What should I do if I think my child has Oppositional Defiant Disorder?

Mothers and fathers who are concerned that their youngster may have Oppositional Defiant Disorder should seek a professional evaluation. This is important as a first step in breaking the cycle of ineffective parenting of the "problem child.” During the evaluation process, the parent may come to appreciate the interactive aspect of this disorder and look for ways to improve his/her management of the youngster. Books and parenting workshops given under the auspices of churches, schools, and community agencies may also help moms and dads respond better to the needs of their kids.

Once Oppositional Defiant Disorder has been diagnosed, the psychiatrist or other professional may recommend a combination of therapies. Among the options your clinician may recommend are following:

1. Cognitive Behavioral Therapy: Behavioral therapy can help kids control their aggression and modulate their social behavior. Kids are rewarded and encouraged for proper behaviors. Cognitive therapy can teach kids with Oppositional Defiant Disorder self control, self guidance, and more thoughtful and efficient problem solving strategies.

2. Family Therapy: Problems with family interactions are addressed in family therapy. Family structure, strategies for handling difficulties, and the ways moms and dads inadvertently reward noncompliance are explored and modified through this therapy. This approach can also address the family stress normally generated by living with Oppositional Defiant Disorder. Sometimes in the course of treatment, a mother or father is also found to have a psychiatric disorder. Treatment of that parent may be helpful since the adult's behavior can affect how the youngster responds to treatment.

3. Individual Psychotherapy: The therapeutic relationship is the foundation of a successful therapy. It can provide the difficult youngster with a forum to explore his feelings and behaviors. The therapist may be able to help the youngster with more effective anger management, thus decreasing the defiant behavior. The therapist may employ techniques of cognitive behavioral therapy to assist the youngster with problem solving skills and in identifying solutions to interactions that seem impossible to the youngster. The support gained through therapy can be invaluable in counterbalancing the frequent messages of failure to which the youngster with Oppositional Defiant Disorder is often exposed.

4. Medication: Medication is only recommended when the symptoms of Oppositional Defiant Disorder occur with other conditions (e.g., ADHD, OCD, anxiety disorder). When stimulants are used to treat ADHD, they also appear to lessen defiant symptoms in the youngster. There is no medication specifically for treating symptoms of Oppositional Defiant Disorder where there is no other emotional disorder.

5. Parent Training Programs: Some moms and dads are helped through formal parent training programs. In these sessions, the parent learns strategies for managing his/her kid's behavior. These are practical approaches to dealing with a youngster with Oppositional Defiant Disorder. The emphasis is on observing the youngster and communicating clearly. Parents are taught negotiating skills, techniques of positive reinforcement, and other means of managing the behavior of the youngster with Oppositional Defiant Disorder.

6. Social Skills Training: When coupled with other therapies, social skills training has been effective in helping kids smooth out their difficult social behaviors that result from their angry, defiant approach to rules. Social skills training incorporates reinforcement strategies and rewards for appropriate behavior to help a youngster learn to generalize positive behavior, that is, apply one set of social rules to other situations. Thus, following the rules of a game may be generalized to rules of the classroom; working together on a team may generalize to working with adults rather than against them. Through such training, kids can learn to evaluate social situations and adjust their behavior accordingly. The most successful therapies are those that provide training in the youngster's natural environments - such as the classroom or in social groups as this may help them apply the lessons learned directly to their lives.

Does bad parenting cause Oppositional Defiant Disorder?

Re: Does bad parenting cause Oppositional Defiant Disorder?

I don’t think there is a causal relationship (i.e., one causes the other) between bad parenting and Oppositional Defiant Disorder – but there certainly is a correlation (i.e., one contributes to the other) between lack of appropriate parenting skills (i.e., skills needed specifically for raising an oppositional child) and this disorder.

Oppositional Defiant Disorder does seem to arise out of a circular family dynamic. The infant, who is by nature more difficult, fussy and colicky, may be harder to soothe. The mom or dad may feel frustrated and unsuccessful at parenting such a child. If parents perceive their youngster as unresponsive or "bad," they may begin to anticipate that the youngster will be unresponsive or noncompliant. They may then become unresponsive or unreliable in return, adding to the youngster's feelings of helplessness, neediness, and frustration.

As moms and dads attempt to assert control by insisting on compliance in such areas as eating, toilet training, sleeping, or speaking politely, the youngster may demonstrate resistance by withholding or withdrawing. As a youngster matures, increasing negativism, defiance, and noncompliance become misguided ways of dealing with grown-ups. In this way the disorder may be a tenacious drawing out of the "terrible twos."

The more a youngster reacts in defiant, provocative ways, the more negative feedback is elicited from the mother or father. In an attempt to achieve compliance, the parent and other authority figures remind, lecture, berate, physically punish, and nag the youngster. But far from diminishing defiant behavior, these kinds of responses toward the youngster tend to increase the rate and intensity of non-compliance. Ultimately, it becomes a tug of war and a battle of wills.

When such patterns typify parent-child relationships, discipline is often inconsistent. At times, moms and dads may explode in anger as they attempt to control and discipline their youngster. At other times, they may withhold appropriate consequences which soon become hollow threats. As the youngster continues to provoke and defy, parents lose control. Then, feeling regret and guilt (especially if they’ve become verbally or physically explosive), the parent may become excessively rewarding and gratifying in order to undo what they now perceive to have been excessive discipline or punitive consequences.

When a youngster starts school, this pattern of defiant behavior tends to provoke educators and peers as well. At school, the youngster is met with anger, punitive reactions and criticism. The youngster then argues back, blames others and gets angry.

These kids tend to have difficult adapting at school. Their behavior can cause disruption in the classroom and interfere with social and academic functioning. When their behavior and defiance affects their schoolwork and performance, kids often experience school failure and social isolation. This, coupled with chronic criticism, often leads to low self-esteem. Usually, Oppositional Defiant Disorder kids feel unfairly picked on. In fact, they may believe that their behavior is reasonable and the treatment and criticism they receive unfair.

Oppositional Defiant Disorder coexists with ADHD in many cases. In fact, the impulsivity and hyperactivity of ADHD can greatly amplify the non-compliance and uncontrolled anger of Oppositional Defiant Disorder. Symptoms of Oppositional Defiant Disorder may also occur as part of major depressive disorder, obsessive compulsive disorder, or mania. Some kids with separation anxiety disorder may also have defiant behaviors. Clingy attachment merges into or possibly reflects oppositional behavior. There also seems to be a correlation between Oppositional Defiant Disorder in a youngster and a history of disruptive disorders, substance abuse, or other emotional disorders in the parents(s).

Help for Parents with Oppositional Defiant Children and Teens

What should be done about a child who abuses animals?

Question

My 11 yr old granddaughter that has lived with me since she was 2 has been hurting my animals. I show dogs and this is a business so it isn't as simple as re-homing a pet. A year ago she dislocated a dog’s ankle requiring 2 surgeries to repair when in anger she stomped on its foot. I made her tell the vet who talked to her, as did I about the inappropriateness of her actions. I found she's still hitting them but not as severely this past week and took her to the police station. They explained to her this is a felony and she could go to jail for 5 yrs and gave me a few options available in our county including institutionalizing her or some juvenile jail time or a program for troubled youth where she would live at home. We did a lot of therapy years ago, but it didn't seem to improve anything and now it's a mess and I am overwhelmed and don't even know where to begin. I really think each time she does something like this and she's talked to and reasoned with she'll quit but of course she doesn't. This makes me feel completely inappropriate to be raising her and at a loss as to what to do next. It's just her and I. She hasn't even seen her mother since she was dropped off 9 yrs ago. My understanding is that her mother, who is a severe and active alcoholic, was diagnosed as bipolar at 7 yrs and has a history much like this. Please ...Where do I go from here?


