RUNNING HEAD: EDPS 651 Final Exam

EDPS651FinalExam
SectionOne:AutismandtheImportanceofCollaboration
SectionTwo:AttentionDeficitHyperactivityDisorderandOppositionalDefianceDisorder
ChristinaMajcher
UniversityofCalgary
30November2012

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Section One: Autism and the Importance of Collaboration

All parents want the best for their children. From the minute a couple hears that they are
expecting, parents begin imagining what it will be like. Dreams and desires for that childs well
being often start long before the birth of the child. Therefore, it can be traumatic to hear that a
child might have special needs or be different or outside of the norm. This conversation tends to
happen at birth when a disability is visible or medically related, but many times invisible
disabilities are not identified until a child enters school and teachers begin to notice specific
learning challenges. When a parent receives this news, they are launched into the grieving
process. The stages identified with grief originate with denial then lead to anger, bargaining,
depression and acceptance. The amount of time needed to reach acceptance and even the ability
to eventually accept a childs diagnosis varies from family to family and even between parents
within a family. This process is one of the most challenging aspects of working with and
supporting children with special needs. This paper will explore how the learning obtained in
EDPS 651 has helped improve my understanding and ability to support parents through this
process to help them along the journey towards an acceptance of their childs diagnosis.
I currently support approximately 40 children with varying needs and learning profiles.
Eleven of these children have complex, multiple needs and are supported by Ministry of
Education supplementary funding as well as outside of school community supports. One of the
more challenging and complex children that I support has a diagnosis of autism. He is a lovely
boy that requires the constant one-to-one supervision of an adult. I have worked with this boy
since his arrival in grade one, four years ago. From my very first meeting with his parents, I
immediately knew they were in the stage of denial. They have hired and fired multiple speech
and language pathologists, occupational therapists and behaviour interventionists which has

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garnished them a reputation in the small special education community of our city. Individual
Education Plan (IEP) meetings have always been challenging with the school encouraging life
skills and parents pushing for straight academics. As the mediator and facilitator of these
meetings, I have always felt uncomfortable, caught between our school administration, the wants
and needs of these parents and the needs of this child. We have tried a vast array of methods to
communicate their childs strengths and limitations, but the parents have advocated for their
child to be taught the same curriculum as his peers with only slight adaptations. The school does
not feel that this is in the best interest of the child, nor possible given the manifestation of his
autism. Over the years, his parents have indicated that their son is far more capable than he is
able to demonstrate at school. They have become increasingly frustrated with his lack of
performance at school and flip between blaming his classroom teachers to blaming his
educational assistants. This family has taken vast amounts of my professional time as I have
attempted to meet everyones needs. I was beginning to accept the rollercoaster ride of
supporting this family until this fall. When registering for this course, I assumed I would get a
brief overview of some disorders that I was familiar with and some new to me. I had no idea that
the information would be so in depth and informative. I also had no idea how much this
information would help me with certain families.
The IEP meeting this fall went as expected: the school encouraged social skills,
communication skills and life skills and the family pushed for more math, social studies, science
and language arts. The gap between this boys abilities and his peers has grown so wide that our
ability to adapt has become nearly impossible. Everyone left the meeting feeling frustrated. I
knew the parents were not happy, but they were desperate to have their child stay at our school.

