christian counseling today
Vol. 20 no. 2
33
The causes of ADHD tend to be varied and complex and can be both
environmental and genetic. A combination of medication and behavioral
interventions may be needed for improvement. Below are a few examples of
empirically supported treatments:
n
Pharmaceutical Interventions:
Psychostimulant medications in both
short-acting forms (Focalin, Methylin and Ritalin) and long-acting
forms (Concerta and Daytrana) can offer effective treatment
n
Behavioral Parent Training:
Patterson’s Parent Management training
– Oregon Model (Forgatch & Patterson, 2010); Eyberg’s Parent-Child
Interaction Therapy (Zisser & Eyberg, 2010); and Webster-Stratton’s
Incredible Years (Webster-Stratton & Reid, 2010)
n
Behavioral Contingency Management in the Classroom:
ADHD
Summer Treatment Program (Pelham et al., 2010)
There is a significant overlap between ADHD and the other defiant
disorders. Some data suggest that children diagnosed with ADHD have
a comorbid ODD, and this increases to 80% for those with ODD who
have comorbid ADHD (Green et al., 2002). This makes treating the more
impaired ODD and CD cases even more difficult and complex.
Oppositional Defiant Disorder
“This school sucks! I hate you and can’t stand this class. I hate middle school.
I am sick of homework, and I don’t want to be here anymore. I am glad I am
suspended so I don’t have to see your face anymore. It is your fault anyway.”
Oppositional Defiant Disorder is a recurrent pattern of negativistic,
defiant, disobedient, and hostile behavior for at least six months in children
(APA, 2000). The severity of this disruption has increased and has become
more aggressive. This is the disorder most frequently referred to counseling
practices for child and adolescent services. The prevalence for ODD is
between 2–16% (APA, 2000) and core characteristics include:
n
Negativity:
blaming others for their own mistakes; easily annoyed
n
Hostility:
irritable mood/temper tantrums; anger; resentfulness
n
Defiance:
arguing with adults; active non-compliance with adults;
spiteful; vindictive behaviors
The causes for ODD are varied and can include both neurobiological
deficits and environmental factors. Children with ODD have executive
(cognitive system) skill dysfunction, emotion dysregulation, relationship
disturbances, and are highly resistant to tradi-
tional parenting practices. Often, treatment
approaches focus on the parents, and with good
cause, as they tend to have the most interaction
with children. One model known as the trans-
actional or reciprocal model (Sameroff, 1995)
looks at both the parent and the child and how
they interact together. For instance, if a child has
difficulty with transitions and frequent outbursts
coupled with a highly anxious parent, it could
lead to very combustible interactions. Helping
parents in a compliance type situation—not
only with the child, but also with their own
feelings—is key. Below are a couple examples of
collaborative treatment:
n
Collaborate problem solving developed by
Ross Greene et al. (2004) focuses on the
parent-child interaction and helping them
develop collaborative approaches to address
both the parents’ and the child’s concerns
n
Treatment protocols by Russell Barkley
(1997) is an approach that works with
parents on the development of skills for
dealing with behavioral outbursts
Conduct Disorder
“These rules are ridiculous. I am in high school
and not a baby anymore. Mom, you can’t tell me
what to do. I should be able to drink and go out
with my friends. So what if I got caught stealing
yesterday. It was the school’s fault for leaving the
computers out!”
The final disruptive disorder that needs to be
discussed is the most severe, pertains primarily
to adolescents, and is the most difficult to treat.
Conduct disorder is described by the
DSM-5
as a
Is this just normal
developmental
struggles, or is
there a clinical
disorder lurking in
the background?
adhd odd cd
