Aspergers, ADHD, and ODD

Question

My 8 year old Aspie also has ADHD and Oppositional Defiant Disorder [ODD]. I can deal with the ADHD and the Aspergers …it’s the ODD I am having a hard time with. How do deal with it and what works with dealing with this disorder? What do you do as far as discipline? We are at our wits end with this part of his diagnoses and would love some advice.

Answer

Aspergers (high-functioning autism) is often not be the only psychological condition affecting a particular youngster. In fact, it frequently coexists with other problems such as:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Bipolar Disorder
• Depression (Major Depressive Disorder or Adjustment Disorder with Depressed Mood)
• Generalized Anxiety Disorder
• Obsessive Compulsive Disorder
• Oppositional Defiant Disorder (ODD)

Oppositional Defiant Disorder, also known as ODD, is a psychiatric behavior disorder that is characterized by aggressiveness and a tendency to purposefully bother and irritate others.

DSM delineates the criteria for ODD as follows:

A. A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present: often loses temper, often argues with adults, often actively defies or refuses to comply with adult requests or rules, often deliberately annoys people, often blames others for his or her mistakes or misbehavior, is often touchy or easily annoyed by others, is often angry and resentful, is often spiteful or vindictive.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functions.

C. The behaviors do not occur exclusively during the course of psychotic or mood disorder.

D. Criteria are not met for Conduct Disorder, and if the individual is age 18 years or older, criteria are not met for Anti-social Personality Disorder.

Facts on Oppositional Defiant Disorder—

• 15% of ODD kids develop some form of personality disorder
• 20% of kids with ODD have some form of mood disorder, such as Bipolar Disorder or anxiety
• 35% of these kids develop some type of affective disorder
• 50-65% of ODD kids also have ADD or ADHD
• 75% of kids with Oppositional Defiant Disorder above the age of eight will still be defiant later in life
• Kids with CD and ODD are also at high risk for criminality and antisocial personality disorders in adulthood
• Many of these kids have learning disorders
• ODD is more common in boys than in girls before puberty
• ODD is reported to affect between 2 and 16 percent of kids
• Once kids enter adolescence, it is extremely difficult for moms and dads to change the ODD behavior

Symptoms of Oppositional Defiant Disorder—

Kids with ODD show defiant, hostile, and negativistic behaviors lasting at least six months, of which four or more of the following behaviors are present:

• actively defies or refuses to comply with adults' requests or rules
• argues with adults
• blames others for his or her mistakes
• deliberately annoys people
• is angry or resentful
• is spiteful and vindictive
• loses temper
• mean and hateful talking when upset
• often being touchy or easily annoyed by others
• seeking revenge

Causes of Oppositional Defiant Disorder—

There has been no systematic research into the causes of ODD; however, there are two theories as follows:

• Learning Theory: ODD comes as a response to negative interactions. The techniques used by moms and dads and authority figures bring about the oppositional defiant behavior.

• Developmental Theory: ODD is really a result of incomplete development. For some reason, ODD kids don't master the tasks that other kids master during their toddler years. They get stuck in the toddler stage (2-3 years old) and never really grow out of it.

Treatment of Oppositional Defiant Disorder—

• Cognitive-Behavioral Psychotherapy to assist in problem solving and decrease negativity
• Family Psychotherapy to improve communication
• Individual Psychotherapy to develop effective anger management
• Parent Training Programs to help manage behavior
• Social Skills Training to increase flexibility and improve tolerance to frustration with peers
• Stimulant Medication is prescribed only when ODD is accompanied by another disorder such as ADD or ADHD

Treatment is particularly important because kids with ODD are also at high risk for criminality and antisocial personality disorders in adulthood.

