by Sandra Smith, Ph.D.
In a previous article, eating disorders were explored in an effort to provide the informed parent with additional information about a group of disorders which are often apparent by late adolescence. This issue will address the questions which are most frequently asked by parents whose children demonstrate behavioral patterns which they describe as consistently negativistic, oppositional and defiant — Oppositional Defiant Disorder, or "ODD". This disorder is often apparent, at least in retrospect, by a much earlier age than in adolescence, however, without appropriate and preferably early intervention.
ODD: WHAT IS IT, EXACTLY???
ODD is a persistent pattern of negativistic, hostile, defiant and blatantly disobedient behavior in a child or adolescent. This pattern must have been present for at least six months for the diagnosis to be made. In addition, there must have been no serious violations of the rights of others.
That is the formal definition of ODD. Here is what a fictional parent's account of their child's ODD behavior would sound like:
"We just don't understand Sean. His teachers and his friends' parents tell us that he is a perfectly 'normal' eight-year-old with good manners and a pleasing personality! At home, it is another story. He flat-out refuses to do his chores, and he doesn't seem to care about losing privileges as a result. He swears at his younger brother and sister, and even at his father and me! If he is placed in his room as a consequence of his behaviors, he'll climb out the window! He talks back constantly. It is just a daily struggle with Sean. We are worn out."
WHAT ARE THE SYMPTOMS? HOW WOULD I KNOW IF MY CHILD HAD IT????
The following behaviors represent the symptoms of ODD. Remember, these behaviors must occur more often than that which is normal for your child's age group. Virtually all teens, for example, become more argumentative and defiant as they prepare themselves for independence from their parents. Often, this is more than the parent of the teen bargained for, or anticipated! Nonetheless, it is part of the process, and eventually the parent sees the signs as "normal" and realizes that they will pass. In ODD, on the other hand, this is a persistent pattern — a "way of life". This teen's negativity and argumentative attitude interferes with his own life, as well as the lives of those around him. (Note, that while I will often use the male gender in text, this is for ease of reading only. ODD also occurs in girls.)
Given all of those rejoinders, here are the behaviors that typify the child or teen with ODD:
1. Arguing with adults; defying adults or refusing their rules or requests.
2. Losing one's temper.
3. Blaming others for their own mistakes or transgressions.
4. Deliberately annoying others.
5. Being easily annoyed or "touchy".
6. Swearing or using obscene language.
7. Being angry and resentful — or even spiteful and vindictive.
8. Having a low opinion of the self.
Finally , the child or teen with ODD generally presents as easily frustrated and moody. They impress others as controlling, rigid and demanding. There is always a strong resentment toward authority which the child or teen is generally unwilling to discuss. Sometimes this is only apparent toward parents; sometimes it extends to other adults. The resentment is usually focused around the child's perception about the adult's expectations for his or her performance.
WHAT IS THE CAUSE? HOW DID IT HAPPEN?
The cause of ODD is not known. This is a relatively "new" disorder, and estimates of prevalence range from 6% to 22% of all school age children. ODD is often difficult to identify because it tends to overlap with other disorders, including mood disorders, learning disabilities and Attention Deficit Disorder. In cases of such overlap the ODD behaviors are often more amenable to change as the other syndromes are effectively treated, often with medication. There is no medication for ODD. Most parents seek help when their ODD children are five or six years old, when they observe that they are NOT becoming more social and cooperative as anticipated by this age.
One prominent theory being investigated suggests that ODD may be a product of the child's inherent temperament and the family's response to their child's style. Others suggest that a predisposition to ODD may be inherited. Still others suggest a neurological cause, and/or chemical imbalance in the brain.
Finally, don't forget that what looks like ODD may in fact be a situational reaction to stress. James Sutton, Ed.D., IF MY KID'S SO NICE...WHY'S HE DRIVING ME CRAZY?, tells the story of a teenage girl brought to his office for oppositional and defiant behaviors which had escalated to the point that she had been placed in an alternative school, and cited for possessing alcohol. When Dr. Sutton asked her what had occurred during the preceding six or so months of her life, she broke down and described her grief at the loss of her beloved grandmother. What looked like ODD was in fact a pronounced grief reaction — and of course she was treated differently than the treatment which would be prescribed for an ODD teen.
WHAT IS THE TREATMENT FOR ODD?
A good treatment plan for ODD generally includes group, individual and family therapy, and education. Most ODD children require a very consistent daily schedule, limit-setting, consistent rules and consequences for unacceptable behaviors, healthy role models, social skills training (ie. how to get along with others) and behavior modification techniques to cement these ways of behaving in the world.
WHAT DOES MY CHILD NEED TO DO?
Ultimately, your child or teen must assume responsibility for his or her disorder, and learn to self monitor. Your child or teen will need to:
1. Attend scheduled therapy sessions.
2. Learn to use self-monitored time-outs when his or her behavior spirals out of control.
3. Learn to identify what increases anxiety, and to talk about feelings instead of acting them out.
4. Learn to set short and long-term goals for oneself.
5. Find activities, including physical activities, that provide tension relief, and build self-esteem.
6. Learn how to talk with others without antagonizing them.
7. Develop a daily schedule of activities.
8. Learn how to limit uncomfortable levels of stimulation, and how to calm oneself when necessary.
9. LEARN HOW TO ADMIT ONE'S FAULT IN A MATTER-OF-FACT MANNER
WHAT CAN INFORMED PARENTS DO TO HELP THEIR ODD CHILD OR TEEN?
