Monday, January 20, 2014

Dealing with defiance and emotional over-reaction in kids with ADHD

A child diagnosed with ADHD may have a short attention span, show defiance to adults and be emotionally over-reactive. Possibly this child can also be intensely curious and often ask questions about existential matters. Parenting such kids is like riding a roller coaster of highs and lows. What type of therapies could be considered to help?

It sounds like such a kid is a curious and inquisitive, and those are great qualities, especially when they can be harnessed in a positive way. You wouldn't want to minimize or discourage that.

Defiance and emotional outbursts. Why is that?

It's not surprising to hear that along with ADHD a child has defiance and emotional outbursts, as they are very common in kids with ADHD, though they are not, themselves, symptoms of ADHD. More than 50 percent of kids with ADHD also exhibit defiance and emotional outbursts.
Kids who have ADHD tend to become defiant in circumscribed situations—when they are expected to do homework, go to bed, stop playing a game, sit down and eat dinner. These situations are difficult for them to tolerate because of inherit deficits in paying attention, tolerating a boring situation, reining in impulses, transitioning from a fun activity, and controlling their activity level. Since these situations are really hard for them—more aversive than they are for typical kids—over time, they try to avoid them. Unfortunately for parents, the avoidance strategies that these kids typically use are tantrums, arguing, defiance, and power struggles. That's why, for parents, getting kids with ADHD to do homework can be such a struggle.

What can you do? 

You should first seek a comprehensive diagnostic assessment with a pediatric psychologist or psychiatrist regarding your child to determine what, if any, disorders are present in addition to ADHD. Medication treatment for ADHD will likely help with the ADHD symptoms themselves, but you may also benefit from parent training to help with your child's defiance and emotional outbursts.

There are a couple of types of parent training interventions that would be a good fit for your child's difficulties, including Parent-Child Interaction Therapy (PCIT) and Parent Management Training (PMT). Both are similar in that they teach you how to pay attention to your child's positive behavior, ignore minor misbehaviors, and provide consistent consequences for non-compliant and aggressive behavior. These two interventions differ in several manners, however, including the structure of treatment sessions. Whereas PMT offers specific skills in a didactic, teaching way with the parents (usually without the child), PCIT has parents interacting with their child in session while receiving live coaching from the therapist regarding which skills to use.

Both of these interventions have been shown through research to decrease disruptiveness, aggression, and non-compliant behaviors as well as reduce parental stress and improve the parent-child relationship. As such, these parent training interventions would likely help make the roller coaster of parenting a much more pleasant ride!

Published: January 3, 2014

SOURCE: Vasco Lopes, PsyD, Clinical Psychologist, ADHD and Disruptive Behavior Disorders Center, CHILD MIND INSTITUTE

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