What Moms and Dads Can Do—

1. Avoid power struggles.
2. Build on the positives.
3. Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the Aspergers child.
4. Exercise and relax. Use respite care as needed.
5. Give effective timeouts.
6. Give the youngster praise and positive reinforcement when he shows flexibility or cooperation.
7. Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time.
8. Manage your stress.
9. Offer acceptable choices to your Aspergers child, giving him a certain amount of control.
10. Pick your battles carefully.
11. Prioritize the things you want your youngster to do.
12. Remain calm and unemotional in the face of opposition.
13. Set up reasonable, age-appropriate limits with consequences that can be enforced consistently.
14. Stay involved in things other than your youngster with ODD, so that your youngster doesn't take up all of your time and energy.
15. Take a break if you are about to make the conflict with your youngster worse. This is good modeling, so be sure to support your youngster if he decides to take a time-out to prevent overreacting.
16. Try to work with other adults that are involved with your youngster, such as educators, coaches, and your husband or wife.

What Teachers Can Do—

It is important for educators to be aware of the disorders that their students are suffering from. Educators may or may not see symptoms of ODD at school. Even if the symptoms are not present at school, it is helpful to know what the moms and dads are dealing with at home. The more you communicate with the family and understand the situation, the better you will be able to help.

Click here for a complete parenting-course on how to deal with the Aspergers child who also has Oppositional Defiant Disorder.

Aspergers versus Nonverbal Learning Disorder: What’s the Difference?

Question

My 4-year-old was diagnosed with Aspergers a month ago. I went for a second opinion, and that doctor doesn’t think she has Aspergers – he thinks it is NVLD. So I was reading about them and I understand that they are very similar (except that with AS, they have obsessions). My daughter does not have anything she is obsessed with, but she does need structure and routine throughout the day to regulate herself. My daughter also has Sensory Integration Disorder, which from what I understand can coexist with AS. I don’t know if I should get a 3rd opinion or just keep the Aspergers diagnosis so she can get services in school. The doctor that says he thinks it is NVLD said that Aspergers usually isn’t diagnosed until age 5 or 6, which I don’t think is true. I am just looking for your input.

Answer

There is often confusion between Aspergers (high functioning autism) and Nonverbal Learning Disabilities (NLD). In fact, sometimes these two terms are mistakenly used interchangeably. There are some basic differences though.

NLD is not included with Aspergers and Autism under the DSM-IV’s umbrella term of Pervasive Developmental Disorders. Both Aspergers and NLD children may show similar social and attentional difficulties, strong verbal skills and a confusing display of strengths and weaknesses. There are a few key items that help in a differential diagnosis though:

• if the child is helped rather than hindered by your verbal explanations, then look to NLD
• if the child’s skill at deriving meaning from what he sees is a strength, then it’s more likely he has Aspergers

The Aspergers profile of neuro-psychological assets and deficits is very similar to the NLD profile. Both have neuro-developmental abnormalities involving functions of the right cerebral hemisphere. In both disorders, there is no delay in cognitive development and speech. In fact, early verbal ability is one of the hallmarks of NLD; children with NLD are often extremely verbal and early readers.

Aspergers has been conceptualized as a "Non-Verbal Learning Disability". A comparison of NLD and Aspergers children revealed 20 out of 21 similarities, including a verbal over spatial discrepancy. Aspergers may be an extreme form of NLD.

Both Aspergers and NLD children seek out social interaction, but are often rejected by their peers. A related problem shared by both disorders is the inability to perceive or understand nonverbal cues (i.e., they are oblivious to nuances of facial expressions, body language, tone of voice, gestures, and appropriate spatial distance). Children without Aspergers or NLD use eye contact appropriately and understand that you can tell how someone feels by looking at their face. These cues are "invisible" to those with Aspergers and NLD.

The most significant problem for both Aspergers and NLD children is in the area of social relationships, whether at home or school:

• exclusion and rejection become part of life
• living with this social disability and constant rejection often leads to uncertainty, confusion, insecurity, depression, and anxiety, which they may try to relieve by creating routines and rituals
• they are often accused of rudeness, laziness, lack of caring, or a poor attitude
• they are often misunderstood
• they can't "connect" socially
• wanting to make friends and fit in, but unable to, they may respond by withdrawing, acting out with emotional outbursts, or refusing to cooperate

Aspergers and NLD diverge in the affective area. Aspergers children do not feel the same range of emotions as children with NLD. Though they may feel very deeply about many things, they may not cry or smile when it's deemed appropriate. They often have a flat affect, and have difficulty with initiating or experiencing normal social relationships. Conversely, children with NLD have normal emotions, but are inept in expressing them - and in recognizing them in others - to the extent that they are expressed non-verbally.

