Education and Counseling for Individuals Affected by Oppositional Defiant Disorder and ADHD

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Words of wisdom?

My daughter has been diagnosed with OCD/OCPD and potentially bipolar disorder, but that last diagnosis is not confirmed yet...right now she is unable to go to school - anxiety and panic attack when the morning comes. We are extremely hesitant to go the home-school route, because of the probability of the anxiety transferring to another area --especially if she has not developed the skills to tackle it when she experiences the anxiety/panic.

I saw on your website the concept of getting her to have going back to school become her idea...any magical ways of getting that to happen??? Her father and I are at the end of our creative strategies rope (her father is a clinical psychologist and also has OCD)...words of wisdom?




Hi M.,

You've raised a lot of issues here. Each one should be addressed in detail. But given the constraints of time, I'll briefly touch on each one.

Let's first identify the individual issues:

1. OCD
2. Possibly bipolar
3. anxiety
4. panic
5. unable [unwilling] to go to school


Is she on an antidepressant? If so, does it help? Another complicating factor is that when anti-depressants are given without mood stabilizers to people with bipolar disorder, the antidepressants may induce mania or hypomania. So her psychiatrist will need about a year of experimentation (the art side of pharmacotherapy) in order to get the right combinations and dosages of medication. It will be important that everyone in the family be patient with this process.

Re: bipolar

Bipolar disorder is difficult to recognize in young people because it does not fit precisely the symptom criteria established for adults, and symptoms can resemble or co-occur with those of other common childhood-onset mental disorders and may be mistaken for normal emotions and behaviors of children and adolescents.

As a result, Bipolar kids are often given any number of psychiatric labels (e.g., ADHD, Oppositional Defiant Disorder, Conduct Disorder, Obsessive Compulsive Disorder, Separation Anxiety Disorder, etc.).

Too often they are treated with stimulants or antidepressants -- medications which can actually worsen the bipolar condition.

Having said that, it has been my experience that when bipolar is suspected, it is eventually diagnosed (i.e., if her doctor believes she may be bipolar, she probably is). Is anyone else in the family bipolar (e.g., uncle, grandparent)? As you probably know, bipolar is highly genetic.

So my advice, based on my best guess (and it is only a guess at this point), would be to begin focusing on the bipolar issue because (a) she probably is bipolar and (b) once the bipolar symptoms are stabilized, the other symptoms (anxiety, panic, oc behavior, etc.) will get addressed by default (at least from a medical standpoint).

(Please read the section of the ebook on Dealing With a Bipolar Teen.)

Re: school

Going on the assumption that she is bipolar (and again, it is just an assumption): Bipolar children will not function well in a regular school setting - so that's out, period!

However, the bipolar kids I work with do very well in alternative school environments or GED programs where the classes are small and they get sufficient amounts of one-on-one attention.

They do miss a lot of class time (e.g., "I got a headache," "I'm sick to my stomach," bla bla bla), but most alternative schools are willing to deal with poor attendance within reasonable limits.

In any event, your task will be to have a relaxed attitude about all things -- model "having a relaxed attitude" throughout the day, everyday!!! Your daughter will pick up on it at an unconscious level. Then you'll be working your magic.


The more you and your husband develop the "art of letting go," the less she will stress. The less she stresses, the fewer symptoms she will experience. The fewer symptoms she experiences, the more she can focus on the really important things in life (relationships, school, work, play, etc.).

It sounds like the whole family may be in "survival mode" (i.e., spending a lot of time and energy just trying to keep the boat from sinking). One can escape from this mode by practicing "having a relaxed attitude," a "grateful heart" and a "sense of humor." If you think you simply can't do this right now, then fake it anyway (i.e., "act as if" you are relaxed, grateful, and finding things to laugh about). With practice, this becomes habit.

In summary, the real issue here as I see it is "stress." Everybody is feeling pressure. And I can promise you that if everyone is uptight most of the waking hours -- you will have a long, hard road ahead.

I really have a lot more to say, but am out of time.

Please stay in touch,


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