Dual Diagnosis in Kids on the Autism Spectrum

“Is it common for children with asperger’s or high functioning autism to also have oppositional defiant disorder?”

While it is common for many children and teens on the autism spectrum to exhibit some of the traits of Oppositional Defiant Disorder (ODD), only about 10% of these young people actually have an ODD diagnosis.

ODD often occurs with other behavioral and mental health conditions (e.g., Autism and ADHD). In fact, it has been estimated that over 50% of the kids suffering from ODD are also suffers of some other disorder. There are plenty of other conditions that are more common in kids suffering from ODD with the majority of these centering around pronounced learning difficulties.

ODD is often diagnosed when the youngster with Asperger's (AS) or High-Functioning Autism (HFA) is in his or her teenage years. The symptoms, which vary in severity, include being irritated and annoyed by authority figures, which in turn leads to them becoming uncooperative and generally defiant.

Experts suggest that ODD affects around 10% of kids on the autism spectrum. ODD will be diagnosed by a specialist when the youngster has displayed a persistent pattern of disobedience towards authority figures (i.e., parents, teachers, etc.).
==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

Diagnosing conditions like ODD is actually quite difficult. However, you can use the list of symptoms below as a starting point. The ODD child:
  • speaks to others in a hateful manner
  • refuses to do anything when asked
  • is argumentative with adults
  • displays touchy, or irritable tendencies
  • displays persistent and prolonged tantrums
  • displays of defiance
  • deliberately tries to upset his or her peers
  • blames others for his or her own mistakes
  • appears to often be angry or irritable

Just because a youngster with AS or HFA is acting up doesn’t necessarily mean that he or she has ODD. It’s perfectly normal for all young people – including those on the spectrum – to test the boundaries, especially at the ages of 2 to 3, and during the teenage years. This is normally nothing to worry about as most of these children will grow out of it eventually.

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There are a number of things that parents can do to successfully parent a youngster diagnosed with both AS or HFA - and ODD. Here are just a few tips:

1. You have to show that you are in control. Although kids with ODD have a lack of respect for authority figures, you must retain control. Create a "rules contract" to help with this. Write down your expectations on paper. This works because it is a more “formal system,” which the youngster may respond to since it is similar to the way he or she is managed at school. This contract will also help these young people realize that they are responsible for what they do. They need to learn that there are consequences for their actions. Once ODD is diagnosed, at least you know the reason behind the defiant behavior. You can also look into treatment options and therapy with your doctor’s advice.

2. If you are particularly concerned about your youngster, then you might want to take him or her to see
your family doctor. If the doctor is concerned that your youngster is presenting significant symptoms of ODD, then he will refer you to a psychiatrist who is familiar with young people that have such behavioral problems.

3. Too many moms and dads do not have the necessary tools to deal with ODD. They will normally react (rather than respond) when their youngster starts showing defiance by (a) giving in, (b) threatening, (c) yelling, or (d) negotiating. This isn’t the ideal thing to do, because you are showing your son or daughter that he or she can get what they want by behaving in an unacceptable manner.

4. Always deal with your youngster in a calm manner – no matter how frustrated you may be at the time.

5. Introduce rules, rewards and consequences to create wanted behaviors and reduce unwanted ones. A strongly defined structured environment will go a long way in preventing defiant behavior, or managing it if it should appear.
==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

6. When the youngster does something right, praise that behavior and reinforce what he or she has done. Whenever your youngster does something for you, be sure to let him or her know that you are grateful.

7. You no doubt know that kids on the spectrum need structure. The problem is that it can be difficult to decide on the right type of structure. Regular parenting techniques (e.g., time-outs, grounding) often don’t work with Asperger/ODD kids, because they will often simply use the time to plot some sort of revenge.

8. Carefully pick your battles – you can’t possibly win every one! Make sure that you pick the ones you can win, and then make sure that you DO win them.

9. ONLY talk over problems when your defiant youngster when he or she is calm.

10. NEVER give in to temptation and join in with the shouting. A "shouting match" always puts the ODD child in a one-up position relative to the parent.

11. Don't offer "false rewards" that are just intended to make your youngster feel better. Rewards that are given for the sole purpose of getting the child to calm down and act right will have worse repercussions in the long run – guaranteed!

12. Even though I mentioned “rewards” earlier, understand that rewards for observed positive behavior are the best way to deal with the ODD child.

==> More parenting methods for dealing with oppositional, defiant behavior in kids on the autism spectrum...