Children with Aspergers generally have greater social problems. Their highly restricted interests present an additional obstacle to their social functioning. These restricted interests seem to be idiosyncratic to Aspergers children (“restricted interests” is not mentioned in the literature about NLD). This is the main difference between the two disorders, as they are most frequently defined clinically. The Aspergers child’s odd behaviors (e.g., rocking, flapping) can also contribute to his social problems (behaviors that are not present in NLD). In contrast, the NLD child’s social ineptness is mainly due to his inability to read nonverbal communication (e.g., facial expressions and gestures).

Literature on Aspergers doesn't mention problems with visual spatial issues, which are a major problem area for children with NLD. In fact, many “Aspies” respond well to visuals and diagrams, and are visual learners. Many find work as engineers or architects. In contrast, Children with NLD don't respond to physical demonstrations and may not understand diagrams. They can't learn by watching, and need everything explained in words. Thus, these children tend to become wordsmiths (e.g., teachers and writers) while “Aspies” often excel in math and find work in computer fields.

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

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COMMENTS:

•    Anonymous said… Aspergers is no longer diagnosed. She should be diagnosed with Autism Spectrum Level I. NVLD is not diagnosable via the DSM 5. Autism is diagnosed young which is important because she will likely need individual therapy, occupational therapy, and a social thinking group.
•    Anonymous said… Don't forget that Aspergers in girls also presents quite differently in part to Aspergers in boys. I feel strongly that any assistance DNS therapy is personalised on the child's individual needs based on the further assessments so take whichever diagnosis will allow you to access the help you need, it won't affect the outcomes
•    Anonymous said… Each child doesn't have to hit every single box to be diagnosed-for my son I do not notice any flapping or rocking-- He is an Aspie but I have also noticed the older he gets the less sensory issues he has- they are so mild now- mostly hands in early am- ot says from no pressure on them all night so am is pretty brutal- he describes them as way to soft- but rest of day very mild if at all- hoodie now just when he is in strange place- it used to be hoodie all the time everywhere even when he was at home watching tv- so the demonstration of penguin  🐧 saying every one  ☝ on spectrum is different is so so true! And I'm realizing he is mastering issues within his self so well! Also as far as interest he does have only one at a time just like friends - only one at a time- but that's his interest - and it seems more like an interest to me v/s obsession--when he was smaller it seemed more like an obsession- strange how things start balancing more as they get older- I'm sure his ot and phyc therapy is doing great things as well!
•    Anonymous said… I had many many doctors/therapists fail to give the correct diagnosis for my daughter with Aspergers -they diagnosed her with generalized anxiety which was correct but it stems from aspergers - she also has sensory issues - I knew that she was on the spectrum but no one else believed it to be true - so go with your gut - truly Mom's know their child best - I wish I did so that I got my child the correct therapy when she was younger -
•    Anonymous said… My daughter has a Aspergers diagnosis. At age 4 she did not obsess over anything, but at age 10 she shows plenty of obsessive behaviors. Things can change over time I guess, so I wouldn't rule out Aspergers based on that behavior not presenting at 4, it may show up as she matures.
•    Anonymous said… My Son has NVLD and my daughter has Aspergers, they are similar but different. This was interesting to read and realize the differences they do have.
•    Anonymous said… My son was diagnosed with Asperger's at 6 & 1/2. I'm not sure what you do if you feel like the diagnosis doesn't quite fit because with our son it's definitely exactly who he is. I can say the extra help to get him through his school day has made a world of difference. The school classifies him as High Functioning Autistic. He almost failed first grade and in third grade,last year, he made honor roll every marking period.. Teacher's knowing your child has a disability instead of thinking he/she is just a disruptive child makes a world of difference in how they are treated and your child's comfort level in school. Right now I think it's a matter of which diagnosis will get you the services you need at the school. If there is a way to make sure the teacher's will work with you to help her work on transitioning through her school day and with her sensory issues then maybe you could even wait on submitting a diagnosis to the school until Kindergarten or 1st grade when there days have a lot more school work and sitting still during the day. It may make it more clear to everyone what her most pressing issues will be moving forward and what diagnosis is most accurate.
•    Anonymous said… My son was diagnosed with NVLD at 10 and it didn't seem to fit from the first moment. I'm still trying to figure out where to go from there. My hunch as he was mildly on the sprctrum. I wish I understood NLVD well enough to know my next steps better.
•    Anonymous said… They dont have to be obsessed with something, sometimes it could be that they like things a curtin way "obsession stands for a broad range of things. Most doctors totally miss understand aspergers and only look for specific things instead of just different quirks about the child and getting the sensory side of things right. There is no list every person is different so therefore there should not be one set list. Apsergers would have to be one of the most complex things to understand on the planet and thats comming from a mother who has aspergers and 3 of her children and each one of us carries different symptoms and tics and quirks. :) ive come to realize a good 90% of the world actually have it in some way
•    Anonymous said… We were told my daughter has aspergers too at the age of 5, she is 7 now and does get help from school. When I look at the criteria for Aspergers alone, it's nothing like her. But then when I look at HFA highly functioning autism or highly sensitive aspergers it's her to a tea!! She is also on the waiting list for autism and adhd too. The thing is with these Is that the spectrum is so huge it is difficult to say exactly what boxes she ticks. The main point is, that is will be able to get some form of help and hopefully it will help your daughter overcome some of her issues. Good luck xx
•    Anonymous said… Yes, our daughter was diagnosed at 4 with NLD. (Non-verbal). We felt that there was more to it than that. Someone else in this thread said that you don't have to check every box to have AS, and I agree. We are looking into AS now because it seems to fit better. We lived in OK when she was diagnosed and now live in UT. Here it seems no one recognizes NLD as a diagnoses. They tend to think it's something diagnosticians use when they have nowhere else to turn and aren't certain on the results. You may also look into PDD-NOS. it's also on the spectrum, but is a little different than Aspergers. I also feel 4 is a young age to diagnose definitively, and it may change over time, but if you have an AS diagnosis I would run with it. It's not the name that matters, it's the symptoms. If you can get better help with one diagnoses than another, I'd say take it! Our babies need the most help they can get. If you want to talk more, I'd love to visit. Just PM me. We all need friends, including me!