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Our administration was becoming exasperated and I was almost ready to give up. That was the
week of our course readings and presentation on autism.
I have always felt that I had a good understanding of autism. I learned about the disorder
in university, worked as a behaviour interventionist while completing my undergraduate degree
and have supported many children on the spectrum over my years as a teacher. However, an
enormous amount of research on autism has taken place since I was in university. I learned a
great deal of information from our studies that week that helped increase my understanding of
this disorder as well as the needs of this individual child.
After reviewing the weeks readings, a very important piece of information stood out to
me. I realized that as a school we had individualized this childs program so minutely that we
had forgotten the most obvious component to his profilehis autism. I realized that we had not
discussed the core symptoms of autism in a very long time, if ever. Upon reflection, I actually
wondered if I anyone at the school had ever even used the term autism. In fact, I began to
wonder if the parents had ever used the term. I am often aware of parents dislike of labels and
try my best to focus on a childs strengths and needs as opposed to their formal diagnosis.
However, this course has helped me identify that there are times when it is important to be able
to refer to the core symptoms of a psychopathology in order to create a meaningful intervention
plan. I also began to wonder if never referring to a childs actual diagnosis might impact or
affect a familys ability to accept their childs diagnosis.
As it happens, the mother of the child approached me this same week to share her
concerns about her sons attention, rigidity and limited interest in activities and interests. She
was thinking that perhaps the educational assistant or teachers were not challenging him enough
to spark his interest. She wanted to share the methods that her and her husband use at home each

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evening to teach the boy, so that we could employ some tough love strategies to increase his
performance. In the past, I likely would have listened to her concerns and her rationalizations
that it might have been the schools method of instruction. However, this time I listened to her
concerns and instead of nodding in agreement, I listened but said, Yes, that is one of the features
of autism. She looked completely taken aback, so I continued, stating, Children with autism
can have stereotyped patterns of behaviour, interests and activities. I continued with, Children
with autism can also have a restricted range of interest and can become preoccupied with narrow
interests. They can also really get stuck on everything being the same and become distressed
with changes to routine. They can also have a hard time with their attention span. The mom
stood back, mouth agape and said, Oh, I hadnt thought of it being tied to autism. She left the
room and I had one of those great moments in a teaching career where I realized what had just
taken place. By no means do I feel that any childs abilities should be limited to their diagnosis.
However, the common features of these disorders have been extensively researched over the
years and this research can help guide our practice. Not using the name of a disorder when
discussing a childs strengths and learning challenges not only limits our ability as educators, but
as the mom left my room, I also wondered if this had also partially factored in to them not
accepting his diagnosis.
That conversation a few weeks ago completely changed my interactions with this boys
family. Several days after our conversation the mom ccd me on an email that she had sent to his
team at B.C. Childrens Hospital inquiring about some of the challenges they were facing with
their sons autism. This was the first time in the 4 years that I have supported this child that they
referred to his challenges related to the diagnosis of autism. That was an incredible moment for
me in my career. My studies in this course helped me feel confident to speak about a diagnosis

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without the fear that I would be offending a parent and in doing so, I believe that I have helped
the family come closer to a place of acceptance in terms of their childs autism, ultimately
helping the child.
Reading the chapter on autism in Mash and Barkley (2003) also helped me understand
current theories of the etiology of this disorder. I have been asked what causes autism more than
any other special education related question. Prior to this course, I believed it was likely a
combination of genetics and environmental factors, but I was not too sure. Over the years I have
had several parents adamant that their child was normal until they received their
immunizations. I found it helpful to read that not only does research not support a link, although
regression occurred in one-third of the children in a particular study, this regression was not
related to age at the time of vaccinations (Grofer Klinger, Dawson and Renner, 2003). It also
made me wonder if placing blame on vaccinations may be related to the stages of grief. It may
be easier for a parent to feel anger towards a medical procedure than towards their child.
Another interesting link between my experience and the required reading was related to
the similarities between parents and children with autism. I have noticed that many of the fathers
of children with autism that I have worked with had interesting autism-like behaviours and
quirks. I now understand that genetic factors do play a role in autism indicated by the
concordance rate of 60% in monozygotic twins (Grofer Klinger, Dawson and Renner, 2003). I
was also fascinated reading about the broader autism phenotype and the similarities in the
information processing abilities in first-degree relatives (Grofer Klinger, Dawson and Renner,
2003). This not only supported my observations, it has also challenged me to rethink the way I
impart information to these families. As described with the aforementioned family, I have
walked away from many IEP meetings feeling that we did a good job of presenting an accurate

