An 8 year old boy was diagnosed with ADHD Combined Type. His mother, a licensed MFT, referred him for the evaluation. He was never referred by teachers or day care providers. They describe him as an active child, minimally disruptive, but not violent. His grades are above average. His parents are divorced with shared custody, every other week. At his mother's house, he is defiant and has violent meltdowns. His mother fears for her safety and the safety of his sister. At the father's home, he does not exhibit these extreme behaviors. There are rules and consequences for not following the rules. The mother accused the father of child abuse because he has spanked him (as a last resort). Charges were investigated and unfounded. The mother wants the boy on medication so she can handle him at her house. The father does not want to medicate him for behavior that occurs only at the mother's house. Again, he is not violent at his father's or at school.
Re: Why does he show this oppositional behavior only toward his mother?
I would say the answer is fairly clear. You’ve heard of children misbehaving at home around mother while father is at work, but when the father returns home – things change. (Remember what your mother may have said to you as a child: “Wait until your father gets home!”) This is because the child respects the father and fears repercussions for misbehavior. In this scenario, the father usually follows through with consequences, whereas the mother tends to nag (bark with no bite).
The recommendation would be for both parents to develop a united front (very crucial for raising ODD/ADHD children).
Re: Is medication appropriate?
Not for the behavioral issue. If the child in question is having great difficulty paying attention in school, then perhaps medication for ADHD would be appropriate. As a general rule, medication should only be considered if (a) medically treatable CO-morbid conditions are present (e.g., ADHD, depression, tic disorders, seizure disorders, psychosis), (b) non-medical interventions are not successful, or (c) when the symptoms are very severe.