Post your comment below…

Problems Getting Up In The Morning: Help for Aspergers and HFA Teens

Hello Mark,

I recently purchased your eBook "Launching Adult Children w/Aspergers" ...It's nicely laid out/a very useful tool indeed! I do have a question for you:

My son and I had a heart-to-heart conversation last night, as a result of getting into an altercation with him one morning. I'm beginning to understand his thoughts/ways more and more. I realize that 'patience' is a must and as you stated it is important to keep one thing at the fore-front of our minds...."Everyone has good intentions!" These kids do not do things to deliberately send our emotions reeling/upset us. With all of that said, my son has great difficulty getting up on time in the morning and as a result he doesn't get to eat breakfast and prepare his lunch before departing. As a Mom I get upset w/him, concerned about his well-being; he is quite thin to begin with. He told me last night that he doesn't want any help from us that he has to be the one to solve his own problem. I was actually shocked w/what he said, however, my concern is that he will not get up for school or will miss the bus, which would not make for a good morning/I would end up being late for work. I will obviously respect his wishes/not interfere, however, my intuition tells me that he will not wake up on time and actually be missing the bus. What course of action would I then take, assuming his best efforts result in failure? I do not want to get confrontational with my son and do more harm. How can I motivate him to get up if he doesn't wake up with the alarm clock going off...??

Do I take away his IPOD/DS Game/TV privileges for an indefinite period of time...? Appreciate your thoughts on the matter. Thanks! L.

Click here for my response...

How Parents Can Help Their Aspergers or HFA Child: 30 Tips and Strategies

CLICK HERE for a concise, cut-to-the-chase list of perhaps the most important strategies for parents of kids with High-Functioning Autism (HFA) and Asperger's (AS)...

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==> 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

==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

____________________

Do you need the advice of a professional who specializes in parenting children and teens with Autism Spectrum Disorders?  Sign-up for Online Parent Coaching today.

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