Attention Deficit Hyperactivity Disorder, better known as its acronym ADHD, is the most commonly diagnosed mental health condition diagnosed in children and teenagers today. Children and young people who have been diagnosed with ADHD typically show signs of hyperactive behavior – which includes the need to constantly be active, are easily distracted, atypically impulsive, are unable to concentrate, and may constantly fidget.
ADHD and aggression
One of the more serious symptoms of ADHD, however, is aggression. Kids with ADHD may exhibit hostile or angry behavior, and may attack those around them either verbally or physically.
According to Russell A. Barkley, Ph.D., who wrote “Your Defiant Child: Eight Steps to Better Behavior,” 45 to 85 percent of children with ADHD also develop something called oppositional defiant disorder (ODD), which is characterized by persistent arguing, nastiness, anger and contending with others, particularly those with authority or those in leadership roles in the child’s life. Physical aggression affects up to 45 percent of kids with ADHD.
Symptoms of ADHD and ODD
The symptoms and list of behavioral problems associated with ADHD include the following:
Lack of focus
Do not listen (or appear not to)
Cannot or will not follow through on instructions
Fidget, squirm, or need to constantly move
Cannot or will not play quietly
Refuses to wait for his or her turn
Always runs instead of walks
The symptoms and list of behavioral problems associated with ODD include:
Will not listen to people in authority
Getting annoyed easily
Intentionally annoys others
Mara and Andrew
Mara, a daycare owner and mother of 10-year-old Andrew, who has ADHD, says that for her, “aggression has been par for the course in caring for a child with this disorder.” At five years old, Mara says, Andrew got so irritable with another child at the beach – a total stranger who was sitting 20 feet away and who happened to be singing a song that Andrew didn’t like – that he got up and trampled the other little boy’s sandcastle. It wasn’t the last time Andrew would exhibit such violent and aggressive behavior – Mara says she’s been called to the school because Andrew was detained for biting, hitting, hissing and kicking.
Still, despite the bad stories, Mara says Andrew’s behavior is improving. After seeking the advice of a therapist, she learned there are indeed ways to help discipline a child with ADHD and ODD. With those skills, she and Andrew, as well as their entire family, have come to learn how to keep his aggression under control.
“I was in early childhood education for a long time before I had Andrew, so I guess I’m one of those lucky ones who were familiar… ADHD wasn’t an entirely alien experience for me,” she admits. “Still, it’s never easy dealing with some of these symptoms, especially impulsive aggression.
“It’s never easy, but it gets easier.”
What can you do for a child with ADHD and ODD?
Here, five tips on how to curb the aggression of a child with ADHD and ODD.
1. Cut down on electronics. Much research is being conducted on what too much screen time can do to the body and mind, considering the world has gone digital. It’s not abnormal to find a person watching a Netflix show on a smart TV while glossing over email on a laptop and scrolling through Snapchats on a smartphone – all at the same time. This kind of behavior is mimicked by our children, so they grow up learning how to multitask on secondary and tertiary screens.
Unfortunately, some of the risks that come with too much screen time include screen addiction, susceptibility to metabolic syndrome (a combination of diabetes, obesity and high blood pressure), and serious eye strain. For kids with ADHD, too much screen time can actually make symptoms worse.
In 2018, the Journal of the American Medical Association (JAMA) published a study that proved there is evidence that excessive screen time and electronic use can increase symptoms of ADHD. Screen time doesn’t cause ADHD, but for a child already diagnosed with ADHD, limiting time spent in front of a device could be helpful.
Why? Well, the rapid-fire images on an electronic device might make it more difficult for a child to focus on tasks that are slower, and require more thought and effort, like reading a book or writing or doing homework. The exciting things on TV or a video game console might make things like swimming or riding a book less thrilling.
Some things you can do to cut down on screen time or electronics is to set a timer or limit the number of hours of electronic use per day (the suggested amount of time is no more than two hours for the entire day). During the periods of the day when you child would have been streaming a TV program, offer alternatives – go out for a walk with the family dog, or cook together, or try out a new activity once a week.
Mara says that of all the tips suggested to her, this was the hardest at first. “When I was 10, I think I still played board games with friends or was climbing trees or something,” she says. “The TV shows I wanted to watch were only on at a specific time, so if I wanted to watch TV, the TV had a schedule for me instead of the other way around.
“Now, you can watch whatever you want whenever you want, which is a good and bad thing. And video games are interactive, so kids use it as a social activity. If I take Andrew away from a video game, he’s yelling at me that he’s missing out on time with his buddies.” Mara says she’s learned to set boundaries with Andrew, and is teaching him to set boundaries too. Because shows are available “whenever you want,” like Mara says, she has a small hourly calendar set up in Andrew’s room that he fills out. In four half hour time slots, Andrew chooses what he’d like to do: a half hour on a video game, a half hour watching YouTube videos, etc. Mara says Andrew feels like he has control of his time this way, instead of feeling punished or like he’s losing out.
