Does marital discord cause Oppositional Defiant Disorder?

RE: Does marital discord cause Oppositional Defiant Disorder?

The short answer is ‘no’ – it doesn’t cause Oppositional Defiant Disorder (ODD), but it is definitely a contributing factor. Much of the research to date addresses the influence of parents’ attitudes and actions on the behavior of their kids. Studies have consistently shown a strong correlation between marital dissatisfaction and overt marital conflict and kid’s oppositional defiant behavior. Studies have examined numerous explanations for these findings.

One such explanation was that dysfunctional marital relationships lead to dysfunctional parenting practices. Marital conflict has been positively linked with callous disciplinary practices used by moms and dads, lower levels of parental participation, and more recurrent parent-child conflict. Conflicted moms and dads are also less likely to praise their kids, read to them, engage in recreation with them, or spend time with them in relational or social activities. This detachment fuels negative relationships within families.

Families where both the mom and dad blame the youngster and “scapegoat” him demonstrate high levels of marital discord and “acting-out” behaviors in the youngster is evident. This type of parenting strategy, or lack of one, may be seen as an example of how maladaptive parenting styles and the youngster’s misbehavior become intertwined and reciprocally reinforcing. What is most important is the way these behaviors are substantiated through family interaction styles and how they serve a homeostatic function, in that it helps to maintain balance within the family system.

Other factors involving parents’ actions and attitudes have been shown to affect a kid’s behavior. For example, depression in the mother or father is related to a particular style of conflict-management in the home. Parents with depressive symptoms were shown to use more evading and aggressive conflict resolution strategies in the marriage and family relationship. These maladaptive conflict resolution styles can be positively correlated to the kid’s destructive behaviors. Negative parental conflict-management styles can also impact the kid’s ability to manage conflict properly himself, with either family or peers.

Parental antisocial behavior has a monumental influence on kid’s adjustment difficulties. Such detrimental parental conduct plays a major role in family disturbance and the growth of kid’s “acting-out” behaviors. This conduct also leads to adjustment problems in kids (e.g., anxiety, low self-esteem, depression, destructive behaviors, etc.).

Parental hostility and conflict seem to be the most prevalent negative influences on kids within the family system. Antagonism and lack of involvement within the marital relationship are the most caustic form of marital disagreement and are linked to dysfunction throughout many levels of the family system. When parents participate in both aggressive and distancing behaviors in their interaction with one another, they tend to have kids who exhibit harmful affect and non-cooperation with peers who have higher levels of “acting-out” issues. This subject can even be narrowed to include moms and dads who improperly argue about what is proper parenting. This aspect of moms and dads fighting with each other over parenting issues has also been shown to adversely influence kid’s actions and attitudes.

Parental marital conflict significantly increases kid’s anxiety and depression. Marital conflict and dissolution of the marital relationship are early environmental adversities that negatively impact kid’s physical health. The impact of the parent’s behavior on the youngster’s behavior is, therefore, well documented. If moms and dads are able to successfully and understandingly work through problems together, they evidence more involved and supportive parenting with their kids.

Mom’s special influence:

A mom’s special influence in a youngster’s life can be a powerful force for good or ill. Kids with moms who feel uncertain of their parenting skills and use love conditionally tend to report more anxious kids. Moms who display hostile control and discipline are more likely to have kids with conduct problems.

Moms tend to have much more of a positive influence on their kid’s behavior than dads. This could be attributed to the fact that it is socially accepted that moms should be psychologically available to their kids in spite of their own problems. Females may be able to deliberately disconnect their roles as spouse and as mom, thereby lessening the impact of a poor marital relationship on their responsibility as moms.

Dads, on the other hand, tend to have a more negative impact. This may be due to the fact that disconnected dads produce a family atmosphere in which kids feel more at ease with their moms. This may cause kids and moms to create alliances that segregate dads and may lead to the dad’s retreat from family interactions and an increased expression of negative behaviors within the family.

Marital conflict has also been shown to be associated with negativity in the mom’s relationship with the pre-teen son or daughter. This marital conflict has been linked to a lack of responsiveness on the part of the mom in the mother–child relationship.

Moms and dads who experience unremitting marital conflict are likely to have limited emotional availability for their kids. The lower the levels of conflict are, the less negative the parent–child relationship tends to be. Although moms and dads have a paramount influence on their kid’s lives and behavior, other environmental factors contribute as well.

Parenting Children with Oppositional Defiant Disorder

What are the best behavior-management strategies that teachers can use with their oppositional defiant students?