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snap-shot of their child only to find out that parents have misinterpreted the information. When
reading the information about the autism phenotype, it made me reflect that it might be helpful to
consider my method and mode of presentation during IEP meetings. It might be helpful to have
visuals and a written synopsis of the main points to help aid in a parents understanding of a
schools perspective. I have realized that in order to meet the needs of the child, I have to
consider the needs of the parents. Often times, I think this piece is forgotten. Could the
misinterpretation of school or assessment reports also be a factor contributing to a parents
acceptance of their childs diagnosis?
Finally, I was fascinated reading about the neuroanatomical findings associated with
autism. I was very interested to read that autism may be caused by abnormal cell growth and
development associated with neuronal growth and pruning (Grofer Klinger, Dawson and Renner,
2003). Prior to this course, I was unaware of the limbic system hypothesis, the theory of mind
hypothesis, the executive functioning hypothesis and weak central coherence hypothesis (Grofer
Klinger, Dawson and Renner, 2003). I was particularly intrigued reading about the theory of
mind hypothesis and have always found this to be a challenging component when working with
children diagnosed with autism, particularly with the child that I have referenced. I also now
understand that there is clear evidence that individuals with autism have impairments likely in
multiple regions of their brains (Grofer Klinger, Dawson and Renner, 2003). This has helped me
understand the great diversity in the presentation of this disorder. Learning this information has
given me a better understanding of the current theories and research to ensure that my IEP goals
are appropriate and within a childs capability.
Although I believe a child can outperform a psychoeducational assessment or perform
higher than might be expected with a given diagnosis, there are associated features with certain

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psychopathologies. These features help determine a diagnosis, but these are also features that
tend to affect the way a child learns. For example, the child that I have been referring to has
enormous challenges with attention that significantly impact his ability to learn in a classroom.
This young boys parents have been advocating for their son to be included in the classroom,
working on the same curriculum with minimal adaptations. There is a significant discrepancy in
the schools perceptions of his abilities versus his parents perception of his abilities. Of course
our school supports a model of inclusion. However, there are times where it seems incredibly
inappropriate to expect him to complete the same curriculum as his peers. We have found that
the traditional method of teaching and instruction is not always an effective or appropriate mode.
This has led me to want to learn more about the associated features of autism and potential forms
of successful intervention. I feel that this greater understanding of the disorder will help me
communicate more effectively with our school based team as well as the childs parents. My
hope is also that this will help support the parents understanding and eventual acceptance of their
childs autism.
As previously stated, I was a behaviour interventionist while working on my Bachelor of
Education. I was hired to participate with one of the original Applied Behaviour Analysis trials
headed by Charles Lovaas and his team through the UCLA. I worked with a young boy and was
trained in this technique of behaviour modification. When I began teaching and supporting
children with autism, this appeared to still be the most common method of intervention
implemented by families. When I began at my current school ten years ago, we had five children
all working with a Behaviour Consultant and Psychologist specializing in this area with a home
and school program. As a team, we saw a great deal of success with the learning of these
children, particularly in the younger years. Overall the challenging behaviours appeared to be

