Hentor and TVAA, it appears as if both of you are trained professionals (forgive any presumption). First off, I really appreciate the clear distinction and proper segregation of ADD or ADHD from ODD and CD. It was an intense concern of mine that the somewhat common finding of AD and ADHD not become a “gateway diagnosis” for ODD and CD. It alarms me deeply to think that a more common disorder like ADD or ADHD might suddenly take on the connotation of merely being a nascent indicator for such serious problems as ODD or CD.
Once again, I’d really like to see this thread deal with the issues presented in the OP. As it has been shown and acknowledged that ADD and ADHD are rather distinct from ODD and CD, let’s please focus on these more serious disorders.
I’m trying to track any cogent link between really crappy parental influences and a propensity or predisposition to ODD or CD. Could someone provide statistics as to the percentage of children placed in protective custody that exhibit ODD and CD? This might begin to indicate some level of external influences on the manifestation of symptoms. Since it is so difficult to agree upon what constitutes a healthy or functional nuclear family, it would seem that whatever component of the juvenile population removed from parental custody who exhibit ODD and CD might be a better way to assess this.
If there are statistics available on the burgeoning numbers of crack babies that display ODD and CD, this might also be another resource. However, these numbers may easily be tainted by in utero physiological damage which is then expressed as ODD and CD.
If others are able to present alternative methods of decoupling psychological and physiological causation, I welcome it heartily.
I’d also like to mention how my own viewpoint (as expressed in the OP) is more than a little common. Witness the ADD thread currently circulating in this (now) same forum. This in no way lends weight to arguments against the value of creating ODD and CD labels. However, it certainly points up some degree of public resistance to these findings. I’m hoping there might also be some avenues available to discuss why there is such reluctance upon the public’s part to readily accept putative medical diagnosis over the perception that many of those found to be ODD and CD are merely ill behaved brats and bullies.
As seen from preceding posts, there has most definitely been occasions where some disorders are quite clearly misdiagnosed. Are there any statistics on the incorrect diagnoses of these syndromes? In this case, it might be useful to include misdiagnosis of ADD and ADHD in order to help portray the level of inaccurate assessment.
I’d also like to provide first hand corroboration that paradoxical sedation (known to me as “cat reaction”) does indeed exist. As a preadolescent, I was once administered a sedative that ended up manifesting as a stimulant. I have also been led to understand that Ritalin depends upon this same effect when ingested by non-adult patients.
Those who treat children’s mental health, be they psychologists, psychiatrists, or whathave you, are dealing with kids behaving in particular ways, and helping them to be in and to cause less pain. If you are psychologists and you are going to communicate with each other, find out what works for particular patterns, and why particular people behave the way they do, then you had better have something to call what you are seeing.
ODD is what to call it when you see that list of characteristics. Then you can trade notes about how well beatings and discipline, or parent training, or therapy, or, yes even particular medications, work or do not work.
Calling it ODD does not automatically mean it is a disease. It is a shorthand to describe the list so professionals can communicate. If a particular intervention works, then the question becomes if it works better and safer than other interventions … or with less investment of time or money … or if the condition is worth treating at all … etc. To study which interventions work (including parenting interventions) you need to define it.
For obvious reasons, we can only objectively confirm when a diagnosis is given when the available data conflict with the standards we’ve created. Without an empirical definition of the condition, we can never show when our standards lead to misdiagnosis.
That’s odd. Every school system in which my son has attended school has held him accountable for his actions–as I have. Not only has he been held accountable, but each of his classmates in the special behavioral classes have also been held accountable. They are segregated so that when they do lose control they are not disrupting other kids, but they have to earn the right to attend classes in the mainstream and they are held to a specific set of behaviors in order to be “rewarded” with mainstream participation or special projects within their special ed. classes. They get no “pass” for misbehavior from either their parents or their teachers.
If a kid misses his (rarely her) meds on a given morning, he may have some of his coursework reduced for that morning, but they are held to the same standards of behavior, regardless.
It sounds as though you live in a disfunctional area where they are not addressing the childrens’ needs.
As to the question regarding dysfunctional families and ODD in children.
The problem is that the data you ask for wouldn’t answer the question that you ask. Assume a higher than typical rate of children who fit the critera for ODD in clearly dysfunctional families: you’d still have to untangle how much is because of the effects of the dysfunction, how much of the dysfunction is secondary to living with an ODD kid, genetic factors (the families are dysfunctional because one or both parents has a biologic and genetically inheritable risk factor), and the potential for exposure to prenatal substances of abuse in a truely dysfunctional environment. In general studies trying to get at genetic versus environmental contributions use twin studies. A higher rate of the same disorder in identical compared to fraternal twins is good evidence for a genetic component. I am not sure that these studies have been done for ODD per se. Any one else know?
We’re looking at interaction between temprament of the child, parenting style, and environment. Any and all of which contribute to the development of health and disorder.
There is no “the” cause.