Solutions for Oppositional Defiant Behavior in ODD Students: Tips for Teachers

1. ODD Behavior: Complying with the letter of the law but not with the spirit of it—

Examples:

• When told, “Take your hat off,” the child may take it off and then put it back on.
• When given the direction “Lower your voice,” the child may speak in a lower tone but use the same volume.
• When given the direction “Bring your chair up to the front of the room,” the child may bring the chair up but then sit on the floor.

Teacher’s Strategy: Teach the difference between the letter and the spirit of the law—

Generally, when faced with the “loophole finding” student, teachers will try to become more precise in their language or to add additional rules. Rather than trying to plug the loopholes, have a lesson at the beginning of the year on the difference between the “letter of the law” and the “spirit of the law.” Unless a youngster has a language impairment, she/he knows what the teacher means and is merely testing the limits. In the lesson, you can give examples of statements an educator might make, and then ask the children in class to identify the intent. 

Examples:

• No talking. Does the educator mean: (a) be silent or (b) start whispering?
• Stop running. Does the educator mean: (a) walk or (b) start skipping or hopping?
• Turn around. Does the educator mean: (a) face front or (b) turn in a circle?

Not only does this lesson get the point across, it generally is a lot of fun for teachers and children. Once the educator is certain the group understands the difference between the letter of the law and the spirit of the law, one additional rule can be added to the classroom list: “Follow the spirit of the law.”

Now, when a child tests the limit, the teacher can ask, “Are you following the spirit of the law?” This effectively derails the child who innocently looks at you and smiles, saying, “But I did what you SAID!”

2. ODD Behavior: Making deals—

Example:

The educator says, “You need to finish your English before you go to recess.” The child responds, “If you let me go to recess, I’ll do my English later. I want to do Math now.” If the educator persists, the child will continue to try to “make a deal” (e.g.,, “I’ll do half my English now, only have half of recess, and then come back in and finish my English”).

Teacher’s Strategy: Ask rather than tell—

Many times this type of interchange can be proactively avoided by asking the children what they should be doing, rather than by telling them what they are supposed to do (e.g., “What needs to be done before you go to recess?”). For the most part, children with defiant behavior really don’t want to be doing something different, they just want to have control and not feel as if they are being told what to do.

Children who are trying to make deals are really saying, “I want to feel like I have control over what I’m doing and when I’m doing it.” If the teacher interprets that sentiment out loud and points out that they do have control, children often will comply (e.g., the teacher could say, “You want to feel like you have control and options about the ‘what’ and ‘when’ of your choices. You do have control. No one can make you do anything you don’t want to. It’s your choice. You don’t do English – then you don’t have recess. It’s totally up to you.”).

3. ODD Behavior: Violating rules right in front of a teacher—

Examples:

• The educator is walking down the aisle and, as she passes, the child puts her/his feet up on the next chair.
• The educator tells everyone to remember to please raise a hand when answering a question, but the child immediately shouts out an answer.

Teacher’s Strategy: Planned ignoring—

Planned ignoring is a conscious decision to not attend to the behavior at the time it occurs. It does not mean ignoring the behavior forever, which would be condoning it. Usually, when a child violates a rule immediately after it has been given, it is an attempt to engage the teacher in an argument and seize control of the classroom. Behaviors that are insubordinate, but do not endanger the physical or psychological safety of others, can be temporarily ignored.

When the child sees that the teacher is not going to “give up” control of the classroom by taking the time to engage in an argument, the behavior often stops. If, however, when the behavior is ignored the child escalates it, the teacher needs to interpret the meaning of the behavior. It is important to let your class know about the strategy of planned ignoring at the beginning of the year. You might say, “There are going to be times when someone violates a rule and it looks like I’m not paying attention or I’m letting them get away with it. I want you to know that I am choosing to ignore them for the time being because what’s most important is that I continue to teach and you continue to learn. I want you to know that the misbehavior will be addressed at a later time and the child will receive consequences for her/his behavioral choices. The rules haven’t changed.”

4. ODD Behavior: Intense need to “have the last word”—

Because oppositional behavior is all about control, children who exhibit it have an intense need to have the last word. Remember that they don’t want the argument to end, because when it does, their sense of control ends also. Unfortunately, dealing with a child who has the intense need to win often generates in teachers the same intense need to come out on top.

Teacher’s Strategy: Give them control—

Make the conscious decision to “surrender to win.” Let the child have the last word. Once her/his goal has been achieved, the behavior generally ceases. Once again, “parting-shot” inappropriate comments can be ignored and consequences given later.

5. ODD Behavior: Constantly questioning “why?”—

Like 3-year-olds, children who are defiant will question the purpose for a direction. Then they will question the explanation. Their purpose is to maintain control of the discussion.

