ODD - any suggestions for therapy/parenting strategies?

[Upheavalkneival]

I am becoming convinced my two stepsons, 10 and 12, have ODD.

We know they have ADHD, but having read some books, I'm looking into ODD which seems to explain a lot.

Does anyone on this board - which I am a first time visitor to after hours of desperate googling - have any experience of this condition or any suggestions?

It pains me to write this, but the children are simply out of control.

Both were formally diagnosed with ADHD a year ago but we have parented as if they have it for much longer. We knew, but waited to pay for the v expensive DX until they were old enough for stimulant medication.

We expected the medication to help more than it has. It has improved focus and academic attainment. But the ODD (if this is what it is) has not changed.

Both children believe they are in charge of themselves and must always do what they want. We would probably get peace if we gave them the run of the home and unlimited Haribo and said it was fine to be on screens for 20 hours a day. But we won't do that.

We provide a comfortable home, nutritious food, every sporting activity we can think of to keep them active and they have therapists and tutors. We are very involved parents and have for years very closely managed their behaviours with positive parenting strategies. Sticker charts, star charts, reward charts, Go Henry. Constant micro rewards for tangible acts of compliance. We've cracked nutrition and bedtimes, but nothing seems to improve much.

Perhaps we have rewarded them too much and they are testing us to see how much more we will bribe them with for basic behaviour standards? This is the thing I torture myself with most often. But we prefer positive parenting to punishment.

You will be shocked to hear how they act. I am shocked to write it.

This is a usual day.

Time to get up
'No'
Reward reminder
'OK'
Brush teeth now
'No '
Reward reminder
'OK'
Make your sandwich
'No'
Reward reminder
'OK'
Time to get in the car for school
'No'
Reward reminder
'OK'
Screen time limit coming up
'No'
Reward reminder
'I want more Youtube as my reward.'
You can't have more Youtube for coming off of Youtube
'I want more tomorrow then. And even more the day after.
OK internet will be turned off
'If you do that I will jump out of a window.'
I'm turning the internet off and have locked the windows
'I have confiscated YOUR phone because if I can't have a screen no-one can.'

Now sometimes this switches, and all rules are followed, but they create mayhem in different ways. A favourite it to choose one adult as 'best' and the other as 'pariah.' Best adult gets all the kisses and cuddles while pariah adult is interrupted, ignored, shoved, has their TV programme or song turned off, is prevented from sitting in the front seat of the car. The idea I think is to divide and conquer us. We are wise to it but it is also tough to deal with.

You'll be wondering where the mother is in all this. Officially she has them 50% of the time but as the children have got bigger and the behaviour harder to deal with when they were younger she is unable to cope We support mum as much as we can including financially. We have hired a specialist carer to give us all some respite. This along with meds and therapy is draining our savings.

I entered these kids lives many years ago and they were pretty much the same but I was certain with the right parenting strategies/diagnoses things would improve. Nothing has worked.

What else can we do?

At a total loss.

I would be careful about going down the ODD route without first considering other things.

I would consider whether their presentations are down to the ADHD - what support do DSC have? How many medications did they try - it can take a while to find the right one/combination/dose?

Are they getting enough sleep? Do they take anything to aid sleep?

Has ASD been considered? You could try some PDA strategies?

Do DSC have EHCPs? What support is in there? What types of schools do they attend or do they not attend school and that’s why you mention tutors? Often if school life was easier, home life improves too.

What support have they received for their mental health and trauma? Have they had OT assessments?

Some people find the book The Explosive Child and The Out of Sync Child helpful. Some find non-violent resistance courses/resources useful. For some, traditional parenting methods, such as reward charts, don't work.

Have you/DC had social care assessments?

Thank you these are excellent questions.

What are in your view the aspects of ADHD that we may have missed that might cause controlling and dominating behaviours?

Tutors, psychatrists, talk therapists all involved with both kids. One has EHCP and goes to specialist school and also has OT and SALT. For the other (no learning difficulties) we fund everything privately but I plan to look into OT. We've had blood tests for both that came back normal, so no mineral deficencies that may cause behaviour/disregulation.

Sleep is well managed. Both are prescribed melatonin to be used as needed although we are keen not to depend on it. Screens are off two hours before bed (with heavy resistance). As both are competitive and active we've been able to use sporting prowess etc as motivation for sleep and balanced diet.

We've both read The Explosive Child and we've tried the 'what's up' and to identify lagging skills. There aren't any, we think, that haven't already been identified.

There are many lagging skills - age-appropriate emotional regulation, ability to self-soothe, showing positive empathy.

Speech and language isn't an issue. Both are highly articulate during acts of defiance (they are very quick to spot and exploit loopholes). Where they differ is that the older one will keep intensifying their tantrum if a limit is imposed (we will just repeat the limit once or twice and walk away, which intensifies the tantrum further). The younger uses more sophisticated methods to evade limits, such as becoming very upset about something that did or did not occur at just before bedtime. As he also then attempts to dictate which adult can offer comfort (we'll give him the other adult, for a set number of minutes) it feels like more than a simple bedtime-avoidance or attention-grabbing technique.

It is probable, I suppose, that these are all ADHD traits and everything can be put into the bucket of 'they enjoy winding us up.' We have medication reviews coming up soon. Its definitely the case that stimulate medication so far has not reduced these behaviours.

Thank you ever so much for your thoughts.

Unmet needs related to ADHD can cause, what appears to others to be, controlling and dominating behaviour. For example, unmet sensory needs, unmet MH needs, rejection sensitive dysphoria, seeking the ‘hit’ they crave, school difficulties, emotional regulation difficulties…

It sounds like a review of the DSC with an EHCP is required because it doesn’t sound like it is meeting his needs at the moment.. DH/DP can use the model letter on IPSEA’s website.

He should also request an EHCNA for DSC2.

Speech and language is an issue, based on your posts. SALT is about far more than the physical ability to speak. It covers things like social communication and social interaction and emotional regulation. An assessment and ongoing support would help.

Tantrum or meltdown?

Thanks so much for all this help and advice.

It is very good to know that a lot of this could be 'just' ADHD. The ODD rabbit hole isn't a fun one to go down.

Kid 1 EHCP we've had for years and its constantly being reviewed and wrangled. Firstly the LA said the best setting was a PRU. We're now in a lovely specialist independent school with small classes and all the therapies. It has not changed much yet, but I do think a PRU or remaining in mainstream could have made things much, much worse.

My ongoing anxiety about the specialist school is what comes next? I fear perhaps it is almost too good. How do we prepare this child for mainstream life where he doesn't get to see his OT/SALT every day or escape to the lovely sensory room or get a sensory diet at lunchtime? How would college work? Children who leave this school mostly become NEETS. It makes me very sad. Kid 1 is intellectually very capable too.

Kid 2 is a lot more socially adept and I do think academically will be fine with reasonable adjustments. The worrying behaviour pretty much only happens at home. It is mainly emotional stuff. What do you think an EHCP would gain us?

EHCPs can last until 25, or 26 in some cases, so following school they/their father could look at a specialist college or some specialist schools cover post 16/18 or EOTAS/EOTIS (with or without the C on the end) or supported internship…

DSC1’s behaviour shows he needs further support. Hence looking to review the EHCP.

EHCPs are about more than academic ability. Social, emotional and mental health needs, communication and interaction and sensory needs are all relevant. An EHCP can ensure those needs are met, which DSC2’s current presentation suggests aren’t currently being met with the support currently being provided.