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well managed. However, in the past couple of years, parents have begun to approach the school
stating that they are no longer interested in using ABA at home and requesting to move away
from this rigid model at school as well. Although I greatly value the applied behaviour analysis
approach to teaching, I have also begun to realize the importance of other developmental models
such as Floor Time and Relationship Developmental Intervention (RDI). I have also become less
comfortable with a one-way approach with all children with autism. Every child is unique and I
feel that I need a better understanding of the variety of teaching strategies to help create a
program for each individual child. After completing this course, I now have an increased
understanding of autism to build upon. Having an increased understanding of the available and
current strategies to support children with autism will also aid in my communication and
collaborative efforts with parents.
I am currently in the process of determining a professional plan or course of action to
learn more about the Floor Time Model, Relationship Development Intervention (RDI), Social
Thinking and Positive Behaviour supports. Jennifer McLeod, our schools Occupational
Therapist, is well versed with the Floor Time/RDI models and has offered to provide the school
with an in-service for me with an added in-service for teachers if deemed to be beneficial. She
has a private home-based clinic where she uses these models and has invited me to come and
observe during a professional development day. In addition, I will be registering our special
education team to attend a workshop this coming February titled Social Thinking meets
Response to Intervention and Positive Behaviour Support. This will be the very first special
education professional development workshop that our current principal has ever attended. I am
excited at the prospect of us attending and learning as a team. I will be informing the families
that I support of our upcoming workshop and inviting them to attend with us. Perhaps this

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collaborative and supportive learning time will also help foster a parents path towards
acceptance.
I will have my first practicum starting in the new year. I will definitely be discussing my
questions, concerns and observations with my mentor and supervisor, Dr. Jillian Roberts. I am
very lucky to be able to learn from her as she has been the Associate Dean of the Education
department at the University of Victoria for the past several years, an instructor and she owns her
own private psychology practice. Dr. Roberts also began her career as a teacher, leading her to
Special Education in a role similar to mine before she went on to obtain her doctorate degree at
the University of Calgary. She understands the nuances of the field of special education, with a
wealth of experience to draw from. I look forward to our future discussions inspired by my
learning in this course.
Most importantly, this course has helped me reach a stage in my career and professional
development where I realize the importance of collaboration. Although I have always considered
collaboration to be an integral part of my job, I have only recently discovered my potential role
in a familys acceptance of their childs diagnosis to aid with the collaborative process. It is
much easier to collaborate when you are talking about the same thing. In addition, I have
discovered that keeping up to date with current theories and practices also supports collaborative
efforts. It sends a message to parents that I understand and care about the needs of their child
and helps create an open discourse when planning IEP goals. I am very appreciative for this
personal and professional growth. Although I have examined this growth in relation to autism, I
believe that this new awareness can be applied to all of the unique children and families that I
support.

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Section Two: From One Disorder to Another.

In my career as a special education teacher, the neurodevelopmental condition that seems

to cause the most frustration to classroom teachers is attention deficit hyperactivity disorder
(ADHD). Every staff room has stories of teachers whose otherwise calm demeanors have been
challenged by students diagnosed with ADHD. Often first identified in elementary school- aged
children, ADHD persists into adolescence and early adulthood (Barkley, 2003). Identified by the
core symptoms of inattention, impulsivity and hyperactivity, children diagnosed with ADHD also
present with many neurocognitive deficits (Barkley, 2003). Some children diagnosed with
ADHD end up with a comorbid diagnosis of oppositional defiance disorder (ODD). Both
considered behaviour disorders, ADHD and ODD, tend to get lumped together. However, they
have many distinctly different features, etiologies and responses to intervention (Barkley, 2003).
ADHD is considered a neurodevelopmental disorder, while ODD is often viewed to have a
stronger links to environmental risk factors, family dysfunction and social disadvantage
(Hinshaw & Lee, 2003). When does a diagnosis remain as ADHD and when does it need to
progress to a diagnosis of ODD? This paper will review the general features and challenges
related to diagnosing ADHD and ODD, examine critical issues of ADHD and ODD and look at
areas of overlap and divergence between the two disorders.
I am interested in exploring this topic further because I currently support a child with an
ADHD diagnosis who has been experiencing significant behaviour challenges in the past year.
His mother, a special education teacher, has recently asked me if I think his challenges have
entered the realm of oppositional defiance disorder. I have not had a lot of experience teaching
children diagnosed with ODD. However, when I listened to the presentation and completed my
readings for this course, I was surprised at the similarities between this child and the associated