Example:

“You need to put your feet down.”
“Why?”
“Because that’s the rule.”
“Why?”
“Because having your feet up bothers other people.”
“Why?”
“Because it bumps their chair or blocks their way.”
“Why is that a problem? They could move or go around.”
“Because people are entitled not to be bothered.”
“Why?”

Teacher’s Strategy: Agree to answer, but during “their” time—

Generally, if you’ve made it a habit of “asking” rather than telling (e.g., “Where do your feet belong?” instead of “You need to put your feet down”), the child isn’t as likely to get into the “whys.”However, if this occurs, the first thing to do would be to try planned ignoring. If the questions continue, you can agree to discuss the reasons – but only during “their time.” For example, “If you’d like to discuss this, I’d be happy to before you go to recess.” Children who are truly interested in the reason will agree to your request. Those who are just trying to get control of the class will usually respond to your reminder (e.g., “It’s not that important. I need to get to recess.”).

6. ODD Behavior: Staff splitting—

Many children who are defiant constantly point out inconsistent enforcement of the rules by teachers and use this as a rationale for their own behavior. What the children are trying to do is make this an issue of whether or not grown-ups are consistent rather than focusing on the real issue—whether they are choosing to follow or break the rules (“I don’t have to follow the rules if the teachers don’t enforce them”).

Unfortunately, many teachers fall for this. There seems to be an irrational belief that if only every teacher in the environment treats children the same way, they will behave. The total weight of the child behavior is put on the grown-ups, and the responsibility is built on enforcement rather than on compliance.

Although consistent enforcement does help keep the rule in the forefront, inconsistent enforcement neither causes nor excuses inappropriate behavior. The issue isn’t whether the teacher is or isn’t doing her/his job, the issue is that the child is violating the rule and is looking for someone else to blame.

Teacher’s Strategy: Put the focus back on the child—

When confronted with “other teachers don’t do anything when I____” rationalizations, say, “You feel because you broke the rule and you weren’t called on it that the rule has changed… it hasn’t.” …or… “You would like it to be Mrs. Jones’ fault that you are breaking the rule.”

7. ODD Behavior: Refusal to comply—

Examples:

• “You can’t make me.”
• “What are you going to do about it?”

When children say, “You can’t make me,” they are asserting their control and challenging yours. They are silently hoping that the teacher will rise to the challenge and try to control them. Like it or not, they are right. Teachers can’t make anyone do anything against her/his will.

These children are also upping the ante—challenging teachers to come up with some consequence that will mean something to them. The “test” is to show teachers their own powerlessness, and these children will often laugh in the face of any consequences teachers might use, even if at a later time they might wish they hadn’t.

Teacher’s Strategy: Agreement—

You can consciously choose to avoid getting into a power struggle. You might generally agree with the child by saying something like, “You are absolutely right. I can’t make you. The only person who can control you is you. I hope you make a good decision for yourself.”

Children who ask, “What are you going to do about it?” are not so much interested in your answer as they are in trying to prove how incapable you are of controlling their behavior. A good response to this question might be, “You are trying to decide if it’s worth it for you. That lets me know that you are in control and are choosing whether or not to behave. That means you’re also choosing to accept whatever the consequences are.”

Note: Rarely, if ever, tell the child what the consequences will be, because (a) it generally doesn’t make a difference to them, and (b) vague consequences can serve to keep them emotionally off balance. Children who are oppositional don’t like uncertainty, and they are often more likely to make a decision to control their behavior if they don’t know what will happen. You could say, “Because you are telling me you’re in control, and it sounds like you’re just trying to see what will happen, is it worth it for you to act-up just to see what the outcome will be?”

Parenting Children with Oppositional Defiant Disorder

All About Behavior Disorders

Behavior disorders (sometimes referred to as disruptive behavior disorders) are the most common reasons kids are referred for mental health evaluations and treatment. All disruptive behavior is not the same. Behavior disorders include mental health problems which include behaviors and emotional problems that create interpersonal and emotional problems for kids and teens during the course of their development.

The most common behavior disorder in kids is ADHD, which includes inattentive, impulsive, and hyperactive behaviors. ODD (Oppositional Defiant Disorder) is another behavior disorder that includes behaviors disruptive to relationships with others (i.e., angry and resentful oppositional behavior). Conduct Disorder (CD) involves behaviors which violate social norms and expectations.

1. Attention-Deficit / Hyperactivity Disorder (ADHD)—

ADHD, usually first diagnosed in childhood, is characterized by inattention, impulsiveness, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the other(s).

The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be apparent in preschoolers. Inattention or attention-deficit may not be evident until a youngster faces the expectations of elementary school.

What are the different types of ADHD?

