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

By Mark Hutten, M.A.
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.

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