Answer

Re: Where do I go from here?

Straight to a therapist! Also, hold her accountable for future animal abuse by calling police and enlisting the help of juvenile probation.

Recognize the severity of the situation. If you think torturing a dog is where it's going to stop, you're wrong. A youngster harming a pet is a precursor to some very serious violent behavior. Research in psychology and criminology shows that people who commit acts of cruelty against animals don't stop there – many of them move on to hurting people. Kids who harm pets are at risk for other kinds of acting-out behavior and need immediate help. What also goes along with torturing animals is setting fires. If you smell smoke, you'd better take it seriously.

More statistics on animal abuse:
  • Animal abuse is not just the result of a minor personality flaw in the abuser, but a symptom of a deep mental disturbance.
  • Kids who abuse animals most likely are repeating a lesson learned at home from their parents or guardians. They are reacting to anger or frustration with violence.
  • Domestic abuse is directed toward the powerless; animal abuse and child abuse often goes hand and hand.
  • Studies show that acts of cruelty toward animals are the first signs of violent pathology that includes human victims.
  • Studies show that violent and aggressive criminals are more likely to have abused animals as kids.
  • The kid’s violence is directed at the only individual in the family more vulnerable than themselves – an animal.
  • The FBI has found that a history of cruelty to animals is one of the traits that regularly appear in its computer records of serial rapists and murderers.

The media has reported on serial killers’ initial practice with pets. Here is a short list of famous killers and their disturbing and sordid beginning:
  • Albert DeSalvo (Boston Strangler) shot arrows into boxes of trapped cats and dogs.
  • Carroll Edmund Cole claimed his first violent act was strangling a puppy …later he murdered 35 people.
  • David Berkowitz (Son of Sam) shot his neighbor’s Labrador retriever.
  • Jeffrey Dahmer is reported to have impaled and killed neighbor’s pets.
  • Keith Hunter Jesperson (Happy Face Killer) began his life of violence by throwing a cat against the pavement and then strangling it to death.
  • Patrick Sherril stole pets, tied them up and allowed his own dogs to mutilate them – later murdered 14 co-workers before killing himself.

Why do some children and teens abuse animals? Here are just a few reasons:
  • animal phobias
  • attachment to animal (child kills to prevent torture by another)
  • curiosity of exploration (usually by a young or developmentally delayed child)
  • forced abuse (coerced into animal abuse by someone more powerful)
  • identification with child’s abuser (victimized child trying to regain control)
  • imitation (copying parent’s discipline)
  • mood enhancement (relieves boredom)
  • peer pressure (peers encourage as part of initiation)
  • post-traumatic play
  • rehearsal for interpersonal violence (practicing on pets before engaging in human violence)
  • self-injury (using animal to inflict pain on his own body)
  • sexual gratification
  • vehicle for emotional abuse (to frighten sibling, etc.)

Types of animal abusers:

1. The Experimenter (ages 1-6 or developmentally delayed): This is usually a preschool youngster who has not developed the cognitive maturity to understand that animals have feelings are not to be treated as toys. This may be the youngster's first pet or he doesn't have a lot of experience or training on how to take care of a variety of animals.

What to do: To some extent, of course, this depends on the age and development of the youngster. In general, though, explain to the youngster that it is not okay to hit or mistreat an animal, just as it's not okay to hit or mistreat another youngster. Humane education interventions (teaching kids to be kind, caring, and nurturing toward animals) by parents and teachers are likely to be sufficient to encourage desistence of animal abuse in these kids,

2. The "Cry-for-Help" Abuser (ages 6 - 12): This is a youngster who intellectually understands that it is not okay to hurt pets. This behavior is not due to a lack of education, instead the animal abuse is more likely to be a symptom of a deeper psychological problem. A number of studies have linked childhood animal abuse to domestic violence in the home as well as childhood physical or sexual abuse.

What to do: Seek professional assistance. While most parents have the ability to weather many of the normal ups-and-downs of child-rearing without professional assistance, this is an exception. It is not "normal" for a youngster this age to intentionally mistreat an animal.

3. The Conduct-Disorder Abuser (ages 12 - 18): Teenagers who abuse animals almost always engage in other antisocial behaviors (e.g., substance abuse, gang activities). Sometimes the animal abuse is in conjunction with a deviant peer group (an initiation rite or as a result of peer pressure), while other times it may be used as a way to alleviate boredom or achieve a sense of control.

What to do: Get professional help immediately. Also, enlist the help and support of friends, family members, teachers, law officials, etc.

Having said all this, it is very likely that your granddaughter was emotionally abused as a young child, and now you are dealing with the aftermath.

Information on children who were abused:

The specific problems that you may see will vary depending upon the nature, intensity, duration, and timing of the neglect or abuse. Some kids will have profound and obvious problems, while some will have very subtle problems that you may not realize are related to early-life neglect. Sometimes these kids do not appear to have been affected by their experiences. There are some clues that experienced therapists consider when working with such kids:

• Aggression: One of the major problems with these kids is aggression and cruelty. This is related to two primary problems in neglected kids: (1) lack of empathy and (2) poor impulse control. The ability to emotionally "understand" the impact of behavior on others is impaired in these kids. They really do not understand or feel what it is like for others when they do or say something hurtful. Indeed, these kids often feel compelled to lash out and hurt others — most typically something less powerful than they are. They will hurt animals, smaller kids, peers and siblings. One of the most disturbing elements of this aggression is that it is often accompanied by a detached, cold lack of empathy. They may show regret (an intellectual response) but not remorse (an emotional response) when confronted about their aggressive or cruel behaviors.

• Developmental delays: Kids experiencing emotional neglect in early childhood often have developmental delay in other domains. The bond between the young kid and her caregivers provides the major vehicle for developing physically, emotionally, and cognitively. It is in this primary context that kids learn language, social behaviors, and a host of other key behaviors required for healthy development. Lack of consistent and enriched experiences in early childhood can result in delays in motor, language, social, and cognitive development.

• Eating: Odd eating behaviors are common, especially in kids with severe neglect and attachment problems. They will hoard food, hide food in their rooms, or eat as if there will be no more meals even if they have had years of consistent available foods. They may have failure to thrive, rumination (throwing up food), swallowing problems and, later in life, odd eating behaviors that are often misdiagnosed as anorexia nervosa.

• Emotional functioning: A range of emotional problems is common in maltreated kids, including depressive and anxiety symptoms. One common behavior is "indiscriminant" attachment. All kids seek safety. Keeping in mind that attachment is important for survival, kids may seek attachments — any attachments — for their safety. Abused and neglected kids can be "loving" and hug virtual strangers. Kids do not develop a deep emotional bond with relatively unknown people; rather, these "affectionate" behaviors are actually safety-seeking behaviors. Therapists are concerned because these behaviors contribute to the abused youngster's confusion about intimacy, and are not consistent with normal social interactions.

• Inappropriate modeling: Kids model adult behavior — even if it is abusive. Maltreated kids learn that abusive behavior is the "right" way to interact with others. As you can see, this potentially causes problems in their social interactions with grown-ups and other kids. For kids who have been sexually abused, they may become more at-risk for future victimization. Boys who have been sexually abused may become sexual offenders.

• Soothing behavior: These kids will use very primitive, immature and bizarre soothing behaviors. They may bite themselves, head bang, rock, chant, scratch, or cut themselves. These symptoms will increase during times of distress or threat.

Help for Parents with Oppositional Defiant Children and Teens

What are the identifying signs of Oppositional Defiant Disorder?

I think my child may have ODD. How would I know for sure?

