not without a ton of other supports. Your son sounds much higher functioning but Autism Spectrum Disorders (ASD) is Autism Spectrum Disorders (ASD) and it requires specialized methods to help a child to follow directions and live in a less anxious state. You are just beginning the journey and it will change over time. He is so lucky to have a family who is working so hard on his behalf! I am sure you will do very well.
  7. TeDo

    TeDo Guest

    I am dittoing what Buddy said:
    My difficult child 1 carried the ODD diagnosis for 3 years before the REAL diagnosis was finally figured out. The way the schools handled ANY behaviors was with a heavy hand and "we have to show him who's boss" mentality because "kids with ODD do what they do on purpose". In difficult child 1's case, it led to the worst depression I ever want to see. That diagnosis almost killed him. I was so glad when the ODD was replaced with the Autism Spectrum Disorders (ASD) diagnosis. It made so much sense once I realized that he wasn't defiant on purpose, there were some serious thinking errors and struggles with doing what he was told to do the minute he was told to do it. He isn't able to switch gears like that. As Buddy said, any Autism Spectrum Disorders (ASD) diagnosis pretty much has ADD/ADHD, anxiety, ODD, and Obsessive Compulsive Disorder (OCD) in some form as symptoms. I would accept the "high-functioning autism" diagnosis over ODD any day.

    As for medications, difficult child 1 can't take stims (imagine a 4 year old on a drug high). Other than that, we've had no problems with the nonstims and behavior.
  8. InsaneCdn

    InsaneCdn Well-Known Member

    The ODD diagnosis assumes that the child can do differently but chooses not to.
    Most of our kids... it isn't a choice.
    There are OTHER drivers for the behavior, and the priority should be on finding those other drivers.
    That could be anything from a pervasive-type diagnosis (such as Autism Spectrum Disorders (ASD)), to a mix of things, most of which "can" also be part of Autism Spectrum Disorders (ASD) but may stand alone...
    - sensory processing disorder
    - auditory processiing disorders (wouldn't be tested for until about age 7)
    - developmental coordination disorder (neurologically based motor skills issues)
    - learning disabilities

    Has he been evaluated by an Occupational Therapist (OT) for sensory and motor skills issues?
  9. PlainJane

    PlainJane Every dog has his day....

    Thank you everyone for your replies. I guess I am nervous about starting medications. But I'm concerned about the way things are going in our family with the way difficult child is now. I just put him on the bus for school and nothing is without fighting. Foot stomping, yelling, screaming, pointing and making other gestures.

    Its starts at breakfast. I made waffles this morning, in the toaster so they are fast and he comes to the table and says "where are my waffles, they should be here by now." And this is not a schedule issue. He is 5 but one of the rudest and most manipulative kids I've ever known. Correcting him never changes his behavior. Rewards, time out, schedule charts, ect all the therapist's suggestions have not worked. Its like he truely enjoys treating people this way. husband and I are embarrassed to take him out to stores, restaurants ect., so we go out while he's at school. My 2 1/2 year old behaves better than he does, and is kind. Its like difficult child enjoys talking down to others and being mean. How can a 5 year old even be like that?

    husband and I really think the issue is a personality disorder and like firehorsewoman said, that ODD is the catch all phrase being thrown around right now. But he's way too young to diagnose it. Sometimes we think we are crazy for thinking a 5 year old can do this! But he seems to fit maybe narcissistic personality disorder. I could type a novel and not describe the manipulation that at only 5 he is capable of. husband sees it too. And often we think he is only a kid, it must be us, that it must be our fault. And yet my younger son, we can already see the difference, from when difficult child was 2.

    But at 5 its like he takes great joy is twisting words, and manipulating people around him and he is so cunning at it that people don't see it. He does it to my 2 1/2 year old but of course we step in and stop him. But I see him doing it to adults. And they are none the wiser. His teacher expresses that she has issues with him not being able to follow directions, and getting disracted, ADHD stuff. And that she notices he blames others for his actions. We have a huge issue at home with this. He will never admit he has ever done anything "wrong".

