Understanding differences in Oppositional Defiance Disorder, Intermittent explosive disorder and ADHD. In working with children who have “melt downs”, or “fits”, I have found there a subtle differences with each diagnosis. There also seems to be different origins or causes.
For a child with ADHD and ODD, it is usually driven by the need to satisfy self. They wants something, they want it now, and they are driven to get it regardless of the method. Some examples of this may be, not wanting to take a bath so they throw a huge fit, manipulate the situation and divert the topic to the fit and something else in order to achieve their goal; not taking a bath. They can use strong manipulative language, like, “you don’t love me”, “I hate you”, “Dad always let me ____”.
With Intermittent explosive disorder, the extreme reaction happens in milliseconds, the child has little control over the process, or regulating or calming themselves as it happens so quickly. The extreme reaction, may be punching a wall, throwing over a table or chair, punching someone or something, and etc. The intense reaction is much greater than the child’s normal reaction to the situation. For example, the parents may not be able to take child to the park today, but the child regularly goes and it will be part of the routine for tomorrow. The child will scream, yell, throw things, and punch things within millisec
onds of hearing that they will not be able to go to the park. The same reaction can occur when the child needs to use his blue toothbrush instead of his green one, or drink from the blue cup instead of the green cup. The reaction is grossly out of proportion with the problem. Helping the child learn about reactions vs actions, emotions, emotional reactions, modeling and watching others and their reactions, and even learning about regulating emotions will be helpful. A therapist or counse
lor will be helpful. Never attempt to teach these skills in the moments of the meltdown, or even shortly after.
Children with each of these diagnosis more often than not have average to above average intellect. They are able to think ahead, devise plans and achieve what they want. They may even be able to forward think and process the consequences and still be driven to accomplish the immediate goal for immediate gain. In these cases, creating an immediate negative reinforcer, or an adverse consequence may be helpful. I have seen too many times where parents have identified the intellect and use way too much language and
explanation to try to achieve compliance with the child. Behavioral training is usually more effective in childhood as they have not developed the emotional understanding enough to truly gain insight from the parents 20 minute discussion as to why we need to drink from the red cup.
One approach I have recommended over and over, is the 3 point directive.
State what the expectation is
State the time frame to have it completed
State the consequence if it is not completed ( you can state the reward, praise, reinforcement if it is completed, but I am reserved with this because too man
y times parents end up un-intentionally bribing. Bribing is a whole other topic of discussion.
The key is consistency. Be consistent with using this in each situation. Be consistent with and follow through with the 3 statements. Be consistent with the statements, they will try to argue with you and derail you. Do not engage in their argument, or pleas for sympathy, simply keep stating the three point directive.
This can be used for all three diagnosis, and can reduce “meltdowns”. This is less successful for IED, but helpful. The key is consistency.
Lisa Willmon M. Ed. LPC-S
www.goseelisa.com
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