Three major types of ADHD include the following:
  • ADHD, inattentive and distractible type- This type of AHD is characterized predominately by inattention and distractibility without hyperactivity.
  • ADHD, impulsive/hyperactive type- This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.
  • ADHD, combined type- This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.

What causes attention-deficit/hyperactivity disorder?

ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown. Available evidence suggests that ADHD is genetic. It is a brain-based biological disorder. Low levels of dopamine (a brain chemical) are found in kids with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in kids with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.

Who is affected by attention-deficit/hyperactivity disorder?

Estimates suggest that about 2 million kids (3 percent to 5 percent) have ADHD. Males are two to three times more likely to have ADHD than females.

Many moms and dads of kids with ADHD experienced symptoms of ADHD when they were younger. ADHD is commonly found in siblings within the same family. Most families seek help when their youngster's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.

What are the symptoms of attention-deficit/hyperactivity disorder?

Most symptoms seen in kids with ADHD also occur at times in kids without this disorder. However, in kids with ADHD, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.

The following are the most common symptoms of ADHD. However, each youngster may experience symptoms differently. The three categories of symptoms of ADHD include the following:

Inattention-

o difficulty attending to details
o difficulty listening to others
o easily distracted
o forgetfulness
o poor organizational skills for age
o poor study skills for age
o short attention span for age (difficulty sustaining attention)

Impulsivity-

o has difficulty waiting for his/her turn in school and/or social games
o often interrupts others
o takes frequent risks, and often without thinking before acting
o tends to blurt out answers instead of waiting to be called upon

Hyperactivity-

o fidgets with hands or squirms when in his/her seat; fidgeting excessively
o has difficulty engaging in quiet activities
o has difficulty remaining in his/her seat even when it is expected
o inability to stay on task; shifts from one task to another without bringing any to completion
o loses or forgets things repeatedly and often
o seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
o talks excessively

The symptoms of ADHD may resemble other medical conditions or behavior problems. Furthermore, many of these symptoms may occur in kids and adolescents who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your youngster's doctor for a diagnosis.

How is attention-deficit/hyperactivity disorder diagnosed?

ADHD is the most commonly diagnosed behavior disorder of childhood. A qualified mental health professional usually identifies ADHD in kids. A detailed history of the youngster's behavior from moms and dads and educators, observations of the youngster's behavior, and psycho-educational testing contribute to making the diagnosis of ADHD. Further, because ADHD is a group of symptoms, often diagnosis depends on evaluating results from several different types of evaluations, including physical, neurological, and psychological. Certain tests may be used to rule out other conditions, and some may be used to test intelligence and certain skill sets. Consult your youngster's doctor for more information.

Treatment for attention-deficit/hyperactivity disorder:

Specific treatment for attention-deficit/hyperactivity disorder will be determined by your youngster's doctor based on:
  • expectations for the course of the condition
  • extent of your youngster's symptoms
  • your youngster's age, overall health, and medical history
  • your youngster's tolerance for specific medications or therapies
  • your opinion or preference

Major components of treatment for kids with ADHD include parental support and education in behavioral training, appropriate school placement, and medication. Treatment with a psycho-stimulant is highly effective in most kids with ADHD.

Treatment may include:

Psycho-stimulant medications are used for their ability to balance chemicals in the brain that prohibit the youngster from maintaining attention and controlling impulses. They help "stimulate" or help the brain to focus and may be used to reduce the major characteristics of ADHD, which include the following:

o hyperactivity
o impulsivity
o inattention

Different psycho-stimulant medications that are commonly used to treat ADHD include the following:

o a mixture of amphetamine salts (Adderall)
o atomoxetine (Strattera) - a newer non-stimulant medication
o dextroamphetamine (Dexedrine)
o methylphenidate (Ritalin, Metadate, Concerta)

Psycho-stimulants have been used to treat childhood behavior disorders since the 1930s. They have been widely studied. Stimulants take effect in the body quickly, work for one to four hours, and then leave the body quickly. Recently many long acting stimulant medications have come on the market, lasting 8-9 hours, requiring one daily dosing. Doses of stimulant medications need to be timed to match the youngster's school schedule - to help the youngster pay attention for a longer period of time and improve classroom performance.

The common side effects of stimulants may include, but are not limited to, the following:
  • decreased appetite
  • headaches
  • insomnia
  • jitteriness
  • rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)
  • stomach aches

Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your youngster's doctor.

Antidepressant medications may also be administered for kids and teens with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.

Psychosocial treatments- Parenting kids with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for moms and dads can help reduce stress for all family members. Training in behavior management skills for moms and dads usually occurs in a group setting which encourages parent-to-parent support.