First of all, STOP thinking about ODD as willful misbehavior and think about it, instead, as what it is — a disorder. ODD children and teens continue to demonstrate oppositionalism even when it is clearly not in their best interest. They lack flexibility, and their frustration tolerance is extremely limited. Parents must assume that they would be doing better if they could. This will allow for the patience your child needs to provide him with the structure, consistency and support he requires.
Consider consulting a psychologist or psychotherapist — first, to determine if your child really does have ODD, and to begin implementing some effective coping strategies. By the time most parents enter a professional's office they have tried and failed to manage their child's behavior, e.g., by loss of privileges, time-outs, etc. Most often, these parents tell the professionals they consult that their teen or child hasn't even made a connection between their behaviors and consequences. These children have lengthy rationalizations for their behaviors, which often center about the blaming of others.
The following are some strategies which may be helpful and which can be solidified in time limited family therapy sessions:
1. Don't personalize your child's behavior. This can be tough when your child is literally screaming and swearing at you. It is far more effective, though, if you can take ten giant steps backward, and use your left analytical brain to make reasoned choices about your next course of action. Dr. Sutton has a good suggestion: pretend that you are a child care worker and this is not your child.
2. Limit parental controls: the more commands you issue, the more probability your child will get "stuck". Instead, choose your battles carefully. Ross Greene, Ph.D. (see reading list) recommends a highly effective "Basket Approach". Parents divide things they want their children to do into three categories: Basket A holds mandatory rules, generally about safety. E.g., you must wear your seat belt in the car; you cannot strike or otherwise physically abuse members of the family, etc. Basket B holds issues you are willing to negotiate with your child, when he is ready and willing to do so. E.g., bedtimes, privileges for good behavior etc. Basket C includes those issues that just are not worth bothering about until your child is better able to manage frustration. Different families put different issues in different baskets. In some families, for instance, swearing is a Basket B or C issue; in still other, it may be a Basket A issue.
3. Don't fight with your child! Remember, he is a pro at turning everything into a power struggle. In a typical encounter with an ODD kid, the parent may state a simple rule, e.g., "No T.V. until the dishes are done." Before long, World War III is well under way, and the parent and child are battling about every facet of the child's life — bedtime, homework, swearing, picking on siblings, etc. You can avoid this, with great patience and restraint, by remembering the following rules for yourself: a) stay calm, repeat the rule and don't discuss other areas; and b) defer comments about your child's behavior until later, when he is not mad and thus more capable of hearing you . E.g., "Earlier, when you called me a so-and-so, it really bothered me. It is not acceptable behavior. What could you do differently next time?"
4. Establish and enforce simple, appropriate consequences. Consequences have to be FAIR, and preferably, understood in advance of any rule violations. E.g., "You know that the consequence for lying is a grounded weekend, so you will be staying in." This helps the parent to avoid fighting with their child or teen, and also discourages them from imposing inappropriate consequences when their teen responds to their comment about grounding by making the most terrible face imaginable, and responding, "Yeah, so what?"
5. Sidestep unimportant conflicts — use the "back door". Avoid direct commands when you can. ODD kids respond quickly and unhappily to these. In younger children the "back door" might mean that you tell your child, "We'll be reading the bedtime story just as soon as you have your p.j.'s on," versus, "Put your pajamas on right now." In an older child or teen it might mean putting all of your parental demands in writing, versus having face-to-face discussions.
6. Teach social skills. These might include simple techniques like deep breathing, visualization and counting when a child feels overwhelmingly angry. If the child's parents feel unsuited to teach these skills, they can be included in group or family psychotherapy sessions, or in a social skills group.
7. Give CHOICES. ODD kids love to be in charge, so allow them a sense of responsibility at an early age. Parents need to be flexible to implement a system of genuine choices in their home. It might include allowing your child to make decisions about what he packs for lunch. Instead of arguing with him about it, you note that perhaps he might want to consider some protein in his lunch bag when he comes home fatigued and starving.
8. PRAISE HIM. Create opportunities to reinforce positive behaviors. Do not expect an appreciative response. It is better to thank the child for helping with the dishes and then move on to another subject. Whether he replies to a compliment or not, he has probably experienced the positive feelings most people associate with cooperation, even if for only an instance.
9. Use the power of AFFIRMATION. Dr. Sutton recommends that you "honor the child with your presence." Snuggle up to him at an unanticipated time, and when he asks you what you are doing, tell him, "I just wanted to be around you." Or, at another unexpected moment, tell him that he is the best thing that ever happened to you.
10. Take care of yourself! Find and practice your own stress busters. This might include exercise, regularly scheduled lunches with a friend, walks on the beach, a funny movie in the middle of the week, etc. If you have a spouse, treat him or her as your ally, not your enemy. When you go out with your spouse, talk about anything but your ODD kid.
SUMMARY:
ODD is a childhood and adolescent disorder which is often experienced as highly frustrating by parents. If you suspect that your child may have ODD, you should consult with a professional. You might start with your pediatrician. Treatment is available, and many ODD behaviors can be resolved or at least minimized by parents who work in conjunction with the child's caretakers, teachers and therapists.
In addition to the help available by professionals, there is a growing body or research and parent help books available on ODD. The following is not intended to be an exhaustive list, but may guide parents in locating reading materials they find useful.
Greene, Ross, Ph.D.: THE EXPLOSIVE CHILD, Harper Collins
Riley, Douglas, Ph.D.: THE DEFIANT CHILD, Taylor Publications
Sutton, James D., Ed.D.: IF MY KID'S SO NICE...WHY'S HE DRIVING ME CRAZY?, Friendly Oaks Publications.
Wenning, Kenneth, Ph.D.: WINNING COOPERATION FROM YOUR CHILD, Jason Aronson