    One time we had visitors, and difficult child was running through the room, no where near us, and difficult child tripped and fell while I was talking to our guest. And he started yelling it was my fault he fell and that I pushed him! And our guest looked at him like he was nuts. He does this often and husband and I worry he will falsely accuse us, a teacher or a peer in school of "hurting him" when in fact they did nothing.

    But its more than that. Its not just lies. He doesn't physically hurt people except he does hit his brother, but its not like he's the kind of kid that I think would kill a pet just for kicks. Although I do worry if he thinks the animal (we only have fish who he doesn't acknowledge) did something to him that he might get angry. He does yell at his toys, furniture and other objects that he says are not doing as he says or not listening, and will throw them or kick them. Like if he's trying to get an action figure to stand up and it keeps falling over, he will yell at it, "I comand you to stand" if after yelling at it more it still keeps falling down each time he tried to stand it up, he will throw it or hit it.

    He mostly though likes to manipulate people's feelings and actions to gain something, or just for fun to be in control. And if control is taken away from him, he then become aggressive, breaking things kicking things, hitting. And taking control away can be as simple as telling him "today's Monday, there's school today". And he says "oh, its Sunday you say, good thing I don't have school" and responding to him with "You are wrong, its Monday". And then he freaks out.

    He'll argue about realities that don't exist. If we walk out side on a freezing day mid winter and I say to my husband, "wow its cold out today". difficult child will say "its sure hot out, why am I wearing this coat". But I don't HAVE to say something. Just walking out into the cold is enough to prompt him to say "wow its warm".

    Ever comment between house hold members, to difficult child, not to difficult child, he says something contradictory.

    We are all losing our minds here. We have thought about family therapy, but we know difficult child will manipulate that so that they don't see the real him. I have tried to record him, but it is hard because no matter how bad his melt down, or what he's doing, if he sees my phone out to record him, he stops. See, he KNOWS what he's doing. husband and I have seen him many many times, stop, then lie about his behavior. He can control it infront of the people he needs to. Which is why we don't think this is a spectrum issue. We thinks its a personality disorder or maybe mental illness. THe only behavior he can not control, that he displays infront of everyone is when he has a tic. He saw a neurologist, they are not actually tics, but compulsions. They are usually verbal and when he gets one it will stick around for a few days to a few weeks. And that he does everywhere.

    Does anyone else have a child that can control their behavoir? The few times I have snuck and got him on tape (on my phone) for a minute or so before he realizes he's being recorded, he tells me that he is going to tell the doctor that its not him, but a boy that looks like him that I asked to act that way to get him in trouble.

    husband and I are scared to see what difficult child will be like in 5 years or 10 years.

    I think what I'm saying is I'm afraid medications won't help, and then I don't know what to do.
  10. InsaneCdn

    InsaneCdn Well-Known Member

    OK... he has an Autism Spectrum Disorders (ASD) diagnosis? Aspie is part of that - and in the new DSM, it's all rolled together anyway.
    Autism Spectrum Disorders (ASD) is pervasive (as is Aspie, for the record).
    Autism Spectrum Disorders (ASD) kids are likely to have traits of a number of other dxes that can also stand alone... but they are part of Autism Spectrum Disorders (ASD):
    - Obsessive Compulsive Disorder (OCD)
    - ADHD
    - sensory processing disorder (SPD)
    - Developmental Coordination Disorder (DCD)
    - Autism Spectrum Disorders (ASD)
    - and other stuff.......

    He's FIVE. Not 10 or 15.
    He is probably going crazy.... from what he is dealing with.
    Not that you aren't trying... "SP, DI, Occupational Therapist (OT)..., social skills group... etc."

    Sleep issues are huge. Not getting enough quantity and quality of sleep is a recipe for... all sorts of behavior problems. (been there done that).
    Sensory issues are huge. Is he sensory seeking, or sensory avoiding? what are you doing to help that?
    School is a huge issue, because he may have learned how to handle his old routines, but the transition into "real" school can be a disaster... way too many simultaneous transitions going on.

