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Attention Deficit Hyperactivity Disorder

Helping A Child with ADD and ODD

01/10/2005

Question:

Help!!I am a first grade teacher, one of my friend`s ,and fellow teacher`s ,son is in my class.He has been diagnosed with ADHD and ODD. He is currently taking 30mg daily of metadate, 20 in the a.m and 10 at noon.He has made improvements with his medication. He is a very bright child and can be quite a pleasure to be around. However, it seems that if he thinks he is in trouble of any kind, he will not do his work, and will write extremely sloppy.He does the same thing with his parents at home. His mom has said that it will often take hours to do short homework assignments. Sometimes he just does this and it seems that no amount of prodding , rewards or punishments, will get him to do it.The 1st nine weeks he did fairly well academically. His grades have dropped drastically this nine weeks. His mom is aware of this site and asked that we see if you have any ideas or resources that could help? His parents are , naturally, very eager to help him be his best, as am I.His parents are planning on taking his report card to his next dr. visit. We do have a 504 in place. His mother and I both suspect that this particular problem is more of the ODD than ADHD. Any insights you`d be willing to share would be greatly appreciated.

Answer:

First, it sounds like you really want to help this boy and, although I bet it seems like just "Well, of course!" to you, not everyone acts on those inclinations, so applause to you!

Your friend’s son may very well have Oppositional Defiant Disorder (ODD) along with his ADHD, but I am always wary of an ODD diagnosis. Not because I think it is often misdiagnosed, but because I fear it is often not very helpful----it can keep us from getting to the root of the problem. And, of course, if the latter happens, we can never solve the problem.

For instance, some children can have ODD because of severe anxiety that has been hidden by bravado, high intellect, fear of punishment if they show the anxiety, or a combination of those and other contributing problems. Other children can have ODD because their parents are on drugs and are consistently inconsistent, giving mixed and inappropriate messages all the time. Still others may receive the diagnosis primarily because of depression---children show depression in very different ways than adults---and so on.

It sounds like this boy needs the expertise that perhaps his primary care physician cannot give him, so encourage his parents to discuss that with his doctor. We primary care docs can do a lot, especially when we have a strong interest and knowledge base in an area, but he may need an ongoing therapeutic relationship with a good counselor who can get to know him well enough to break through the surface and uncover what is under the ODD shell.

Hopefully, his family’s insurance will allow for this kind of necessary long-term relationship with a good therapist, or his parent’s have the ability to afford it if insurance will not pay for it. As you likely know, most "health insurance" today does a poor job remembering that one cannot separate the mind from the body when it comes to health care.

I wish him, his family, and you the best. If they need a referral in your area, have them ask his doctor. If we can help with that, let me know and I'll try to help if i can.

Keep up your involved caring! Teaching is a WONDERFUL profession!!! Thank you for being there for our little ones...

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Response by:

Susan Louisa Montauk, MD
Formerly Professor of Family Medicine
University of Cincinnati