Behavior management skills may include the following:
  • contingent attention (responding to the youngster with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)
  • point systems
  • use of "time out"

Educators may also be taught behavior management skills to use in the classroom setting. Training for educators usually includes use of daily behavior reports that communicate in-school behaviors to moms and dads.

Behavior management techniques tend to improve targeted behaviors (e.g., completing school work or keeping the youngster's hands to himself/herself), but are not usually helpful in reducing overall inattention, hyperactivity, or impulsiveness.

Prevention of attention-deficit/hyperactivity disorder:

Preventive measures to reduce the incidence of ADHD in kids are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the youngster's normal growth and development, and improve the quality of life experienced by kids or teens with ADHD.

2. Oppositional Defiant Disorder (ODD)—

Oppositional Defiant Disorder is a behavior disorder, usually diagnosed in childhood that is characterized by uncooperative, defiant, negativistic, irritable, and annoying behaviors toward moms and dads, peers, educators, and other authority figures. Kids and teens with Oppositional Defiant Disorder are more distressing or troubling to others than they are distressed or troubled themselves.

What causes ODD?

While the cause of Oppositional Defiant Disorder is not known, there are two primary theories offered to explain the development of Oppositional Defiant Disorder. A developmental theory suggests that the problems begin when kids are toddlers. Kids and teens that develop Oppositional Defiant Disorder may have had a difficult time learning to separate and become autonomous from the primary person to whom they were emotionally attached. The "bad attitude" characteristic of Oppositional Defiant Disorder is viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years. Learning theory suggests, however, that the negativistic characteristics of Oppositional Defiant Disorder are learned attitudes, reflecting the effects of negative reinforcement techniques used by moms and dads and authority figures. The use of negative reinforcement by moms and dads is viewed as increasing the rate and intensity of oppositional behaviors in the youngster as it achieves the desired attention, time, concern, and interaction with moms and dads or authority figures.

Who is affected by ODD?

Behavior disorders, as a category, are, by far, the most common reason for referrals to mental health services for kids and teens. ODD is reported to affect 20 percent of the school-age population. Oppositional Defiant Disorder is more common in males than in females.

What are the symptoms of ODD?

Most symptoms seen in kids and teens with ODD also occur at times in kids without this disorder, especially around the ages or two or three, or during the teenage years. Many kids (especially when they are tired, hungry, or upset) tend to disobey, argue with moms and dads, or defy authority. However, in kids and teens with ODD, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.

Symptoms of ODD may include:
  • always questioning rules; refusal to follow rules
  • behavior intended to annoy or upset others, including grown-ups
  • blaming others for his/her misbehavior or mistakes
  • easily annoyed by others
  • excessive arguments with authority figures
  • frequent temper tantrums
  • frequently has an angry attitude
  • refusal to comply with adult requests
  • seeking revenge
  • speaking harshly, or unkindly

The symptoms of Oppositional Defiant Disorder may resemble other medical conditions or behavior problems. Always consult your youngster's doctor for a diagnosis.

How is ODD diagnosed?

Moms and dads, educators, and other authority figures in child and adolescent settings often identify the youngster or teen with Oppositional Defiant Disorder. However, a youngster psychiatrist or a qualified mental health professional usually diagnoses Oppositional Defiant Disorder in kids and teens. A detailed history of the youngster's behavior from moms and dads and educators, clinical observations of the youngster's behavior, and, sometimes, psychological testing contribute to the diagnosis. Moms and dads who note symptoms of Oppositional Defiant Disorder in their youngster or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, ODD often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Consult your youngster's doctor for more information.

Treatment for ODD:

Specific treatment for kids with ODD will be determined by your youngster's doctor based on:
  • expectations for the course of the condition
  • extent of your youngster's symptoms
  • your youngster's age, overall health, and medical history
  • your youngster's tolerance for specific medications or therapies
  • your opinion or preference

Treatment may include:

• Family therapy is often focused on making changes within the family system (e.g., improving communication skills and family interactions). Parenting kids with Oppositional Defiant Disorder can be very difficult and trying for moms and dads. Moms and dads need support and understanding as well as help in developing more effective parenting approaches.

• Individual psychotherapy for Oppositional Defiant Disorder often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.

• While not considered effective in treating Oppositional Defiant Disorder, medication may be used if other symptoms or disorders are present and responsive to medication.

• Peer group therapy is often focused on developing social skills and interpersonal skills.

Prevention of ODD in childhood:

Some experts believe that a developmental sequence of experiences occurs in the development of ODD. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. These experiences compound and continue, and oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and 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 oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the youngster's normal growth and development, and improve the quality of life experienced by kids or teens with ODD. 