Some kids need more structure to feel safe naturally. The more a kid needs structure to feel safe, the more likely an ambiguous environment is to cause this child to feel fear, and subsequently manifest in some sort of disorder such as ODD or CD.
With those two disorders, I’m a pretty firm believer that in most cases that a major contributing is some sort of trauma or long term fear/stressor. Attachment disruptions, generational boundary crossing, abuse, neglect, non-validating emotional environment, unpredictable parenting; that sort of thing.
What percentage of kids who are removed from the home have ODD, CD, or some sort of disorder? (eyeballed) quite a few, I’d say a high percentage; but that doesn’t tell us where the disorder came from. EVERY parent has the capacity to be that abusive monster givent the right amount of stress. Maybe hearing a child cry unconsolably for hours every day for a week and not having anyone to call might cause a parent to detatch from, or abuse a child. Maybe if he/she had someone to call it might make a difference. Maybe if that parent hits her baby out of anger, he/she then feels so guilty (as well she should) that she can’t admit it to anyone and so she carries that stress around with her, influencing her to make further bad decisions. Maybe then the child distrusts mom/dad just a little and goes about looking for reasons to prove/disprove his hypothesis that mom/dad is untrustworthy. Maybe he lends a little too much weight to his little experiments; maybe they’re really stressful.
Maybe the teacher at school does something similar to what mom did and that proves that the whole world is inconsistent.
Maybe his brother didn’t cry nearly as much. So maybe to him, the world seems allright and there’s no need to test it.
It’s just not as simple as any one cause.
There are some cases where the parent is DEFINITELY to blame; even then it’s of little use to do so.
Can you provide a cite for this statement? I must say that if you are a professional in this area as suggested by Zenster, I would have thought you would know the effect is not that of sedation but of improved ability to focus. It appears that the idea of a paradoxical effect in children (and in adults as well) with ADHD was wrong. Psychostimulants actually affect both ADHD adults and children and normal adults and children in the same way.
I would also like to point out that although Primaflora’s comment on ODD, CD and ADHD being on a continuum is not strictly correct, she is correct in that they are all related and are what is know as externalising disorders, ie they create problems for the child’s external world.
These disorders are thought to have genetic influence, although ODD and CD less than ADHD; brain damage of varying sorts is sometimes implicated, and chronic underarousal of the autonomic nervous system leading to sensation seeking behaviours is also believed to be an issue.
Zenster, it is no secret that parental and societal influences as well as factors intrinsic to the child have an effect on the development and outcome of disorders such as ODD and CD, nor is it hard to find evidence that these kids are statistically more likely to end up with things such as Antisocial Personality Disorder as adults, or that they are over represented in both juvenile and adult correctional institutions.
Any good (recent) text on abnormal psychology, eg, Oltmanns and Emery (2001) which I have used here, will give you information on the diagnosis, etiology and treatments for these disorders, and anything recent by Curt Bartol will give you information about criminality and psychological disorders.
Stimulants given to ADHD children often have emotional effects as well; it’s been noted that they sometimes feel distressed or unhappy when placed on the drugs.
** No. They lead to increased focus in children and adults in all cases. Whether the changes are perceived as positive or negative depends on the environment.
I am not sure what you mean by the last comment. The supposed paradox was that the amphetamine medication used caused the opposite to expected effect in people with ADHD - it “calmed” the hyperactivity, impulsivity and lack of focus, whereas in those without ADHD it had the expected effect of increasing activity and agitation etc. This used to be thought of as an indicator that there was a biological difference in the brains of people with ADHD. (I am not saying there aren’t differences, just that this paradoxical effect was not a proof) However it was found that both those with ADHD and those without experienced the same reaction to the medication - increased ability to focus - hence no paradox.
Acknowledged. Nevertheless, stimulants have similar effects in all children: reduced initiative, reduced enthusiasm, and vague feelings of distress.
Now, plenty of children who were having massive problems at school and home are probably happier on medication because those problems have diminished. But when you watch videos of children with ADHD before and after medication, they often seem listless and uninterested in what’s around them. The contrast can be striking.
In children (people who have not entered puberty), stimulants are known to have a reverse, paradoxical effect. Instead of stimulating, they deaden. It’s similar to sedatives, except that sedatives typically dull attention while the stimulants increase it.
This has cognitive and emotional effects by definition – just as stimulants necessarily have cognitive and emotional effects in adults.
TVAA, Once again I ask you, as this is in Great Debates, to produce a reputable cite to support these claims about the effects of stimulant medication you are making, patricularly some evidence that their effect is different in prepubescent children.
Now, if any of you wish to continue discussing ADHD, I think it would be appropriate to take it to the ADD thread currently on these boards. This thread was intended to discuss ODD.
Now, here’s a topic of discussion: what do you all think of the practice of prescribing antipsychotic medications to children with ODD?
TVAA- you are aware that your post about the paradoxical sedative effect and the quote you posted subsequently about it contradict one another, right?