    But remember... it is NOT YOU. As in... you can't just change some parenting approach and magically have a new kid. You might need to learn some alternative approaches etc., but... it's not because you are a bad parent. If you were? He wouldn't have his dxes at age 5.
  11. buddy

    buddy New Member

    My son is sixteen, so imagine..... I am talking from many years of puzzling through this....

    I can VERY MUCH relate to these exact situations! Kids on the spectrum are not great at interactions. Having control and keeping it THEIR AGENDA is a big big reason for many conflicts. My son says the opposite of a situation or an expected response more often than not.

    There are different reasons for different kids but if I had assumed that he was doing this to tick me off or just control for the sake of control or narcissism, we would probably still be back there. He can now not only not be the one to initiate a topic but can comment for at least one appropriate turn especially if it is about a concrete task he is interested in. I know the feeling of wanting to rip your hair out as we were sitting out to dinner last night in a new restaurant with my parents....

    My dad got a steak. I said it looks like they did it nicely. Q said no it is awful and bloody, but was trying to make a joke (and my kid is LOUD).....just wanted in the conversation but had no clue of a nice thing to say. I gave him a look and said try to stay on topic (yes he kind of was but at this point he knows what I mean by that ) so he said I like my food too. We are at a point now where this happens mostly in anxiety situations (even if it is a fun thing)....I say have some gloves ready for horse back riding, he says it is ninety degrees and men dont get cold.

    I would have (when he was little) said no, its cold, get mittens or just have done it. NOW??? I say to myself, what is his real message???? That day I knew that it was a worry that the horses would slip which is what happened last time it was icy. So I respond as if that is what he said...I do not get into the power struggle trying to correct him. That goes no where. So this time (last saturday) I just put a bag together of mittens, hat etc...and set it in the front seat. Once he got there he just calmly took the bag and I did not say a thing to even open the door for an oppositional remark.

    The message under the message is a huge key for us. (may not be for you but it is a place to start, right?)

    Then there is the medication issue. (this I think is why many of us go many factors) Sunday night he wouldn't let me change his clonidine patches so he started kicking off. Arguing about everything and YES!!! IT IS ALWAYS MY FAULT. Even if I was no where near. He did that when little too. If I put my hand on his back gently to guide him he would say I pushed him. He slammed his finger in a car and I was no where near....MY FAULT. His galaxy player got crashed (again in a door) and I should have told him to check his coat pocket (which got caught in the door and thus the player was smashed)....and all these things come up years later even though he can tell what really happened, when he is anxious or upset it is my fault again. And boy can he be rageful about it.

    Last night his new camera lens cover got stuck and he said I had to go right then to get a new camera for him. I told him we could get it fixed. Well, if I didn't then he was going to break something of mine. ...

    His ability to see cause and effect is very very concrete and even then often very limited. In a young child's world everything is controlled by parents and parents are it makes sense that we are the go to "at fault" person. Especially when they become overwhelmed by the event. I often try to hear a message under that of "I want mom to fix it.....I'm just so upset".

    If his diagnosis of Autism Spectrum Disorders (ASD) is correct and put together with the fact that he is young so naturally would be more egocentric (I prefer that to is really that developmentally the world is all about them and that persists in many kids with autism) then that is a big key to working on things. I truly hope you can find a competent professional in Autism Spectrum Disorders (ASD) to help work on behaviors. It is rare that I have seen the mental health field help unless the person has experience with Autism Spectrum Disorders (ASD) and that kind of thinking. The behaviors can look the same on the outside but the treatment is often very different and happily, pretty effective if the person understands this is not a misparenting issue or a choice ...but rather that the child needs direct teaching (including social stories and very structured social skills training along with all the other things we do....Occupational Therapist (OT), s/l therapy, etc....).