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features of both ADHD and ODD. This childs behaviour is causing a great deal of upset at my
current school, stressing existing resources and leading to a lot of frustration and anger. My
Administration is looking to me for direction and advice on how to proceed to better meet this
boys needs. Unfortunately, all of the strategies and interventions are having limited effect and
my concern is that this child is on a quick path of being expelled from our school. My hope is
that this paper will help me identify a positive course of action to aid the child, his family, his
classmates and the school.
Research generally points to two identifying factors that underlie the behaviour challenges
associated with ADHD: inattention and inhibition (Barkley, 2003). Current theories identifying
the core features of ADHD have identified problems with behavioural inhibition, self-regulation
and executive function (Barkley, 2003). Children with ADHD are said to have an impaired
ability to sustain attention, persist, remember and follow through with rules all while ignoring the
distractions occurring around them (Barkley, 2003). Barkley (2003) feels that these challenges
are likely related to a deficit with executive functions. His model of ADHD has become a highly
regarded and widely accepted theory as to help identify the underlying concerns associated with
ADHD.
In regards to inhibition, Barkley (2003) states that children with ADHD have challenges
inhibiting prepotent responses linked to rewards seeking and excessive fear. In a classroom
setting, these are the children that are described as having a high level of fidgetiness, are
constantly moving, and talk excessively and are prone to frequent interruptions. These tend to be
children with a wide range of externalizing behaviours such as temper outbursts, bossiness and a
low frustration tolerance (Barkley, 2003). These behaviours are also often associated with poor
self-esteem and challenges with peers (Barkley, 2003).

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There are currently three distinct subtypes of ADHD that a child can be diagnosed with
based on the predominant symptoms observed (Barkley, 2003). ADHD, Combined Type
(ADHD-C) is the most common subtype with children exhibiting six or more symptoms of
inattention and hyperactivity (Barkley, 2003). ADHD, predominantly Hyperactive-Impulsive
Type (ADHD-PHI) is used when children meet the criteria with symptoms of hyperactivity
(Barkley, 2003). The final subtype is ADHD, predominantly Inattentive (ADHD-PI) where
children meet the criteria for symptoms of inattention (Barkley, 2003). There has been a great
deal of research into these three subtypes, with many researchers suggesting that the inattentive
subtype is a completely separate disorder (Barkley, 2003). Correlations between oppositional
defiance disorder and attention deficit disorder are generally compared in relation to ADHD- C
and ADHD-PHI (Hinshaw & Lee, 2003). As a result, when discussing ADHD, this paper will be
referring to these two subtypes, unless otherwise specified.
Oppositional Defiance disorder is diagnosed when a child displays a pattern of hostile and
deviant behaviour such as hostility, arguing with adults, defying or refusing to comply with adult
requests, anger and a lack of ability to accept responsibility for his or her actions (Hinshaw &
Lee, 2003). In a school setting, these can be some of the most challenging children to support.
In the classroom, they can disrupt instruction with their resistance to following directions or
compromising with peers or adults, verbal aggression and a constant testing of limits and
boundaries (Hinshaw & Lee, 2003). Many teachers report that they are constantly trying to side
step power struggles when teaching children with a diagnosis of ODD. Children with these
needs require a great deal of adult support and can challenge even the most capable and
experienced teachers.
When looking at the core features of ADHD and ODD it is not surprising that they are both