3. Conduct Disorder (CD)—

Conduct Disorder is a behavior disorder, sometimes diagnosed in childhood, that is characterized by antisocial behaviors which violate the rights of others and age-appropriate social standards and rules. Antisocial behaviors may include irresponsibility, delinquent behaviors (e.g., truancy or running away), violating the rights of others (e.g., theft), and/or physical aggression toward others (e.g., assault or rape). These behaviors sometimes occur together; however, one or several may occur without the other(s).

What causes CD?

The conditions that contribute to the development of CD are considered to be multi-factorial, with many factors contributing to the cause. Neuro-psychological testing has shown that kids and teens with CD seem to have impairment in the frontal lobe of the brain that interferes with their ability to plan, avoid harm, and learn from negative experiences. Childhood temperament is considered to have a genetic basis. Kids or teens that are considered to have a difficult temperament are more likely to develop behavior problems. Kids or teens from disadvantaged, dysfunctional, and disorganized home environments are more likely to develop CD. Social problems and peer group rejection have been found to contribute to delinquency. Low socioeconomic status has been associated with CD. Kids and teens exhibiting delinquent and aggressive behaviors have distinctive cognitive and psychological profiles when compared to kids with other mental health problems and control groups. All of the possible contributing factors influence how kids and teens interact with other people.

Who is affected by CD?

Approximately 1 percent to 4 percent of kids (ages nine to 17 years old) have CD. The disorder is more common in males than in females. Kids and teens with CD often have other psychiatric problems as well that may be a contributing factor to the development of the conduct disorder. The prevalence of CD has increased over recent decades. Aggressive behavior is the reason for one-third to one-half of the referrals made to youngster and teen mental health services.

What are the symptoms of CD?

Most symptoms seen in kids with CD also occur at times in kids without this disorder. However, in kids with conduct disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.

The following are the most common symptoms of conduct disorder. However, each youngster may experience symptoms differently. The four main groups of behaviors include the following:

Aggressive conduct causes or threatens physical harm to others and may include the following:
  • bullying
  • cruelty to others or animals
  • forcing someone into sexual activity, rape, molestation
  • intimidating behavior
  • physical fights
  • use of a weapon(s)

Destructive conduct may include the following:
  • arson
  • vandalism; intentional destruction to property

Deceitful behavior may include the following:
  • delinquency
  • lying
  • shoplifting
  • theft

Violation of ordinary rules of conduct or age-appropriate norms may include the following:
  • mischief
  • pranks
  • running away
  • truancy (failure to attend school)
  • very early sexual activity

The symptoms of CD may resemble other medical conditions or behavioral problems. Always consult your youngster's doctor for a diagnosis.

How is CD diagnosed?

A youngster psychiatrist or a qualified mental health professional usually diagnoses CD in kids and teens. A detailed history of the youngster's behavior from moms and dads and educators, observations of the youngster's behavior, and, sometimes, psychological testing contribute to the diagnosis. Moms and dads who note symptoms of CD in their youngster or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Further, CD often coexists with other mental health disorders, including mood disorders, anxiety disorders, post-traumatic stress disorder, substance abuse, attention-deficit/hyperactivity disorder, and learning disorders, increasing the need for early diagnosis and treatment. Consult your youngster's doctor for more information.

Treatment for CD:

Specific treatment for kids with CD will be determined by your youngster's doctor based on:
  • expectations for the course of the condition
  • extent of your youngster's symptoms
  • your youngster's age, overall health, and medical history
  • your youngster's tolerance for specific medications or therapies
  • your opinion or preference

Treatment may include:

• Peer group therapy is often focused on developing social skills and interpersonal skills.

• While not considered effective in treating conduct disorder, medication may be used if other symptoms or disorders are present and responsive to medication.

• Family therapy is often focused on making changes within the family system (e.g., improving communication skills and family interactions).

• The goal of cognitive-behavioral therapy is to improve problem solving skills, communication skills, impulse control, and anger management skills.

Prevention of CD in childhood:

As with ODD (Oppositional Defiant Disorder), some experts believe that a developmental sequence of experiences occurs in the development of conduct disorder. This sequence may start with ineffective parenting practices, followed by academic failure, and poor peer interactions. These experiences then often lead to depressed mood and involvement in a deviant peer group. Other experts, however, believe that many factors, including youngster abuse, genetic susceptibility, history of academic failure, brain damage, and/or a traumatic experience influence the expression of conduct disorder. Early detection and intervention into negative family and social experiences may be helpful in disrupting the development of the sequence of experiences that lead to more disruptive and aggressive behaviors.

Help for Parents with ADHD/ODD Children

How should parents handle a violent child with Oppositional Defiant Disorder?