Distinguishing Oppositional Defiant Disorder from age appropriate normal defiant behavior isn't easy. Symptoms of the disorder tend to mirror (in exaggerated form) child rearing problems common in all families. In addition, different families have various levels of tolerance for defiant behavior. In some, a minor infraction of the house rules produces major consequences, while in more liberal homes, defiant behaviors are largely ignored until they cause major problems.

In kids with Oppositional Defiant Disorder, there is a pattern of uncooperative, defiant, and hostile behavior toward adults that seriously interferes with the youngster’s day-to-day functioning. Regularly, they lose their temper, argue with adults, actively defy adult rules, refuse adult requests, and deliberately annoy others. The symptoms are seen in multiple settings (e.g., home, school, in the neighborhood, etc.) and are not simply the result of a conflict with a particular mother/father or educator.

Blaming others for their mistakes, these kids often appear touchy, angry, resentful, spiteful, or vindictive. Although overtly aggressive behavior tends to be limited, some kids engage in mild physical aggression. However, their language tends to be aggressive and often obscene.

Children with Oppositional Defiant Disorder were probably fussy, colicky, or difficult to soothe as babies. During the toddler and preschool years, when a certain degree of defiance is considered normal, ordinary points of contention in the family become battlegrounds for intractable power struggles with these kids. These defiant episodes typically center on eating, toilet training, and sleeping. Tantrums are usually extreme in a youngster with Oppositional Defiant Disorder.

Children with Oppositional Defiant Disorder consistently dawdle and procrastinate. They claim to forget or fail to hear and, as a result, are often referred for hearing evaluations, only to be found to have normal hearing. The issue is not obeying what was heard rather than a problem with not hearing.

As the youngster matures, struggles may center on keeping his room picked-up, cleaning-up after himself, taking showers, going to bed on time, not interrupting or talking back, and doing homework. In all cases, winning becomes the most important aspect of the struggle. At times, a youngster with Oppositional Defiant Disorder will forfeit cherished privileges rather than lose the argument.

Milder forms of Oppositional Defiant Disorder are limited to the home environment, while at school the youngster may be more passively resistant and uncooperative. More severe forms involve oppositional behavior toward other adults (e.g., teachers, coaches, etc.).

The defiant youngster typically has little insight and ability to admit to the difficulties. Rather, he tends to blame his troubles on others and on external circumstances. He is always questioning the rules and challenging those he perceives to be unreasonable.

Help for Parents with Oppositional Defiant Children and Teens

How does a therapist diagnose Oppositional Defiant Disorder versus Conduct Disorder?

There is a large overlap between Conduct Disorder and Oppositional Defiant Disorder, with similarities in both disorders that include:
  • anger
  • bullying of peers and siblings
  • defiance
  • disobedience
  • rebellion against authority
  • resentment
  • school problems

In order to differentiate between the two, one of the things a therapist will generally look at is how the adolescent treats animals. Is he or she mean or cruel to the family pets or kind to them?

Another area that is looked at is whether or not there have been legal problems, what those legal problems were, and if they are recurring or one-time events. For example, many adolescents experiment with shoplifting and end up getting caught, but this does not mean they have either a Conduct Disorder or Oppositional Defiant Disorder. However, if they keep shoplifting, or their activities turn to more serious stealing behavior, it is probably safe to assume that there is a more serious behavior problem going on.

In addition, setting fires and stealing (e.g., breaking into cars and stealing stereo) are more serious offenses that would generally tend to indicate a Conduct Disorder rather than Oppositional Defiant Disorder.

To further complicate the process of making a diagnosis, some research is now beginning to show that Conduct Disorder may be a component of childhood Bipolar Disorder, and there is a possibility that the behaviors attributed to Conduct Disorder or Oppositional Defiant Disorder are perhaps motivated by a mood disorder.

Bipolar disorder, formerly known as manic-depressive illness, described in simplest terms is a chemical imbalance in the brain that causes major mood swings, from elation to severe depression, which many times can be helped greatly with the right medication. Adolescents with Bipolar Disorder can experience mood shifts from very elated to very depressed several times in a day, making it nearly impossible for these adolescents to concentrate and get anything done. These mood shifts can cause symptoms that are similar to ADHD, and therefore this is just one more diagnostic dilemma for the therapist.

Other research shows that adolescents with ADHD can also present in a very similar way as those with either Conduct Disorder or Oppositional Defiant Disorder. The possibility that both Conduct Disorder and Oppositional Defiant Disorder may be a component of ADHD or Bipolar Disorder is being researched. Therefore, Bipolar Disorder and ADHD - as well as Conduct Disorder or Oppositional Defiant Disorder - are processes that the therapist must take into consideration when attempting to diagnose an adolescent who is displaying severe behavior problems.

The therapist may resolve the problem of overlapping behaviors and disorders by assigning more than one diagnosis to a youngster (called “dual diagnosis”). And as many moms and dads have discovered, because distinguishing among these disorders can be quite difficult, their youngster may receive one diagnosis from the therapist and a different diagnosis from the psychiatrist. This only adds to the concerns of the moms and dads, leaving them to wonder if anybody at all knows what is really going on!

More than half of adolescents with Conduct Disorder stop exhibiting these behaviors in early adulthood, but about one third of the cases persist, developing into antisocial personality disorder or other mood or anxiety disorders.

Parenting Children and Teens with ADHD, ODD and CD

Is there a connection between ADHD and Conduct Disorder?

Data collected in numerous studies indicates that about 50% of kids with ADHD will also develop Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) at some point during their development.

An interesting finding has been that although "pure" ADHD (i.e., without either Oppositional Defiant Disorder or Conduct Disorder) is quite common in kids, the reverse is less likely. In other words, it appears that most kids under age 12 who meet criteria for Oppositional Defiant Disorder or Conduct Disorder will also be diagnosed with ADHD.

In these cases, it appears that the impulsivity and over activity that is characteristic of ADHD kids, and the ensuing difficulties this creates in parent-child, teacher-child, and peer relationships, increases the risk for the kind of problematic interactions that promote the develop of these other disruptive behavior disorders.

The long term outcomes of kids with pure ADHD - and with ADHD plus Conduct Disorder - are very different. For example, in one study in which samples that followed two samples of ADHD kids (one with high levels of aggressive behavior and the other without) there were no cases of drug or alcohol abuse at age 14 in the ADHD only group, while for the ADHD aggressive group, over 30% had engaged in substance abuse.

In a similar study using different samples of kids, approximately 1/3 of ADHD/Conduct Disorder males had committed multiple crimes as teens compared to fewer than 4% of males who had been diagnosed with ADHD alone.

Parenting Children with ADHD, ODD and CD

What is Conduct Disorder?

Conduct Disorder (CD) is a more severe type of behavioral disorder than Oppositional Defiant Disorder (ODD) and is more likely to develop in kids with ADHD. According to the publication of the American Psychiatric Association that provides current diagnostic criteria for all recognized psychiatric disorders, the essential feature of Conduct Disorder is "...a repetitive and persistent pattern of behavior in which the basic rights of others or age appropriate social norms or rules are violated." These behaviors fall into 4 main groupings:
  1. Serious violation of rules (e.g., truancy from school; running away from home; staying out at night prior to age 13)
  2. Non-aggressive conduct that causes property loss or damage (e.g., fire setting with intent to cause damage; deliberate destruction of property)
  3. Deceitfulness or theft (e.g., shoplifting; breaking into someone's house; frequent lying to obtain goods or avoid obligations)
  4. Aggressive behavior that causes or threatens to cause harm (e.g., initiating fights; cruelty to people or animals)

For the diagnosis of Conduct Disorder to be correctly assigned, at least 3 of the specific symptoms must have occurred during the prior 12 months, with at least one criterion present in the last 6 months. In addition, the disturbance in behavior must clearly result in clinically significantly impairment in the youngster or teenager's social, academic, or occupational functioning. These criteria are intended to assure that the diagnosis is not assigned for an isolated antisocial act, but is instead reserved for children/teens who show a pattern of antisocial behavior over a significant period of time.