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considered disruptive behaviour disorders. Although these disorders have definite differences,
they share some primary features related to challenges with self-regulation, interpersonal
relations and some eternalizing symptomology (Barkley, 2003; Hinshaw & Lee, 2003). More
than 50% of children with ADHD may also be diagnosed with ODD (Barkley, 2003; Hinshaw &
Lee, 2003). This high comorbidity is one of the challenges facing diagnosticians. Where does
the ADHD end and where does the comorbid condition of ODD take over? As indicated in Mash
and Barkleys text (2003), the strongest predictor of a later diagnosis of ODD is the severity of
the hyperactive-impulsive behaviour displayed by a child. In addition, hostile behaviour, poor
child-parent relationships, maternal depression and mental health are predictors associated with
ADHD developing into ODD (Barkley, 2003; Hinshaw & Lee, 2003). Research has also
indicated a link between the genetic contributions of these two disorders (Barkley, 2003;
Hinshaw & Lee, 2003).
Many commonalities can be found within these two differing disorders. Children
diagnosed with ADHD and ODD are often both prone to academic underachievement (Barkley,
2003; Hinshaw & Lee, 2003). The association between learning challenges and aggressive
behaviour is often associated with the comorbidity of ADHD to ODD (Barkley, 2003; Hinshaw
& Lee, 2003). Barkley (2003) connects ADHD with deficits associated with executive functions.
These deficits affect both academic skill development as well as behavioural regulation (Barkley,
2003). It is also felt that over time, children who experience negative associations with
schooling are more likely to lose motivation towards studies, be drawn towards negative peer
influences thus increasing patterns of negative, externalizing behaviour (Barkley, 2003).
However, the challenge remains in identifying whether it is learning challenges that lead to
increased behaviour problems, or behaviour problems and challenging relationships with

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teachers that lead to learning needs (Barkley, 2003; Hinshaw & Lee, 2003). These challenges
tend to present fairly early on, even during the preschool years (Barkley, 2003; Hinshaw & Lee,
2003). Some researchers feel that other factors such as language deficits, socioeconomic
disadvantage or family variables may also lead to the comorbidity and similarities found between
the pattern of academic underachievement found in children diagnosed with ADHD and ODD
(Barkley, 2003; Hinshaw & Lee, 2003).
There is a great deal of similarity between the risk factors associated with both disorders.
One factor that has received a significant amount of attention and research is the possibility of
genetic influence (Barkley, 2003; Hinshaw & Lee, 2003). ADHD has a strong level of genetic
heritability as indicated through research drawn from twin studies, family studies and molecular
genetic studies (Barkley, 2003). It is believed that if a parent has ADHD, their child is 57%
likely to have the same diagnosis (Barkley, 2003). ODD does not show this same link with
genetics. However, having a diagnosis of ADHD comorbid with ODD has been noted to have a
genetic component (Barkley, 2003; Hinshaw & Lee, 2003). It is important to consider these
findings with caution, as it is impossible for one to consider the influence of genetics without
also considering the effects of parenting. These familial factors cannot be considered a cause of
ADHD (Barkley, 2003). However, they can lead to increasing the intensity of the condition or
contributing to the persistence of the disorder thereby increasing the likelihood of a comorbid
diagnosis of ODD (Barkley, 2003; Hinshaw & Lee, 2003).
A lot of research has been conducted exploring the relationship between family interactions
and parent child relations related to ADHD and ODD (Barkley, 2003; Hinshaw & Lee, 2003). A
child raised in a hostile and confrontational environment with lack of structure and poor
disciplinary practices has an increased risk of being diagnosed with ODD (Hinshaw & Lee,