Violent behavior in kids and teens with Oppositional Defiant Disorder (ODD) can include a wide range of behaviors:
  • cruelty toward animals
  • explosive temper tantrums
  • fighting
  • fire setting
  • intentional destruction of property
  • physical aggression
  • threats or attempts to hurt others (including homicidal thoughts)
  • use of weapons
  • vandalism

Numerous research studies have concluded that a complex interaction or combination of factors leads to an increased risk of violent behavior in ODD kids and teens. These factors include:
  • Being the victim of physical abuse and/or sexual abuse
  • Brain damage from head injury
  • Combination of stressful family socioeconomic factors (e.g., poverty, severe deprivation, marital breakup, single parenting, unemployment, loss of support from extended family, etc.)
  • Exposure to violence in media (e.g., TV, movies, etc.)
  • Exposure to violence in the home and/or community
  • Genetic factors
  • Presence of firearms in home
  • Previous aggressive or violent behavior
  • Use of drugs and/or alcohol

ODD kids and teens who have several risk factors and show the following behaviors should be carefully evaluated:
  • Becoming easily frustrated
  • Extreme impulsiveness
  • Extreme irritability
  • Frequent loss of temper or blow-ups
  • Intense anger

Parents and teachers should be aware of the following tips for dealing with violent ODD children and teens:

1. Stop being intimidated by your ODD youngster. Many moms and dads are afraid to discipline an unruly youngster for fear that he will resent them for being an authority figure. Your youngster doesn't have to like you or even love you, but he does have to respect the parent-child relationship, and realize that there will be consequences for negative actions. Recognize that you don't have to be your youngster's buddy, but you do have to be his parent.

2. Seek treatment. Whenever parents become concerned about violent behavior, they should immediately arrange for a comprehensive evaluation by a qualified mental health professional. Early treatment by a professional can often help. The goals of treatment typically focus on helping the ODD youngster to:
  • accept consequences
  • be responsible for her actions
  • express anger and frustrations in appropriate ways
  • learn how to control her anger

In addition, family conflicts, school problems, and community issues must be addressed.

3. Maintain a unified front. Sometimes aggressive kids know that if they engage in "divide and conquer" tactics with their moms and dads, they will be able to get their way. Thus, parents need to be unified in their parenting. If you're together, if you're unified and if you're there for each other, then all of a sudden there's strength in numbers. Don't forget to close the ranks.

4. Every youngster has currency. Use it! There's not a kid born that doesn't have currency (e.g., toys, clothes, games, television, etc.). Access to this "currency" needs to be contingent upon proper behavior. For example, if an ODD youngster throws a tantrum in a crowded store, he should not be rewarded with a toy or a coloring book. He needs to understand the consequences of his behavior. Predict the consequences of his actions with 100 percent accuracy.

5. Don't get into a power struggle with an ODD youngster. Sometimes aggressive kids know that if they struggle long enough with their moms and dads (e.g., by yelling, screaming, throwing temper tantrums, etc.) that they will get their way. Don’t fall for these tactics. Be firm in disciplining your youngster, and let him know that there are boundaries that he has to observe.

6. Acknowledge your role. When an ODD youngster is acting out, the family will blame him for the family's dysfunction. Oftentimes, you will see a family that will present a disruptive youngster for treatment ... this is the sacrificial lamb for the family's toxicity. Moms and dads should examine their own behavior, and if need be, the entire family should seek counseling.

Help for Parents with ODD Children and Teens

What can parents do to help their oppositional defiant children?

Since kids pass through many developmental stages as they mature, it is important to understand the differences between normal childhood attempts to defy authority and symptoms of full-blown Oppositional Defiant Disorder (ODD).

Oppositional defiant kids share many of the following characteristics:
  • are driven to defeat authority figures
  • are relentless in their pursuit of proving authority figures to be wrong or stupid
  • are socially exploitive and very quick to notice how others respond; they then use these responses to their advantage in family or social environments
  • are vigorously intent on “getting their way”
  • deny responsibility for their misbehavior and have little insight into how they impact others.
  • have thoughts that revolve around defeating anyone’s attempt to exercise authority over them
  • possess a strong need for control, and will do just about anything to gain power
  • tolerate a great deal of negativity – in fact they seem to thrive on large amounts of conflict, anger and negativity from others, and are frequently the winners in escalating battles of negativity
  • turn most interactions with authority figures into win-lose situations

Besides Oppositional Defiant Disorder, ODD kids may also have another psychiatric disorder. Oppositional Defiant Disorder is frequently a co-morbid condition with ADHD. It can also be diagnosed along with Tourette’s, OCD, anxiety and mood disorders, Aspergers, language-processing impairments, sensory integration deficits, or nonverbal learning disabilities.