    IC said it very well...all those symptoms/conditions are very common in a person on the autism spectrum (Aspergers is diagnosed as Autism Spectrum Disorders (ASD) in the new criteria and is under Pervasive Developmental Disorder in the old criteria.....)and that umbrella diagnosis can truly be helpful in moving forward.

    I offer you hope, but admit we still have days when ...uggggg! Still, it is so so much better and he is not nearly as negative and controlling as he was just a few years ago. LOTS of therapy and slow progress though....VERY WELL WORTH IT.

    You are so not alone. This is hard to live with.
  12. Tiapet

    Tiapet Old Hand

    Jane, it's normal to have the fears you are having. Yes, our difficult children can make us feel like we are going crazy at times too (ok sometimes it feels like ALL the time when it gets really bad). My middle difficult child holds our house hostage much in the same way yours does. It's not easy I know. You can get through this. Have him tested. It is your choice on the medications but if you don't start somewhere you'll never know how things "might" be able to change and in what ways either. There never is a magic bullet for any of this but there are ways things can get better and believe me, every little bit of "better" can help. As you see in my profile my difficult child's ages. Middle one is about to turn 16 so she has been doing this for a while.
  13. Hi again Jane. I am back now I hope!

    My son exhibited many of the same behaviors you are describing so I understand how you feel. He still does to some extent:
    being irritated and angry a lot
    aggressive towards his sister, me and our pets
    yep, have lived through all of that and more...the worst was the suicidal and hypersexual stuff though.

    Things are so much better for us now that we have a medication combination and diagnoses that seem to fit. That is the key. Getting a good diagnosis and then treating appropriately. But so much easier said than done! Especially when they are very young. Sometimes it has to get worse in order to get to that diagnosis. That is what happened with us.

    Good that you and your husband are on the same team. Believe me, that is HUGE. I would recommend family therapy. Something we never did because my ex was opposed but I am sure it is a good thing to at least try. Do not give up hope. It is hard I know. And very scary. I am still scared even though things are going so much better.

    Last edited: Jan 16, 2013
  14. SmallTownMom

    SmallTownMom New Member

    Hi Jane,

    My son is 9 and was diagnosed with ADHD, ODD, Turrets and anxiety disorder when he was 7. I was a single mom at the time with little to no support from his bio father. I read what your son does with his manipulation and being contradictory... wow that rings a bell with me.

    Your son will not be the same or react the same as my son but here are some things that I have discovered. VERY STRICT routines have helped us. In the past I have discovered that if I let him stay up 30 min later then normal to watch a show then to him that is the norm and it should now be allowed every night. He now follows the exact same routine every night (when possible). There are times if we are not at home it will cause huge waves in his world. He is very concrete in his thinking, if the norm is he goes to bed at 8 and has 30 min of calm time in his bed before lights out, then if we come home at 8:30 he still expects that 30 min calm down time.

    When he is struggling with a problem you can see his wheels turning to try and figure out a solution. For example: Last week my difficult child, easy child and I were going to the mall my easy child had saved up enough money to buy Microsoft point for the family Xbox. My difficult child was excited about all the games HE could get. We stopped him and explained that these were his brothers points, not his and the games that were going to be downloaded were not his choices. He was upset, he started asking questions as to how many point easy child was buying and how many he was using. I could see where this was leading up to.. he assumed that he would be allowed to use the leftover points for himself. I stopped him and explained yet again that these were not his to use... WOW.. MELTDOWN commenced!!!

    In the past 2 years since his diagnosis I have seem a great improvement with him. Through medication and strict routines we have found a middle ground. He is on Concerta for his ADHD and Clonidine for his ODD. I wish I could say that we maintain that balance but we don't. We struggle daily, there are days that I go to my room an cry because I don't know what else to do... but I tell you those days when we hit that middle ground, those days where he sends me facebook messages saying " I love waking up to see your beautiful face"... wow... those days are amazing.

    Keep being strong, that middle ground is out there.