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2003). Often times ineffective parenting practices are associated with both ADHD and ODD
(Barkley, 2003; Hinshaw & Lee, 2003). Research states that a disharmonious relationship
between a parent and child can increase risk factors associated with both ADHD and ODD
(Barkley, 2003; Hinshaw & Lee, 2003). However, it is difficult to determine whether negative
parenting styles are a reaction to challenging and aggressive behaviours exhibited by children
with these diagnoses (Barkley, 2003; Hinshaw & Lee, 2003).
Children with ADHD are noted to be more talkative, defiant, less cooperative, more
demanding and less able to play independently and as a result are generally hard to parent
(Barkley, 2003). Likewise, research indicates that mothers of children with ADHD are less
responsive to their childs questions, more negative and less rewarding towards their child
(Barkley, 2003). It is not overly surprising then that children and adolescents diagnosed with
both ADHD and ODD have the highest interaction conflicts with their parents (Barkley, 2003;
Hinshaw & Lee, 2003). The comorbid diagnosis of both ADHD and ODD is also associated
with parental psychopathology, marital discord and divorce more frequently than a child
diagnosed with only ADHD (Barkley, 2003; Hinshaw & Lee, 2003).
These adversarial relationships for children diagnosed with both ADHD and ODD also
extend to teachers and peers. It is said that children with ADHD are corrected, punished and
criticized more than their peers, particularly when they have a comorbid diagnosis with ODD
(Barkley, 2003). Children with both of these diagnoses also appear to be less accepted by their
peers (Hinshaw & Lee, 2003). Research states that up to 70% of children with both ADHD and
ODD have no reciprocated friendships by the time they are in grade four (Hinshaw & Lee,
2003). It is felt that the lack of peer relationships and friendships is not necessarily strictly
caused by impulsive behaviours, but also from lack of social skills, physical behaviours and

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greater emotions (Hinshaw & Lee, 2003). Children with a diagnosis of ODD tend to gravitate
towards risky, trouble and sensation seeking activities, which leads to further marginalization
from their peers (Hinshaw & Lee, 2003). Finally, children that have a comorbid diagnosis of
ADHD and ODD are more likely to misinterpret emotions of peers and adults as anger and are
also more likely to respond with anger and aggression (Barkley, 2003; Hinshaw & Lee, 2003).
It is important to note that age of onset has also been tied to the comorbidity of ADHD and
ODD (Barkley, 2003; Hinshaw & Lee, 2003). Children with executive functioning and verbal
reasoning deficits affect interactions at an early age between parents and care-takers often
leading to lack of consistent parenting and negative associations with schooling (Barkley, 2003;
Hinshaw & Lee, 2003). It is indicated that this leads to the intensification of antisocial
behaviours (Hinshaw & Lee, 2003). Peer rejection mentioned in the previous paragraph is also
strongly associated with the early onset of aggressive behaviour and ADHD symptomology,
particularly when combined (Barkley, 2003; Hinshaw & Lee, 2003). Considering oppositional
and defiant behaviours can be fairly common with preschoolers, it would likely take an
extremely high level of intensity, frequency and duration to lead to a formal diagnosis (Hinshaw
& Lee, 2003).
It is important to note that not all children diagnosed with ADHD will end up with ODD
(Barkley, 2003; Hinshaw & Lee, 2003). When a child diagnosed with ADHD is not treated, it
can lead to increasing feelings of frustration. When children are frustrated, they tend to act out in
anger, particularly when there are any associated challenges with expressive language abilities
(Barkley, 2003; Hinshaw & Lee, 2003). It is interesting to consider the possibility that some
children with ADHD who later receive a diagnosis of ODD are in fact acting out to defend
themselves from ongoing feelings of embarrassment and low self-esteem instead of meeting the

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criteria for another separate disorder (Barkley, 2003; Hinshaw & Lee, 2003). As a result, there
are some researchers who believe that ODD should be considered a symptom of ADHD
(Barkley, 2003; Hinshaw & Lee, 2003).
Another important difference that distinguishes ADHD from ODD is the effects of
treatment and intervention strategies (Barkley, 2003; Hinshaw & Lee, 2003). When a child has a
diagnosis of ODD, psychiatrists often indicate the importance of the involvement of parents
through programs to aid with parenting strategies (Hinshaw & Lee, 2003). However, children
diagnosed with ADHD tend to respond very well to pharmacological treatments (Barkley, 2003;
Hinshaw & Lee, 2003). Children with ADHD are believed to have challenges with sustained
attention and inhibition that is corrected by stimulant medication (Barkley, 2003). Conversely,
stimulant medication is only prescribed to children with ODD to treat the comorbid symptoms
associated with ADHD (Hinshaw & Lee, 2003).
What determines whether a childs behaviour is the result of ADHD or ODD? The answer
lies in the reasons for the behaviour. A child with ADHD has behaviour resulting from deficits
with inhibition and the executive functions of working memory, self-regulation, internalization
of speech and reconstitution (Barkley, 2003; Hinshaw & Lee, 2003). These challenges are
associated with brain areas and structures throughout the brain, but also commonly referred to
being connected to the prefrontal cortex (Barkley, 2003). These children not only have a hard
time determining the consequences of their behaviour, they also have problems knowing if their
behaviour is appropriate for particular environments (Barkley, 2003). In contrast, it is believed
that a child with ODD understands the consequences of their actions; they simply have no
intention to comply with adult requests (Hinshaw & Lee, 2003). Although there has been
extensive research into the neurophysiology of ADHD, limited research has been done on the