In addition to these core diagnostic criteria, children/teens with Conduct Disorder often display a number of associated features as well:
  • guilt and remorse over clear misdeeds are often absent, other than feeling badly about having been caught
  • poor frustration tolerance and irritability are often present
  • self-esteem is often poor even though an image of "toughness" is often presented
  • they are prone to often misinterpret other's intentions towards them as being hostile which can lead them to overreact in a retaliatory, aggressive manner
  • they often have little empathy or concern for the feelings and wishes of others

Conduct Disorder is often also associated with:
  • dropping out of school
  • early onset of sexual behavior
  • excessive risk taking
  • poor academic performance
  • school suspension
  • self-destructive behavior
  • substance use and abuse
  • suicide

It is important to recognize that the symptoms of Conduct Disorder do not really share any overlap with diagnostic criteria for ADHD. These two disorders certainly share many of the "associated features," but the actually symptoms that are used to make the diagnosis for each condition are really quite distinct.

This is why if a youngster with ADHD is also displaying the types of behaviors that may warrant a Conduct Disorder diagnosis, it is important not to attribute the antisocial behavior to just another facet of the youngster's ADHD. The danger in doing this is that the youngster may not receive the necessary and appropriate treatment as a result.

Two different types of Conduct Disorder are currently recognized:

1. The Adolescent-Onset Type. This type is applicable to teens who currently meet the diagnosis for Conduct Disorder but who showed no symptoms of Conduct Disorder prior to age 10. People with adolescent-onset Conduct Disorder are less likely to display aggressive behavior and are more likely to have decent peer relationships. Of utmost importance is that adolescent-onset Conduct Disorder less likely to be associated with serious behavior problems that persist into adulthood.

2. The Childhood-Onset Type is defined by the onset of at least on symptom of Conduct Disorder prior to age 10. Thus, even though a youngster may not meet full diagnostic criteria before age 10, if these criteria are met when the youngster is 12, and at least one symptom was present (e.g. running away) before 10, the Childhood-Onset Type would apply. Almost all kids who meet criteria for childhood-onset Conduct Disorder would have previously been diagnosed with Oppositional Defiant Disorder.

Although Conduct Disorder may occur in kids as young as 5-6, its onset is usually in late childhood or early adolescence. The course of Conduct Disorder is variable: in a majority of people, the disorder remits by adulthood. Nonetheless, a substantial percentage continues to display sufficient antisocial behaviors into adulthood to warrant the diagnosis of antisocial personality disorder as young adults. This is most likely to be true as noted above, for people whose Conduct Disorder begins early in life and is marked by aggressive behavior.

Parenting Children and Teens with ODD and CD

What is the best way to work with oppositional defiant high school students?

The first thing to keep in mind is this 10 letter word: PREVENTION. Once an ODD student has it out for you (i.e., you’re on his/her hit list), then it is nearly impossible to re-establish a positive relationship with that child. It is helpful to understand how ODD children think when trying to come up with prevention methods.

How does a student with ODD think?
  • “Because I know how much you want me to change, I will be very stubborn about changing behaviors.”
  • “I am equal to those in authority.”
  • “In spite of experiencing your intended punishments and/or rewards, if I change, it will be on my time and for me.”
  • “My greatest sense of control comes from how I make others feel.”
  • “No one has the right to tell me what to do.”
  • “When you punish or reward me, I feel that you are trying to control or manipulate me.”
  • “Yes, I sometimes do the wrong thing, but it is usually your fault.”

Now let’s look at the prevention methods that work best with ODD students:

1. Act, don’t discuss. Prompt actions work better than trying to reason with a student that has ODD. It can quickly turn argumentative.

2. Address the student’s basic needs of belonging, competence, independence, and generosity.

3. Avoid disliking the ODD student (he/she will pick up on your ‘dislike’ because ODD kids are very perceptive).

4. Build a good relationship through consistent boundaries and respectful attitudes.

5. Create a distraction. Think of a happy or funny moment and remind the student of it.

6. Create a predictable environment within the classroom and have a safe-haven for the student (some place he/she can go when he/she need space).

7. Do not bring up the past. You can do nothing to change it.

8. Don’t ‘react’. Do ‘act’. If you react, you are giving the student exactly what he/she wants.

9. Educate yourself thoroughly about ODD.

10. Embrace the student’s feelings, “I see that this is really important to you.”

11. Find an area of interest or expertise and ask for the student’s help.

12. Find the time to help the student develop life skills for impulse control, anger-management, decision-making skills, and social-skills.

13. Have clear rules and appropriate consequences in place.

14. Have the ODD student answer the question, “What has anger done for you lately?”

15. Have the student get involved in a service-learning project.

16. Help the student set a goal each day. Also, help him/her monitor success.

17. Help the entire family. Educate family about ODD (if needed) and work together to help the student.

18. Keep a relaxed facial expression when the ODD student “gets to you” (i.e., he/she says or does something that makes you angry). Composure is contagious (i.e., you stay calm – the ODD student will likely stay calm too).

19. Keep a volcano calendar: Use an illustration to help the student keep track of the intensity and frequency of anger situations.

20. Know that an ODD child is, by definition “oppositional.” This means, in a way, that he/she will do the “opposite” of what you ‘want’ or ‘need’. Thus, be careful not to use phrases like, “I need you to pay attention” … “I want you to sit with your head up” … “I would like for you to stop tapping your pencil” …etc. You will likely get the opposite of what you want in these cases.

21. Phrase directions as statements not as questions. If you ask an ODD student to do something he/she probably won’t.

22. Pick your battles carefully. Keep in mind the struggles that students with ODD go through every day and be willing to ignore some of the less serious behavior.

23. Practice emotional neutrality.

24. Send the student on an errand if you anticipate a resistant behavior.

25. Take a time-out to cool down when things get heated (e.g., “I need some time to think about the points you are making”). A short walk down the hallway and back can be very helpful in gaining your composure. If the ODD student perceives that he/she has pushed one of your buttons, he/she will continue to push, push, and push.

26. Take care of your mental health during off-school hours (e.g., plenty of rest, exercise, healthy food, etc.).

27. Time Projection: Have the student try to imagine 1 or 2 months into the future when he/she is having a difficult time.

28. Trust the student enough to use him/her as a peer-helper.

29. Use behaviors that diminish power struggles (e.g., privacy, listening, simple directives and choices, brevity, walking away, saying “I want you to have the last word”).

30. Use the No-Confidence Approach: You may say, “Hmm, I don’t think you’re ready for this yet.” The ODD student will probably try to prove you wrong.

In summary, remember the following:
  • There are things that work – it may just take some time to find out what they are.
  • Small successes are something to be very proud of.
  • Never take the child’s behavior personally.
  • Keep calm and never get emotional around your ODD student.
  • An ODD child has needs just like every other student. 

Parenting Children with Oppositional Defiant Disorder



Help for Parents with Oppositional Defiant Children and Teens

Oppositional Defiant Disorder: What Parents Need To Know

Oppositional Defiant Disorder (ODD) is defined by the Diagnostic and Statistical Manual of Mental Disorders as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that persists for at least 6 months and is not due to a mood or psychotic disorder. To fulfill the diagnosis, the person must have 4 of the following:
  • Often actively defies or refuses to comply with adult requests
  • Often angry or resentful
  • Often argues with adults
  • Often blames others for his or her mistakes or poor behavior
  • Often deliberately annoys others
  • Often loses temper
  • Often spiteful or vindictive
  • Often touchy or easily annoyed

Symptoms are almost always present at home and may or may not be present in the community and at school. 