2. Teach your child compromise and negotiation skills.
Kids with ADHD have difficulty being flexible and compromising. Adapting to new situations and rules they’re not accustomed to isn’t a pleasant activity for them. Kids with ADHD may also have a low threshold for irritation and frustration, meaning that they not only get cranky with situations and circumstances, but with people – those people who don’t seem to understand their point of view. This difficult temperament isn’t because of poor parenting or because the kids want to be difficult – they just have a hard time going from one mind-set to the other.
Take, for example, a child with ADHD who is playing. He’s having a great time, and he’s in the zone! Mom comes out and says it’s time for dinner, and the child’s inherent cognitive inflexibility – their incapability to go from one activity to the other without emotional disruption – causes him to exhibit signs of anger, frustration, or irritability.
Connor, a seventh-grader who was diagnosed with ADHD at 8 years old, is impressively self-aware and recognizes this behavior. “I get grounded a lot,” he says with a smile. “It’s not like I want to be bad. I want to listen to my parents. I just get upset really fast. I’m trying, though.”
Connor says that he and his parents have established a set of “rules” that he had a hand in creating.
Tara, Connor’s mom, says that in their household, TV and play time are considered “currency.
“For every chore Connor completes, he gets 15 minutes of PlayStation time or 15 minutes of TV time or 20 minutes of time outside with his friends,” she explains. “He helped determine those times. At first, he wanted an hour of time with every chore, so we had to negotiate that time too.”
Another rule they established at home was that if Connor is feeling aggressive, he can’t hit his sister, Rachel. Instead, he suggested (on his own) going into his room and screaming for five straight minutes, as loudly as he wants. This strategy came with interesting results.
“At first, the five minutes wasn’t enough; he wanted to keep screaming,” says Tara. “Then, he wanted to watch the clock and scream for exactly five minutes just because. Sometimes now he screams once and it might last ten seconds.
“I think knowing he’s not being kept from expressing his emotions is why it works. Hitting was his way of showing that he was upset. Now he can scream, and it’s still not pleasant, but he’s not hitting anyone. It’s a good compromise, and I can’t wait to get to the next step, where the aggression is gone and there’s no screaming at all.
“Getting to this next step gives me hope for the next one.”
3. Help your child express his or her emotions positively. The next step Tara is excited about is the movement toward positive emotional expression. Kids who learn how to express their emotions in a healthy way grow up to be supportive of others, perform better in school, have better relationships with partners and peers, have better coping skills, and have an overall healthier sense of sense.
Here are some of the things you can do to help your child with ADHD express emotions positively:
a. Tune in to your child’s feelings. Sometimes it’s hard enough for an adult to explain what they’re feeling – harder for a child who may not have the vocabulary to do it. Observe their behavior and gently talk to them. By listening, you’ll help your child manage his or her feelings.
b. Recognize that every behavior is disguising a feeling. If or when your child acts out, gently get to the bottom of why.
c. Encourage with praise. When a child does something positive and good, don’t hesitate to reward with kind words. Often we’re quick to scold, but we may not shower kids with excited praise as much as we should.
d. Lead by example. When we’re angry, instead of throwing things or cursing or slamming down the phone, we can take deep breaths and count to 10, which is often a successful exercise in calming rushed, angry feelings. Your child will learn from your calm composure and mimic it. Showing your child how you deal with feelings is the best way of teaching them how to deal with their own.
4. Show your child stability and structure. Whether you’re a single parent, are divorced and committed to co-parenting, or are in a two-parent home, it’s important that you are consistent with discipline and rewards.
Children with ADHD need structure and routine. Daily routines and a predictable, organized schedule help make your child feel safe. Maintain consistent house rules. Remind your child of your expectations and the consequences of not meeting those expectations. Because of an ADHD child’s inability regulate, establishing this kind of environment – one of routine and regularity – helps give your child the security and reassurance he or she needs. Aggression and anger as a symptom of ADHD is often tied to fear, so showing your child that he or she is safe and secure is a great way of mitigating aggression.
5. Exercise. Exercise is a fantastic activity for anyone, even for kids without an attention disorder. But for kids with ADHD, it’s particularly helpful.
Science has proven that exercise is a great way for kids to unleash and unwind; it’s also a way to work out any feelings or anger and frustration.
Some things you can do with your child (or that your child can do on his or her own) include:
Going for a walk with the entire family
Joining a house league sports team
Enrolling in a sport and recreation program
Experts say that even 30 minutes of vigorous exercise per day can help kids with ADHD manage their moods. It can even decrease or eliminate the need for medications that are prescribed to aid in symptom management. It’s also an excellent way of reducing aggression.
If you have a child with ADHD and need further guidance on how to manage aggression, visit www.hopetherapyandwellness.com.