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interactions between the neurophysiology and environmental circumstances with ODD (Barkley,
2003; Hinshaw & Lee, 2003). There has been some research leading to a possible link with early
neurophysiological and biological factors (Hinshaw & Lee, 2003). However, their affect appears
to be minimal and researchers believe could be more strongly related to the interaction with
environmental factors (Hinshaw & Lee, 2003). As such, Hinshaw and Lee (2003) note the
crucial need for further study in this area.
The question that I attempted to answer with this paper was whether or not the young boy
that I am currently supporting would benefit from a referral for a possible additional diagnosis of
ODD to his current diagnosis of ADHD. Although there are clear diagnostic criteria in the DSMIV manual identifying the diagnostic criteria for these disorders, due to the significant overlap in
behavioural manifestations, it is not always easy to rely purely on this method of diagnosis to
determine a referral (Barkley, 2003; Hinshaw & Lee, 2003). Based on the research and chapters
in the Mash and Barkley (2003) text, I have identified the following behavioural changes to help
me determine my course of action. Research indicates that children with a diagnosis of ADHD
are more responsive to consequences (Barkley, 2003). This boy responded very well to methods
of behaviour modification prior to the heightened level of his behaviour evident in the past year
and a half. He no longer responds to redirection or positive rewards or praise and conversely
reacts with complete lack of compliance and cooperation. In fact, it appears that efforts to praise
him only increase his acts of defiance. Research also indicates that family environment can have
a significant influence on a childs behaviour (Hinshaw & Lee, 2003). This may be a further
influence that may be contributing to this boys current challenges. His younger brother was
recently diagnosed with autism and I feel that the family is having a very difficult time in their
home environment. Furthermore, his mother has shared with me that the second she gets home,

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she heads out the door to the gym. There are enough distinguishing factors indicating that this
childs current needs have increased. However, does it warrant a referral? After completing the
extensive research for this assignment, I still feel that this young boy meets a great deal of the
criteria for a potential oppositional defiance disorder diagnosis. However, I also think that it is
best to monitor his needs as there may be some significant environmental factors influencing his
behaviour. The main intervention that is proposed for children with ODD is improving parentchild relations. As I know this is an area of need, this is where I will focus my efforts in the new
year. I now feel that I have the necessary information to better support the needs of the boy, his
family and the school.

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References

Barkley, R. A. (2003). Attention-Deficit/Hyperactivity Disorder. In Barkley, R. A. & Mash, E. J.

Editor (Eds.)., Child psychopathology, 2nd edition (pp. 75-144). New York: Guilford
Press.
Grofer Klinger, L., Dawson, G., & Renner, P. (2003). Autistic Disorder. In Barkley, R. A. &
Mash, E. J. Editor (Eds.)., Child psychopathology, 2nd edition (pp. 409-455). New York:
Guilford Press.
Hinshaw, S. P., & Lee, S. S. (2003). Conduct and Oppositional Defiant Disorders. In Barkley, R.
A. & Mash, E. J. Editor (Eds.)., Child psychopathology, 2nd edition (pp. 144- 199). New
York: Guilford Press.