Treatment & Management—

Children with Oppositional Defiant Disorder need to be assessed for the presence of Attention-Deficit/Hyperactivity Disorder and learning disorders, given the high co-morbidity. If Attention-Deficit/Hyperactivity Disorder is present, guanfacine or stimulants may be very useful in helping the youngster contain his behavior and reversing the vicious cycle the youngster and the mother or and father have gotten into. Parent guidance, as well as therapy for the youngster, is needed. Parent Management Training consists of procedures in which parents are trained to change their own behaviors and thereby alter their youngster's problem behavior in the home.

These patterns develop when mothers and fathers inadvertently reinforce disruptive and deviant behaviors in a youngster by giving those behaviors a significant amount of negative attention. At the same time, parents, who are often exhausted by the struggle to obtain compliance with simple requests, usually fail to provide positive attention. Often, moms and dads have infrequent positive interactions with their kids. The pattern of negative interactions evolves quickly as the result of:
  • ineffective harsh punishments
  • insufficient attention and modeling of appropriate behaviors
  • repeated, ineffective, emotionally expressed commands and comments

Parent Management Training alters the pattern by encouraging the mother or father to pay attention to pro-social behavior and to use effective, brief, non-aversive punishments. Treatment is conducted primarily with parents. The therapist demonstrates specific procedures to modify parental interactions with their youngster. Parents are first trained to simply have periods of positive play interaction with their youngster. They then receive further training to identify the youngster's positive behaviors and to reinforce these behaviors. At that point, mothers and fathers are trained in the use of brief negative consequences for misbehavior. Treatment sessions provide parents with opportunities to practice and refine the techniques.

Follow-up studies of operational Parent Management Training techniques in which mothers and fathers successfully modified their behavior showed continued improvements for years after the treatment was finished. Treatment effects have been stronger with younger kids, especially in those with less severe problems. Recent research suggests that less severe problems, rather than a younger patient age, is predictive of treatment success. Approximately 65% of families show significant clinical benefit from well-designed parent management programs.

Regardless of the youngster's age, intervention early in the developing pattern of oppositional behavior is likely to be more effective than waiting for the youngster to grow out of it. These kids can benefit from group treatment. The process of modeling behaviors and reactions within group settings creates a real-life adaptation process. In younger kids, combined treatment in which mothers and fathers attend a Parent Management Training group while the kids go to a social skills group has consistently resulted in the best outcome. The efficacy of group treatment of teens with oppositional behaviors has been debated. Group therapy for teens with Oppositional Defiant Disorder is most beneficial when it is structured and focused on developing the skills of listening, empathy, and effective problem solving.

Clinical Course—

If a youngster with a difficult temperament or Attention-Deficit/Hyperactivity Disorder grows up in a family with mothers and fathers that respond to the youngster's behavior with harsh, punitive, or inconsistent parenting, there is a high risk of the youngster will develop Oppositional Defiant Disorder. While moms and dads may have been adequate for a youngster with an easy temperament, faced with a youngster with a difficult temperament who often fails to do what he or she is told, perhaps due to Attention-Deficit/Hyperactivity Disorder, parents become angry, punitive, and inconsistent. The youngster, in response, becomes angry and oppositional.

While problems initially appear at home, in time they may affect relationships with educators and peers. Problems with educators and peers lead to depression, anxiety, and additional problematic behavior. Children with Oppositional Defiant Disorder and poor social skills often do not recognize their role in peer conflicts, and they tend to not take responsibility for their own actions.

Symptoms frequently remit, especially if the youngster receives treatment, including treatment for the underlying Attention-Deficit/Hyperactivity Disorder, and moms and dads receive parent guidance. At times, Oppositional Defiant Disorder may give way to Conduct Disorder.

Risk Factors and Etiology—

Oppositional Defiant Disorder is most likely to arise when a strong-willed youngster with a reactive and high-energy temperament has a parent who is authoritarian rather than authoritative. An authoritarian parent who expects obedience will be frustrated with a youngster who does not listen as a result of being strong willed or having a high energy level.

Children with Attention-Deficit/Hyperactivity Disorder are particularly vulnerable. The youngster will react to the excessive control of the parent by becoming angry and wanting to assert himself even more. The youngster will see the parent as inappropriately domineering and bossy, rather than helpful. The parent sees the youngster as unreasonable and disrespectful and is likely to try doubly hard to enforce her authority.

A downward spiral occurs, with the parent trying to control the youngster and the youngster feeling he must refuse to give in and must defend his autonomy. Both parties become angry and increasingly rigid in their stances as they try to defend their self-esteem. The youngster's negative behaviors may be inadvertently rewarded by attention, which, even though may be negative, is still desired.

Help for Parents with Oppositional Defiant Children and Teens

Recommended Reading for Clinicians Working with ODD Clients

1. American Psychiatric Association (2000), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR). Washington, DC: American Psychiatric Press.

2. Angold A, Costello EJ, Erkanli A (1999), Co-morbidity. J Child Psychol Psychiatry

3. Burke JD, Loeber R, Birmaher B (2002), Oppositional defiant and conduct disorder: a review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry

4. Collett BR, Ohan JL, Myers KM (2003), Ten-year review of rating scales. VI: Scales assessing externalizing behaviors. J Am Acad Child Adolesc Psychiatry

5. Connor DF (2002), Aggression and Antisocial Behavior in Children and Adolescents: Research and Treatment. New York: The Guilford Press.

6. Loeber R, Burke JD, Lahey BB, Winters A, Zera M (2000), Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry

7. Olweus D (1994), Bullying at schools: basic facts and effects of a school based intervention program. J Child Psychol Psychiatry

8. Santisteban DA, Szapocznik J, Perez-Vidal A, Kurtines WM, Murray EJ, LaPerriere A (1996), Efficacy of intervention for engaging youth and families into treatment and some variables that may contribute to differential effectiveness. J Family Psychol

9. Skovgaard AM, Houmann T, Landorph SL, Christiansen E (2004), Assessment and classification of psychopathology in epidemiological research of children 0Y3 years of age: a review of the literature. Eur Child Adolesc Psychiatry

10. Wilson J, Steiner H (2002), Conduct problems, substance abuse and social anxiety. Clin Child Psychol Psychiatry

Facts About ODD, CD and Personality Disorder

Some important statistics about Oppositional Defiant Disorder, Conduct Disorder, and Personality Disorder:

  • 15% of oppositional defiant children develop some form of personality disorder later in life.
  • 20% of children with Oppositional Defiant Disorder have some form of mood disorder (e.g., Bipolar Disorder or anxiety).
  • 35% of these children develop some type of affective disorder.
  • 50-65% of Oppositional Defiant Disorder children also have ADD or ADHD.
  • 75% of children with Oppositional Defiant Disorder above the age of eight will still be defiant later in life.
  • About 30% of Conduct Disorder kids continue with similar problems in adulthood.
  • About 50-70% of ten-year-olds with Conduct Disorder will be abusing substances four years later. Cigarette smoking is also very high.
  • Children with Conduct Disorder and Oppositional Defiant Disorder are at high risk for criminality and antisocial personality disorders in adulthood.
  • Girls with Conduct Disorder more often end up having mood and anxiety disorders as adults. Substance abuse is also very high.
  • Females with Conduct Disorder showed that they have much worse physical health.
  • Females with Conduct Disorder were almost 6 times more likely to abuse drugs or alcohol, eight times more likely to smoke cigarettes daily, where almost twice as likely to have sexually transmitted diseases, had twice the number of sexual partners, and were three times as likely to become pregnant when compared to girls without Conduct Disorder.
  • It is more common for males with Conduct Disorder to continue on into adulthood with the same types of problems than females.
  • Many ODD children have learning disorders.
  • Once children enter the teen years, it is almost impossible for parents to change the Oppositional Defiant Disorder behavior.
  • Oppositional Defiant Disorder is more common in boys than in girls before puberty.
  • Oppositional Defiant Disorder is reported to affect between 2 and 16 percent of children.
  • If a child has a personality disorder as a teenager, by the time he is a young adult, here are the chances that the following things will happen:
  1. Difficulties with interpersonal relationships: 20-30%
  2. Ending up with other psychiatric problems: 35-40%
  3. Having at least one of the above bad outcomes: 70-80%
  4. Having at least two of the above bad outcomes: 50%
  5. Make a suicide attempt: 6-10%
  6. Not get as far in school as should have been able to: 25%
  7. Serious assault on another: 25-35%

Help for Parents with Oppositional Defiant Children and Teens

What does the future hold for a child with Oppositional Defiant Disorder?