More resources for parents of children and teens with High-Functioning Autism and Asperger's:

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism

==> Parenting Children and Teens with High-Functioning Autism: Comprehensive Handbook

==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism


* Anonymous said... My 10 year old daughter has both, but as she ages, her temper gets calmer and she hasn't slammed a door in two years!!
* Anonymous said... We switched to gluten free diet. Her fits are almost none!

•    Anonymous said...Sometimes these discussions drive me crazy. especially when very revelvant age appropriate behaviours are blamed on our kids DX. Our kids might not proces all things the same but they can be taught. My 9 boy is mouthing off at present, thinks he is 16 and the boss and is pretty disrespectful. so are most of the 9 yo NT boys at his school. the only difference is that its taking jax and myself a very pain staking process to get to understand what is his business and what isnt and what is called disrespectful. many dx to do with behavioural issues that dont have specific proving (ADHD does) are more for the parent then the child. I dont mind if you have a go at me. lets just look at behaviours according to were a child is at, what they might be able to process or express.
•    Anonymous said...Yes Mine sure has ODD!
•    Anonymous said...Yes My son is ADHD, Aspergers, Mood Disorder NOS, ODD and insomnia. Recently his psychiatrist removed the ODD because he believe's that my son is not "defiant". He believes that my son's "defiance" is triggered by things that bother him because of his Aspergers such as, change in routine, over stimulation and from being so tired from his insomnia.
•    Anonymous said...Yes My son was diagnosed at 4 with ADHD and ODD and at 9 he got the Asperger diagnosis.
•    Anonymous said...Yes The Autism Discussion Page on FB is a wealth of information as well. I love the Parenting Asperger's Children page too.
•    Anonymous said...Yes The more I dealt with all of this with my own daughter, the more I realized all these labels are just that; fancy designations slapped onto observed behaviors. They don't necessarily indicate there's a specific "cure" (such as a medication) for the issue, or even a single "right" way to deal with it. In that sense, I agree that ODD is a "B.S. diagnosis". The opposition and/or the defiance is observable and real ... but those are just normal human responses to what happens around them and to them. Why does ANYONE behave this way? Usually, it's a defense mechanism of some sort.
•    Anonymous said...Yes V.S. Ramachandran and other prominent neuroscientists say that ODD is a b.s. diagnosis: look for the processing and/or anxiety issue underlying the behavior, rather than claiming opposition and defiance constitute a disorder in themselves.
•    Anonymous said...Yes We talk it out also when situations come up Lori. We try to 1) see if the situation really warranted the reaction. 2) What could we do differently the next time the situation arises. 3) What kind of outcome do we expect with our behavior? Do we want a positive reaction or a negative one? I try to get my son to see that everything he does has a consequence, be it positive or negative(That is what our therapist has suggested.) We role play to show the positive and negative solutions of certain behaviors ie anger/rage usually will have a negative reaction with people whereas if we can be calm and deal with the situation without yelling we can have a positive resolution. It is a slow process though.
•    Anonymous said...Yes Yes our Boy has a combo of everything!
•    Anonymous said...Yes YES! I just recently figured out that this is what my 9 year old daughter has, in addition to AS. We are having a lot of issues with her rage, and violence. ANY suggestions?? I would LOVE to hear. She is so smart, it makes it difficult to discipline her. Nothing seems to matter to her.
•    Anonymous said...Yes Yes. ASD in general has many other things that occur - ODD, ADD, ADHD, OCD, etc. It's different for every child. My 13 yr old is a rager as well Monica. He has gotten better as he matures but still struggles with things that us NTs could care less about. What I have read and heard from other Psychologists is that Their brains are so emotionally centered (especially in the heat of the moment) that their rational side doesn't work until after the meltdown/rage. They can train their brain to work more rationally but it takes work. My son is working with his Psychologist using role play to 1) Figure out if the situation is Fight or Flight (worth the energy to fight with words/fists or not) 2) Figure out the consequences of the first decision. 3) Act - which sometimes means going back to #1. NTs do this figuring unconsciously, ASD brains do not. At home, we talk through situations as they come up with the same 1, 2, 3 idea as he is getting agitated. The more you help guide them to the more accepted response, the better they will behave when not around you (School, etc). The most important thing I think is to make sure they understand that their emotions are valid, even if you personally don't agree with their feelings at the time. They need to feel understood, appreciated, and SAFE. Listen to their reasoning and then guide them to the more acceptable response.
•    Anonymous said...Yes, I have 2 with Aspies and ODD

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