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Oppositional Defiant Disorder

Mark-

Thank you for your contact. I would like to run a couple of items by someone- here goes.

D____ (16) has apparently had alcohol and drug problems since he was 12 - we only noticed when he was 14. He has come home high many times - he also went into a residential substance abuse program voluntarily for 6 months - completed, and was great at home for about 6 weeks - same friends, same problems came back.

He got into some light trouble, crashed a motorized skateboard into a car (DUI), got a delay on license eligibility, went back to residential (court said to this time) for 45 days, administratively released without completion by residential as "dual diagnosis", and therefore not their type. He is now in contempt of court waiting for a court date.

The residential part time Psychiatrist came up with the ODD - diagnosis during his second stay. Not that I deny it - I just want to verify it. His behaviors certainly match ODD, but I'd like a real evaluation before the court has its say on Nov 17. They will likely place him somewhere, and if he refuses the program (and I expect he might) the Judge will levy a lesser time period but in Juvenile Hall - where it is lock down - the programs - depend upon wanting to get well - not locks. So he is a candidate for running if he wants to - and his defiance will lead him to tell the Judge to lock him up - whatever is the fastest way to be done with them and back on the street. Need I mention his school history is poor and liberally sprinkled with confrontations with authority figures?

D____ is also diagnosed add/adhd. Also, he is adopted. We know his parental history on the mother's side - she is a chronic drug/alcohol abuser with many stays in psychiatric facilities for "white out" due to overindulgence in drug combinations. She is not dead.

Does this kid need a residential program? He is obviously a risk to himself, but am I just taking a "time out" with a residential program, or can I hope for some lasting outcome? How do I get a real evaluation I can trust on the ODD component? Am I better off with therapy or behavioral mod? Should the AOD problem be treated first or simultaneously or after the ODD problem is validated and under therapy? Is there an underlying psychological cause of all this, or is the AOD feeding the ODD, or the reverse? Should I be searching for a cognitive - cognitive/behavioral - or straight behavioral treatment plan ....or something other? Are there drugs that he needs, or might take, that would alleviate symptoms (Depacote had no noticeable affect, Adderol seemed to help in school a bit, but the MD said no more unless he gave up drinking alcohol)?

Sorry to overwhelm you - but this stuff is my constant companion. I'll also talk to my wife on this (we are not separated or divorced - I just told her I was going to look into more avenues for information and direction, so I'm keeping her in the loop). I am not necessarily looking for solutions, but direction would be a big help.

Thanks,
J.

___________________

Hi J.,

We'll take a look at each question in turn:

>>>>>>>>>>>>>Does this kid need a residential program?

Yes!

>>>>>>>>>He is obviously a risk to himself, but am I just taking a "time out" with a residential program, or can I hope for some lasting outcome?

You need some time away from him. Will residential tx be a waste of time? Not totally. Keep in mind you have something very important working in your favor (what I call the "maturity factor"). ODD kids mature by default. The longer you can keep him from killing himself, the older he becomes. And the older he becomes, the more he matures - at least to some degree - simply by virtue of the passage of time. So yes, you should hope for some lasting outcome. But you'll need to hunker down for the long haul.

>>>>>>>>>>>How do I get a real evaluation I can trust on the ODD component?

If your son has only four of the following characteristics, he is ODD. And ODD never travels alone, so it doesn’t surprise me that he has some ADHD symptoms going on as well. 30% to 40% of ADHD kids also have ODD:

1. Often loses temper
2. Often argues with adults
3. Often actively defies or refuses to comply with adults' requests or rules
4. Often deliberately annoys people
5. Often blames others for his or her mistakes or misbehavior
6. Is often touchy or easily annoyed by others
7. Is often angry and resentful
8. Is often spiteful and vindictive

All of the criteria above include the word "often". Recent studies have shown that these behaviors occur to a varying degree in all children. Thus, researchers have found that the "often" is best solved by the following criteria.

Has occurred at all during the last three months:
· Is spiteful and vindictive
· Blames others for his or her mistakes or misbehavior

Occurs at least twice a week:
· Is touchy or easily annoyed by others
· Loses temper
· Argues with adults
· Actively defies or refuses to comply with adults' requests or rules

Occurs at least four times per week:
· Is angry and resentful
· Deliberately annoys people

>>>>>>>>>>Am I better off with therapy or behavioral mod?

Cognitive-behavioral therapy. But when he comes home, your best bet is to use the strategies I discuss in my eBook. In working with ODD kids for nearly 20 years, I have discovered that parents are in the best position to do behavior modification -- moreso than a therapist.

>>>>>>>>>Should the AOD problem be treated first or simultaneously or after the ODD problem is validated and under therapy?

We (or at least I) know your son is ODD. And it should be treated now along with everything else.

>>>>>>>>>>>Is there an underlying psychological cause of all this, or is the AOD feeding the ODD, or the reverse?

Odd is hereditary. The ODD child's parent is usually an alcoholic or drug addict and has been in trouble with the law.

>>>>>>>>>Should I be searching for a cognitive-cognitive/behavioral - or staright behavioral treatment plan ....or something other?

Cognitive-behavioral.

>>>>>>>>>Are there drugs that he needs, or might take, that would alleviate symptoms (depacote had no noticeable affect, adderol seemed to help inschool a bit, but the MD said no more unless he gave up drinking alcohol)?

Has anybody along the way mentioned anything about Bipolar Disorder as a possible diagnosis. If your son is self-medicating to the degree you describe, he may be Bipolar. Pharmacotherapy is an art and a science. His psychiatrist will have to experiment with different doses and combinations of drugs over a year long period of time.

Good questions. I hope I answered them sufficiently.

Please stay in touch,
Mark

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