Re: What does the future hold for a child with Oppositional Defiant Disorder?

The short answer is this: It depends on whether or not the child gets help. It was once thought that most kids would outgrow Oppositional Defiant Disorder (ODD) by adulthood. We now know this is not always true. While some of the symptoms of Oppositional Defiant Disorder can go away over time, and while some kids do outgrow the disorder, many kids with Oppositional Defiant Disorder will continue to experience the consequences of this condition during their later years.

For those who do not receive treatment, Oppositional Defiant Disorder can develop into Conduct Disorder, a more serious behavioral disorder. Of those with Conduct Disorder, almost 40% will develop Antisocial Personality Disorder in adulthood.

If your youngster is showing signs of Oppositional Defiant Disorder, it is very important that you seek help from a qualified professional immediately. Without treatment, kids with Oppositional Defiant Disorder may experience rejection by classmates and other peers because of their poor social skills and aggressive and annoying behavior.

Early diagnosis and treatment can help these children learn how to cope with stressful situations and manage their behavioral symptoms. Psychotherapy, parent-management training, skills training, and family therapy work.

Research shows that kids and teens respond well to therapy for Oppositional Defiant Disorder. In fact, for those who receive treatment, many are symptom-free once therapy has concluded and will go on to lead rewarding and happy lives.

Help for Parents with Oppositional Defiant Children and Teens

What therapies are ineffective in treating Oppositional Defiant Disorder?

Experts agree that therapies given in a one-time, short-lived approach (e.g., boot camps, tough-love camps, scared straight programs, and brat camps) are not effective for kids and teens with Oppositional Defiant Disorder. In fact, these approaches may do more harm than good.

Trying to scare or forcibly coerce kids and teens into behaving only reinforces aggressive behavior. These children may comply while under duress, but will learn from the scare tactics that were used on them – and use those same tactics on others at a later date. Kids respond best to treatment that rewards positive behavior and teaches them skills to manage negative behavior.

Before you send a troubled child or teen with Oppositional Defiant Disorder to a boot camp, it's important that you understand what these boot camps are and how effective (or not) they are in transforming angry, unhappy, struggling kids.

The theory behind most boot camps is that “if you scream enough at kids and discipline them, they will shape up." Angry, defiant, oppositional children and teens may shape up while in the intensely overwhelming, military-like environment of a boot camp, but in most cases, these short-term "SCARE camps" do not create lasting changes in behavior. It is more likely this type of setting will create more hostility and resentment toward authority figures.

Most troubled children need structure, strong guidance, therapy, and the discovery of natural consequences of behavior. For this reason, if your child or adolescent is truly struggling with behavior, emotions, and academics, he/she needs something that is more sophisticated and sensitive than a tough drill sergeant in his/her face.

Parenting Children and Teens with Oppositional Defiant Disorder

Does oppositional defiant behavior improve as the child gets older?

Some lucky kids will outgrow Oppositional Defiant Disorder. About 50% of kids who have this disorder as preschoolers will have no psychiatric problems at all by age 8. Follow-up studies have found that approximately 67% of kids diagnosed with Oppositional Defiant Disorder who received treatment will be symptom-free after three years. However, studies also show that approximately 30% of kids who were diagnosed with Oppositional Defiant Disorder will go on to develop Conduct Disorder.

Other studies show that when the behavioral symptoms of Oppositional Defiant Disorder begin in early life (i.e., preschool or earlier), the youngster or teen will have less chance of being symptom-free later in life. Also, the risk of developing Conduct Disorder is three times greater for kids who were initially diagnosed in preschool. In addition, preschool kids with Oppositional Defiant Disorder are more likely to have coexisting conditions (e.g., ADHD, anxiety disorders, mood disorders, depression, bipolar disorder) later in life.

In all age groups, approximately 10% of kids and teens diagnosed with Oppositional Defiant Disorder will eventually develop a more lasting personality disorder (e.g., antisocial personality disorder). However, most kids and teens will improve over time, especially if they receive treatment. Mothers and fathers who suspect that their youngster has a behavioral problem should have their youngster evaluated. For kids who receive treatment early, the outlook is very good.

By the time children diagnosed with Oppositional Defiant Disorder reach the 5th or 6th grade, about 25% will have mood or anxiety problems. Thus, it is very important to watch for signs of mood disorder and anxiety as kids with Oppositional Defiant Disorder grow older. By the time preschoolers with Oppositional Defiant Disorder are 8 years old, only 5% have Oppositional Defiant Disorder and nothing else (i.e., no other coexisting conditions).

About 5-10 % of preschoolers with Oppositional Defiant Disorder will eventually end up with ADHD and no signs of Oppositional Defiant Disorder at all. Other times Oppositional Defiant Disorder turns into Conduct Disorder. This usually happens fairly early though (i.e., after a 3-4 years of Oppositional Defiant Disorder, if it hasn't turned into Conduct Disorder, it probably never will). The best predictor of a youngster with Oppositional Defiant Disorder graduating to Conduct Disorder is if there is a history of a biologic parent who engaged in criminal activity and also had (or has) Oppositional Defiant Disorder.

Grown-ups who had Oppositional Defiant Disorder as a child often do best if they can work for themselves and stay away from drugs and alcohol. However their tendency to irritate others often persists even into adulthood, which often leads to a lonely life.

Help for Parents with Oppositional Defiant Children and Teens

How Is Oppositional Defiant Disorder Treated?

There is no one-size-fits-all treatment for kids and teens with Oppositional Defiant Disorder. The most effective treatment plans are tailored to the needs and behavioral symptoms of each youngster. Treatment decisions are typically based on a number of different things, including the youngster’s age, the severity of the behaviors, and whether the youngster has a coexisting mental health condition.

The goals and circumstances of the moms and dads also are important when forming a treatment plan. In many cases, treatment may last several months or more and requires commitment and follow-through by moms and dads as well as by others involved in the youngster’s care.

Treatment usually consists of a combination of:

1. Cognitive Problem-Solving Skills Training to reduce inappropriate behaviors by teaching the youngster positive ways of responding to stressful situations. Kids with Oppositional Defiant Disorder often only know of negative ways of interpreting and responding to real-life situations. Cognitive problem solving skills training teaches them how to see situations and respond appropriately.

2. Medication may be necessary to help control some of the more distressing symptoms of Oppositional Defiant Disorder as well as the symptoms of coexisting conditions (e.g., ADHD, anxiety, mood disorders). However, medication alone is not a treatment for Oppositional Defiant Disorder. Medication alone has not been proven effective in treating Oppositional Defiant Disorder. However, medication may be a useful part of a comprehensive treatment plan to help control specific behaviors.