What people don’t get is that just because the kid seems calmer, doesn’t mean he’s been sedated. Stimulants awaken the brain allowing the child to pay closer attention, thus eliminating the need to self-stimulate via hyperactivity.
But back on topic.
Re: antipsychotics for oppositional kids.
Now THOSE have a sedative effect. What do I think of it? I like it if it keeps a kid from being so angry + so impulsive as to hit me or someone else; but it’s a patchwork intervention to target a piece of the problem and shouldn’t be seen as a long term solution.
I’ve got a good deal of psych hospital/residential treatment experience, I know that if you give an angry person haldol, they get sleepy. In fact, if you give anyone haldol they get sleepy. Risperdal, zyprexa, they do the same. This new generation of antipsychotics is really good, but I don’t think we have a med that’s specific to oppositionality or defiance yet. I don’t think we’re likely to in the near future either.
The issue is one of safety and the ability to live one’s life. If a kid needs some sedative to make him calm enough to make choices, fine. It’s nice that there’s less chance he’ll develop tartive dyskenesia (sp?) nowadays, but I don’t think medication should be part of the long term plan.
The paradoxical effect is not limited to children with ADD or ADHD. It’s common to children in general. The problem is that the articles are using the concept of “paradoxical effect” in slightly different ways. As the Australian site points out, sufficient levels of stimulants act as stimulants in children. Lower doses have a paradoxical calming effect on all children.
** But this ‘calming’ effect occurs in all children.
** More to the point, they affect the regions of brain involved with desire and motivation. They’re not merely used as forms of sedation, they make people more pliant and malleable.
** And since ‘defiance’ is merely being willing to ignore the desires of another, we should hope no one ever finds a way to “treat” it.
** The point is not that they’re being sedated or calmed. Their motivational imperatives are being depressed. The kids could “make choices” just fine before the drugs – they were just choices those around them didn’t approve of.
First off my “Bullshit” call is on the claim that the effects of stimulants in kids are “reduced initiative, reduced enthusiasm, and vague feelings of distress.”
Just untrue. Plenty of initiative, often more than previous. If you define enthusiasm as bouncing off the walls and touching everything then it is reduced, but curiousity for knowledge is not changed. They can can focus on one thing at a time for a prolonged period on meds is all. Impulse control is improved: they have the split second to decide if they really want to do that instead of having done it first. Distress? I’ve seen it a few times and usually only at high doses.
As to paradoxical effect: outdated thinking. Stimulants work just as well for adults with ADD. Past speculations for mechanism of action include stimulating atttention centers and that the hyperactive symptoms were a consequence of the short atention span. Increase any kids attention span and they’ll sit still longer. Some current speculations include the suggestion that the prime effect is cerebellar. (The cerebellum’s role in cognition and attention is just beginning to be understood and interesting difference have been found in the brains of kids with ADD both on MRI and fMRI.)
As to meds for ODD. Depends on the symptoms and the severity. I’ve seen kids place on the atypical antipsychotics to good effect. But as said, it is symptomatic care for severe cases.
Yes, people need to be more pliant and malleable in order to change. THAT’S THE WHOLE POINT OF THERAPY. We actually use the word flexible more than pliant. Again, if they can do this without meds, great; cause chances are they’re not going to stay on risperdal for very long anyway.
“Defiance” is NOT merely willingness to ignore the desires of another. It’s refusal to adhere to legitimate authority. We’re not talking about kids who argue about assigned seating or refuse to tuck in their shirts; and might be suspended here. We’re talking about kids who are willing to be expelled from school, not because of some moral principle, but because it was some authority figure who told them to tuck in their shirt. This could very easily be a kid who LIKES tucking in his shirt, who believes philisophically that assigned seating is a good thing; but whose oppositionality is so strong that it gets him in trouble despite his wishes.
Spoken like a person who has never known anyone with Oppositional defiant disorder. The whole point is they aren’t “‘making choices’ just fine” the choices they’re making are not just fine at all. The choices they’re making are hostile, hurtful, and sometimes dangerous to themselves and others.
The day you “approve” of a 14 year old throwing a chair at you, well… Let me know when you get back from the ER if you’ve changed your opinion on whether that kid needs sedatives.
We’re talking about the difference between staying out 1/2 hour after curfew and sleeping in a crack house for the sake of defiance here.
We’re talking about a neat freak who refuses to clean his room simply because he thinks someone’s pressuring him to.
** This is often an effect of giving stimulants to children. Your objections have no merit – presumably not everyone will experience these effects to the same degree, or at all, and some people will have these effects masked by external influences. Nevertheless, those are effects that can commonly seen in children given these drugs.
** Not at all. The “paradoxical effects” do not include the increased concentration, which is expected, but the lack of excitation and activation that would reasonably be expected. Again, it’s dose-related: give anyone enough stimulant and they become wired, whether they have ADHD or not.