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

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He became involved in recreational drugs...

Dear Mark

Thanks very much for sending the parenting sessions through. I have read and watched most of the sessions now and see how they can be effective. Our situation is that my son C (although never completely diagnosed) I have always felt shows signs of ADHD. He has always been immature in comparison to his peers but none the less feels that he is and should be treated as an adult.

As soon as he was 16 he decided that he wanted to leave home and since that time we have had one disaster after another. He became involved in recreational drugs but within a space of about 8 months was doing them to such a large degree he started to have psychotic episodes and now suffers from residual paranoia. He (I believe) has not taken anything now since about last October and is under the supervision of the Early Intervention Team for Psychosis and is taking an anti psychotic medication.

In the last 18 months he has started to take his A Levels twice, the first time dropped out due to his distractedness with the drug taking and repeatedly leaving home, then last September started at another college to try again and has now had to drop out on medical grounds because of the paranoia. The current situation is that he is at home most of the time, rarely goes out and uses his paranoia as (I feel) an excuse not to have to do anything that he does not want to, (which is most things other than occasionally meeting a friend for a couple of hours). He seems to have made an alternative world for himself on the computer on MSN and online games and if we are not at home I know he can easily spend 10 hours a day on line.

We have tried to help him find alternative interests but is not interested in trying anything so therefore has no other interests. When he was involved in the drugs he became almost obsessed with them and spent most of his time and energy when not taking them finding out as much as he could about them and even now sees this as something that he is proud of as he feels his knowledge on the subject is second to none.

We have another 10 year old son and for obvious reasons we are keen to make the atmosphere at home a happier one as C creates a huge amount of negative energy where he is angry and belligerent and sometimes depressed or swings to being silly, difficult and annoying. C wants to go back to college in September to start a media course but i do not want him to sit at home for the next 4 months as I feel that if he does he will fail again as he will not be ready to cope.

How do I help him to motivate himself to get back into the real world without pushing him before he is ready, and in the meantime differentiate between real fear and his manipulation of the situation. There is no doubt in my mind that he is a very unhappy and frightened young man but seems to see us as the enemy whenever we try to help in any way, although always expects me to be there on demand when he wants something or things go wrong. He still has hopes of going to University so can see a future for himself but does not seem able to understand that he has to put the effort in to get there. He has a very good mind and can be a funny end engaging young man but his anger and resentment are hiding his true nature.

Your thoughts on the matter would be greatly appreciated.

Kind Regards



Hi S.,

You’ve mentioned several problems here. I’ll try to address as many as I can in the time I have.

Re: “alternative world for himself on the computer” —

Obsessively checking e-mail, playing online games for 10 hours or more at a time, placing more value on chat-room friends than real friends neglecting family, work and even personal health and hygiene... these are all symptoms of a new form of addiction that has surfaced only in recent years: computer addiction.

Creating a single definition for computer addiction is difficult because the term actually covers a wide spectrum of addictions. Few people are literally addicted to a computer as a physical object. They become addicted to activities performed on a computer, like instant messaging, viewing Internet pornography, playing video games, checking e-mail and reading news articles. These activities are collectively referred to as Computer Mediated Communication (CMC). Computer addiction focused on Internet use is often called Internet Addiction Disorder (IAD).

The various types of computer addicts have different reasons for their habits. Obsessive chat room use or e-mailing might fill a void of loneliness, while excessive viewing of pornography might stem from relationship problems or childhood abuse. The matter is further complicated by the fact that a computer is a useful tool. It's not like heroin for example -- there are many legitimate reasons why someone might spend hours using a computer. Even if someone uses a computer extensively for purely recreational purposes, that doesn't necessarily represent a real addiction any more than someone who spends hours working on a model train set, making quilts or gardening is "addicted" to those activities. Even the agreed-upon definition of addiction itself has evolved over the decades and remains a matter of debate in the medical community. In fact, the American Medical Association and the American Psychiatric Association do not currently consider computer addiction a valid diagnosis, a controversy we'll discuss later.

As a result of all these complications, any single definition of computer addiction is necessarily broad and a little vague. If the computer use is so pervasive that it interferes with other life activities, and if the user seems unable to stop using the computer to excess despite negative consequences, the problem might be a computer addiction.