Successful treatment of coexisting conditions often makes Oppositional Defiant Disorder treatment more effective. For example, medication used to treat kids with ADHD has been shown to lessen behavioral symptoms when Oppositional Defiant Disorder and ADHD coexist. When kids and teens with Oppositional Defiant Disorder also have a mood disorder or anxiety, treatment with antidepressants and anti-anxiety medications has been show to help lessen the behavioral symptoms of Oppositional Defiant Disorder.

3. Parent-Management Training Programs and Family Therapy to teach moms and dads and other family members how to manage the youngster’s behavior. Parents, family members, and other caregivers are taught techniques in positive reinforcement and ways to discipline more effectively.

Studies have shown that intervening with moms and dads is one of the most effective ways to reduce the behavioral symptoms of Oppositional Defiant Disorder in all age groups. Parent management training teaches moms and dads positive ways to manage their youngster’s behavior, discipline techniques, and age-appropriate supervision. It is the treatment of choice to prevent disruptive childhood behavior for many mental health professionals.

This approach embraces the following principles:
  • Consistent punishment for disruptive behavior
  • Decreased negative parenting practices, such as the use of harsh punishment and focus on inappropriate behaviors
  • Increased positive parenting practices, such as providing supportive and consistent supervision and discipline
  • Predictable, immediate parental response

4. Social-Skills Programs and School-Based Programs to teach kids and teens how to relate more positively to peers and ways to improve their school work. These therapies are most successful when they are conducted in a natural environment (e.g., at school, in a social group).

For preschool-age kids, treatment often concentrates on parent-management training and education. School-age kids perform best with a combination of school-based intervention, parent-management training, and individual therapy. For teens, individual therapy along with parent-management training has been shown to be the most effective form of treatment.

Behaviors that go along with Oppositional Defiant Disorder are difficult to change. Therefore, early identification and treatment of Oppositional Defiant Disorder give kids and teens the best chance for success.

Most treatment plans for kids and teens with Oppositional Defiant Disorder last several months or longer. For those with a more severe Oppositional Defiant Disorder, or Oppositional Defiant Disorder that does not respond to therapy, treatment can last many years and may include placement in a treatment center.

A residential treatment center only should be considered for families who are not able to provide therapy at home or at school. In-home services are preferable to residential placement and are often sponsored by state and local youngster welfare agencies.

Help for Parents with Oppositional Defiant Children and Teens

Support and Education for Parents with Oppositional Defiant Children and Teens

WhatIsOppositionalDefiantDisorder.com is a resource for families and medical professionals who deal with the challenges of Oppositional Defiant Disorder [ODD].

Our website provides sources of professional help, recommended reading, moderated support message boards, lists of camps and schools, links to local/national/international support groups, educational resources, conference information, and articles.

We strongly believe that all children and teens faced with the challenges of ODD have the right to – and deserve – appropriate education, inclusion, support, and understanding so that they and their families may enjoy the highest possible quality of life.

Mark Hutten, M.A.

Personal:

Mark was born in Freemont, Ohio in 1956. He graduated from Anderson High School (Anderson, IN) in 1974. Mark’s wife is a paralegal for a local defense attorney. They are members of Living Hope Christian Church in Gaston, Indiana.

Educational:
  • Bachelors Degree; Psychology -- Anderson University, Anderson, IN
  • Masters Degree; Counseling Psychology -- Vermont College of Norwich University, Montpelier, VT

Current Employment:
  • Madison County Community Justice Center
  • Madison County Correctional Complex
  • Sowers of Seeds Counseling
  • Indiana Juvenile Justice Task Force

Mark has worked in the “addictions” field since 1994 and has worked with children who are experiencing emotional and behavioral problems - and their parents - since 1988. He is a Probation Officer as well as a Family Therapist and performs home-based counseling and supervision for families experiencing difficulty with their children's emotional and behavioral problems. His primary mission is to help these families develop much needed coping skills so that they can avoid involving their children in the Juvenile Justice system.

Mark also conducts the following group therapies for court-ordered individuals (although many volunteer):
  • Parent Education Training
  • Anger Management Groups
  • Relapse Prevention Groups
  • Drug/Alcohol Workshops
  • Sex Offender Groups

Accomplishments:

Mark is the creator of the Parent-Support Group (a parents only group for parents with strong-willed, out of control children). He is the author of My Out-of-Control Teen and My Out-of-Control Child eBooks, and the founder of Online Parent Support (the online version of the Parent Support Group).

Many of Mark's articles and columns related to parenting children with ADHD, ODD, Conduct Disorder, Bipolar Disorder, Asperger’s Syndrome, Autism, Reactive Attachment Disorder, and more, are featured on prominent "online" magazines (ezines) and websites.

Contact:

Mark Hutten, M.A.
Online Parent Support, LLC
2328 N 200 E
Anderson, IN 46012

Cell: 765.810.3319 (available between 9:00 AM & 5:00 PM Eastern Time)

Why would a child only show oppositional defiant behavior toward his mother?

Question

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.

Answer

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.

Are there ways to prevent Oppositional Defiant Disorder?

Research shows that early-intervention and school-based programs along with individual psychotherapy can help prevent Oppositional Defiant Disorder.

A developmental sequence of experiences occurs in the development of Oppositional Defiant Disorder. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. As these experiences continue, defiant behaviors develop into a “pattern” of behavior. Early detection and intervention into negative family and social experiences can be very helpful in disrupting the sequence of experiences leading to more defiant behaviors.

Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of defiant behaviors in interpersonal relationships with grown-ups and peers, and school and social adjustment.

Among preschoolers, the Head Start program has been shown to help kids do well in school and prevent delinquency later in life. Head Start is a program of the United States Department of Health and Human Services (US-HHS) that provides education, health, and other services to low-income kids and their families. Young kids in this program learn social skills, how to resolve conflict, and how to manage anger. A home visit to high-risk kids also has been shown to help prevent Oppositional Defiant Disorder among preschoolers.

Among teenagers with Oppositional Defiant Disorder, talk therapy, social-skills training, vocational training, and assistance with academics can help reduce disruptive behavior. In addition, school-based programs can be effective in stopping bullying, reducing antisocial behavior, and improving peer relationships.

Parent-management training programs have proven effective in preventing Oppositional Defiant Disorder among all age groups. These programs teach moms and dads how to develop a nurturing and secure relationship with their youngster and how to set boundaries for unacceptable behavior.

Since Oppositional Defiant Disorder is caused by many different factors, it is impossible to completely protect your son or daughter from developing this disorder. However, you can carefully control the environment in which your youngster lives, especially if he or she has existing conditions that put him or her at risk. These conditions include ADHD, developmental disorders, anxiety, and depression.

Consistent, caring parenting with appropriate rules and boundaries can teach a youngster or teen how to correctly follow guidance and respect authority figures. Early diagnosis improves the prognosis of treatment, so contact your doctor if your son or daughter begins to exhibit symptoms of Oppositional Defiant Disorder, especially if he or she has other existing risk factors.

Help for Parents with Oppositional Defiant Children and Teens

Does Oppositional Defiant Disorder Usually Occur Alongside Other Disorders?

Re: "Does Oppositional Defiant Disorder usually occur alongside other disorders?"

The short answer is “yes, more often than not!” Many kids who are diagnosed with Oppositional Defiant Disorder also have other treatable mental health and learning conditions. Having more than one condition is called having a coexisting or comorbid condition. Some conditions that coexist with Oppositional Defiant Disorder are:
  • Language disorders
  • Anxiety disorders
  • ADHD
  • Mood disorders (e.g., depression, bipolar disorder)
  • Learning disorders

Research indicates that some kids develop the behavioral symptoms of Oppositional Defiant Disorder as a way to manage anxiety or uncertainty. Anxiety disorders and mood disorders are similar to Oppositional Defiant Disorder in that they are often a response to uncertainty and an unstable home and school environment. These similarities make it more likely that Oppositional Defiant Disorder and anxiety disorder and a mood disorder will occur together.