Much of our understanding of computer addiction comes from decades of research on other addictions, like alcoholism or gambling addiction. Psychologists have identified several danger signs for computer addiction. Any of these signs would be a red flag, and multiple signs could mean there's a real problem:

·Continued excessive computer use despite incurring negative consequences, such as marital problems or getting in trouble at work due to computer use
·Hiding the extent of computer use from family and friends
·Making conscious efforts to cut back on computer time and repeatedly failing
·Missing events or opportunities or failing at non-computer-related tasks because of time spent on the computer. This could include poor job performance or missing out on family activities
·Staying on the computer for much longer than intended, or not noticing the passage of time while using the computer
·Thinking frequently about the computer when not using it or constantly looking forward to the next opportunity to use it
·Using the computer as an escape when feeling depressed or stressed

Computer addiction can have a variety of negative effects on a person. The most immediate are social. The user withdraws from friends and family as he spends more and more time on the computer. Relationships begin to wither as the user stops attending social gatherings, skips meetings with friends and avoids family members to get more computer time. Even when they do interact with their friends, users may become irritable when away from the computer, causing further social harm.

Eventually, excessive computer use can take an emotional toll. The user gradually withdraws into an artificial world. Constant computer gaming can cause someone to place more emotional value on events within the game than things happening in their real lives. Excessive viewing of Internet pornography can warp a person's ideas about sexuality. Someone whose primary friends are screen names in a chat room may have difficulty with face-to-face interpersonal communication.

Over the long term, computer addiction can cause physical damage. Using a mouse and keyboard for many hours every day can lead to repetitive stress injuries. Back problems are common among people who spent a lot of time sitting at computer desks. Late-night computer sessions cut into much-needed sleep time. Long-term sleep deprivation causes drowsiness, difficulty concentrating, and depression of the immune system. Someone who spends hours at a computer is obviously not getting any meaningful exercise, so computer addiction can indirectly lead to poor overall physical condition and even obesity.

Eventually, the consequences of computer addiction will ripple through the user's life. Late-night use or use at work will affect job performance, which could lead to job loss. As the addiction takes its toll on family members, it can even lead to failed marriages.

If you're looking to curb your son’s computer use, here are some helpful tips:

·Enlist family members to help encourage your son to limit computer use. It might be too difficult to stop on his own.
·Install software to restrict access to Web sites that he visits compulsively. Keep the passwords for the software hidden.
·Make a list of things he could be accomplishing instead of wasting time on the computer, and post it prominently near his monitor.
·Make specific time limits. Set an alarm to go off in one hour and end computer time when it rings.
·Put the computer in a high-traffic area of the house. With others looking over his shoulder all the time, he'll be less likely to overuse the computer.
·Set aside "computer-free" parts of the day. If computer abuse starts after dinner and extends into the night, have him get all his computer work done in the morning – he can’t touch it after dinner.

Re: paranoia—

Are there any family members who have Bipolar Disorder? I would strongly recommend that your son get a comprehensive psychiatric evaluation – if he has not already had one. There may be some underlying mental disorder that needs treatment.

Re: “How do I help him to motivate himself to get back into the real world without pushing him before he is ready, and in the meantime differentiate between real fear and his manipulation of the situation.” —

You need to rule out any possible mental disorders (e.g., bipolar, chemical dependency, schizophrenia, aspergers, etc.). Then you will know whether or not he’s (a) manipulating people or (b) suffering with some form of mental illness.

On a side note, teens who have a genetic predisposition to bipolar or schizophrenia run the risk of “triggering” the disorder if they use hallucinatory chemicals. Also, anti-depressants can trigger bipolar in a child with a genetic predisposition to the disorder. Thus, I would think that an evaluation by a Child-Adolescent Psychiatrist would be paramount.

A less worrisome possibility is that he may simply have a social phobia. Teens with social phobia are less adept in social interactions. Peer relationships, school functioning and attendance, and family functioning all suffer as a result of a social phobia.

Social phobia may have a combination of the symptoms listed below:

·Anxiety attacks when anticipating or attempting social interactions Fearfulness with peers as well as adults
·Avoidance of social situations
·Consistent and extreme fear of situations involving new people
·Depression or thoughts of not wanting to be alive
·Extreme fear of social and performance situations
·Reluctance to participate in ordinary outings or activities
·Severe distress in routine social situations
·Difficulty transitioning from home to school
·Refusal or reluctance to attend school
·Avoidance of activities with peers
·Low self-esteem
·Difficulty concentrating
·Other anxiety disorders, mood disorders such as depression, or behavior disorders such as attention deficit/hyperactivity disorder (ADHD
·Behavioral or cognitive side effects from medication
·Learning disorders and cognitive problems

Social phobia is treatable through ongoing interventions provided by a child's medical practitioners, therapists, school staff, and family. These treatments include psychological interventions (counseling), biological interventions (medicines), and accommodations at home and at school that reduce sources of stress for the child. Open, collaborative communication between a child's family, school, and treatment professionals optimizes the care and quality of life for the child with social phobia.

I would be willing to go into more detail regarding treatment of social phobia at a later date if you need more information.


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