Among all conditions that coexist with Oppositional Defiant Disorder, ADHD is the most common. Both disorders share common symptoms of disruptive behaviors. However, kids and teens that have both Oppositional Defiant Disorder and ADHD tend to be more aggressive, have more of the negative behavioral symptoms of Oppositional Defiant Disorder, and perform less well in school than those who have Oppositional Defiant Disorder alone. These kids also tend to have more disruption in their families and with their relationships with authority figures than kids that do not have Oppositional Defiant Disorder.

Researchers have found that Oppositional Defiant Disorder can be a precursor to Conduct Disorder. Conduct Disorder is a more serious behavioral disorder that can result in destructive antisocial behavior. While Oppositional Defiant Disorder behaviors may start in early preschool years, Conduct Disorder usually appears when kids are older. A youngster or teen who has ADHD as a coexisting condition also seems to be at increased risk of developing Conduct Disorder. In addition, studies show that having Conduct Disorder puts kids and teens at risk of developing a mood disorder or antisocial personality disorder later in life.

While having Oppositional Defiant Disorder and a coexisting condition puts a youngster at risk for developing other more serious mental health issues, treatments exist that can improve the symptoms of ADHD, anxiety disorders, mood disorders, and learning and language disorders. Also, treating other mental health and learning conditions that occur along with Oppositional Defiant Disorder has been shown to decrease the behavioral symptoms of Oppositional Defiant Disorder.

Help for Parents with Oppositional Defiant Children and Teens

What is the best way to deal with a student who has Oppositional Defiant Disorder?

Question

My son is 9 and has Aspergers, but also definitely is developing ODD in school with his teacher. I've tried desperately to talk to my son and his teacher, as well as his school Psychologist about what is triggering his behavior. My son told me he doesn't like his teacher's "loud voice" and that it scares him. Her response when I told her and the School Psychologist that was if he doesn't want to hear her loud voice, then he better do his work and stop staring into space.

I told them about your site and have shared your articles with them, but they don't seem to want to try anything but fighting fire with fire, which is leading to more meltdowns and disasters! I have documented everything and written to my son's Psychiatrist who originally diagnosed him, and asked for his advice and help getting my son into a better school system.

There is a special school available in my county for Aspergers and ODD/Behavioral children that worked wonders with him when he was young. Because of budget cuts, they pulled him out and he is now in a "Learning Disabled" class within a main stream school.

I feel as though I'm talking to the wall with this school, who claims they feel they are talking to the wall with my son. I asked that they not take it personally, and perhaps try some of your methods, or send him back to the school he thrived in. They asked me to medicate him; I did, he is still the same, maybe even more stressed.

He is not Oppositional to me (his mom) but he now does not trust any authority figures in school because of his bad experiences and is very vocal about it. When I have the money, I am going to sign up for your online counseling. My doctor should be getting back to me sometime this afternoon as well. In the meantime, I'm so frustrated and worried about the damage that is being done that I think my son is going backwards. Any ideas? Thanks!

Answer

Having your son return to the school for Aspergers and ODD/Behavioral children sounds like the best option. Do whatever you can to get him back into that school. In the meantime, please copy and print the information below and share with your son’s teacher:

Tips for Teaching Students with Oppositional Defiant Disorder—

1. Acknowledge small steps toward improvement by whispering a positive comment to the youngster. Avoid expressing your feelings like, “I am so proud of you!” Instead say something like, “This is A+ work.” Or, you could write a note to give to the child.

2. Ask the school counselor to work with the child individually or in a small group to help the youngster develop anger-management and social-relationship skills.

3. Avoid arguing, lecturing, or threatening a youngster with Oppositional Defiant Disorder because he/she will most likely view your words as rewarding rather than as punishment.

4. Avoid raising your voice or exhibiting any emotion. Be neutral and calmly say something like: “Since you broke the rule, this is what you will do.” Act like a referee who simply states the consequence and holds the player accountable. Do not allow the youngster to argue. Just restate what happens when a rule is broken.

5. Believe in the youngster`s ability to manage his/her behavior in an appropriate way.

6. Discover what the youngster truly enjoys doing (e.g., participating in a sport or hobby).

7. Focus on only a few problem behaviors at a time. Decide what behavior you will ignore and what you will not accept. Communicate the consequences for those you cannot tolerate.

8. Furnish a place for the youngster to regroup and release negative emotions in a time-out area. You could say to the youngster, “Would time in the rest area be helpful?” or "Your time will begin when you go to the rest area." If regarded appropriate at your school, provide a stress ball to squeeze, a pillow to punch, or old magazines to tear as a way for the child to release some of his/her hostility.

9. Have clear expectations and firm rules and boundaries.

10. Identify skills or attributes that you can reinforce.

11. If deemed helpful, devise a way to show the youngster that he/she is making progress (e.g., use stickers, tokens, or marks on a chart that could be traded for privileges that are reinforcing to the child). Extra computer time, eating lunch with a friend, additional free time, helping a favorite teacher, or doing a classroom task are good rewards as well.

12. Meet privately with the child about specific concerns, but first establish that you will be respectful toward each other. Be calm as you discuss his/her actions. You could say something like, “Tell me what you think the problem is that keeps you from being successful in school.” Listen to the youngster without interrupting. Decide together on a behavior plan that can be copied and shared with the child.

13. Post classroom rules and a daily schedule so that the youngster knows what to expect.

14. Provide recognition when the youngster exhibits appropriate behavior. However, be aware that since many kids with Oppositional Defiant Disorder feel compelled to do the opposite of what you want, avoid direct, lavish praise (e.g., following a commendation, the child might retaliate by tearing up his/her work or by hitting someone).

15. Provide some closely supervised cooperative learning activities to assist the child in learning constructive ways to interact with peers.

16. Realize that any sort of change in the classroom routine may be upsetting to a youngster with Oppositional Defiant Disorder.

17. Realize that teaching a youngster with Oppositional Defiant Disorder is difficult, stressful, and exhausting – so take care of yourself.

18. Seek assistance from the school administrator, counselor, psychologist, special education teacher, or other school professional when you feel overwhelmed or when you feel you or the kids in your classroom are unsafe due to the behavior of a child with Oppositional Defiant Disorder.

19. State your directions in simple, straightforward language. Be as clear, immediate and as consistent as possible.

20. Understand that you are not the cause of the defiance, only an outlet for it.

21. When dealing with a youngster with Oppositional Defiant Disorder, it is important to remember that behavior management techniques that work well with other children may be ineffective with him/her. The youngster will frequently misbehave and annoy adults to elicit a reaction.

22. When possible, meet with the parents so that everyone can present a united front. Since these kids are adept at convincing others that someone else caused their behavior, they usually are not included in this meeting. After stating the problem, brainstorm ideas on ways to assist the child in improving his/her behavior. Agree on a behavior plan or contract for the behaviors necessary for the youngster to be successful in school.

23. When possible, concede control to an object such as a clock or the bell. You could say, “Be ready to go when the bell rings,” rather than, “I want you to get ready to go!”

24. When problems arise, questions you could ask the youngster are:

• “How may I help you?”
• “Is what you are doing working for you?”
• “What could you have done differently to avoid the problem?”
• “What would work better?”

25. Work hard to establish trust with the child by being fair and consistent.

Help for Parents with Oppositional Defiant Children and Teens