What causes this troubling behavior? Some researchers believe that many of the symptoms of these disorders may share common neurobiological mechanisms. If your youngster is affected by one of these disorders, it is critical to keep in mind that Oppositional Defiant Disorder can create additional problems for you and your youngster.

Many authorities on parenting have indicated that ODD is more prevalent when structure in the home is out of balance (i.e., when there is either too much structure or not enough). In an overly structured environment, the parenting is rigid and inflexible. These moms and dads “micromanage” and come down hard on their kids, controlling every aspect of their lives. This particular style of parenting only serves to create more ODD behavior. On the other hand, structure that is too loose can also cause difficulties. Kids can exhibit ODD behavior when moms and dads do not provide enough structure by setting appropriate boundaries, or establishing and following through with consequences for misbehavior. These moms and dads usually give in to all of their youngster’s demands, either out of fear of the youngster, or in an effort to keep themselves in the youngster’s good graces.

In order to prevent or reduce ODD behavior, moms and dads should aim towards a firm and loving parenting style in which the structure is balanced. They must take charge, and place themselves at the top of the family hierarchy. They must use their authority as parents and, at the same time, make the youngster feel protected, loved and soothed.

How well the moms and dads get along, whether married or divorced, is another factor to consider in preventing ODD. When couples are unhappy or defiant in themselves, they frequently disagree on parenting issues, significantly limiting their success in changing the behavior of their youngster. ODD kids are experts at dividing their parent’s authority, and will most certainly take advantage of exploiting rifts between their mom and dad. Couples counseling may be in order to decrease the hostility and conflict between the mother and father and set the stage for united, successful parenting.

Another factor to consider is how the family is affected by this disorder. This can be one of the most stressful conditions a family faces and, when it is secondary to another neuropsychiatric disorder, that stress is compounded. Family counseling may be helpful to resolve family difficulties. The family therapist can provide a controlled environment which offers support and skills training to weary moms and dads.

Once marital and family issues are addressed, moms and dads can begin to train both themselves and their youngster. If parents continue to respond to quarrelsome behavior as they always have, the ODD child will continue to tune parents out, escalate the arguments, and push parent’s buttons. Most authority figures engage in an argument with concern for the outcome. The parent’s/teacher’s goal in an argument is to come to a resolution. In other words, what transpires as a result of the conflict is most important. As a mother or father, from your perspective, if you have determined the outcome of the argument, you are the one in control. For the ODD youngster, the process of creating an argument is more meaningful to him than the outcome of the conflict. These arguments over insignificant issues may seem pointless however, with such a strong need for control, it is your defiant youngster’s goal is to escalate the conflict until you are no longer the one in control. What is important to him is not the issue being argued over, as much as what is going to happen during the argument.

In order to control the process of the argument, the ODD youngster attempts to determine the topic and direction of the conflict, and seems to instinctively know when parents are feeling most vulnerable and when their energy is low. The ODD child will bring up conflict-laden issues during these times, aiming towards pushing the parent’s buttons and diverting them from issues in which they are likely to be attempting to exert authority over the ODD child.

When the Oppositional Defiant Disorder youngster finally pushes the parent’s buttons, in his mind, he has gained control of the parent and her emotions. At this point, he has now successfully taken over the position of authority. Furthermore, when the parent loses control of her emotions, the youngster’s anxiety level rises along with his defensiveness. When his defenses increase, he becomes more defiant, which is his main defense mechanism. As he becomes more defiant, the situation escalates and the parent is caught in an endless cycle of conflict.

What can parents do?

1. It is critical not to take what your youngster says personally. As soon as you defend yourself, your youngster, by the rules governing arguments, has the right to defend himself against your attack. In turn, you get to defend yourself, and he has now pushed your buttons and gained power. You do not have to defend yourself or try to convince him you are right. Do not lower yourself to the level of your oppositional youngster.

2. Once you have successfully avoided having your buttons pushed and have gained some control over your youngster’s behavior, it is time to go on the offensive to soothe him and help him get back to a calm state of mind.

3. One of the driving forces behind Oppositional Defiant Disorder is that the youngster is trying to grow up too quickly and considers himself to be equal to his mom and dad. The Oppositional Defiant Disorder youngster may feel less loved due to the amount of conflict going on, and it is difficult to simultaneously feel loved as a youngster and try to operate on an adult level. Your youngster may know intellectually that he is loved, but not feel loved. Moms and dads must be able to show love, and soothe and nurture their youngster. This is not always easy to accomplish, especially when previous negative behavior patterns have become ingrained.

4. Rules and consequences must be clear and in writing to provide clarity for both youngster and parent before the conflict occurs. Begin by removing reinforcers (e.g., television, stereos, CD’s, DVD’s, computers, video games, telephones, bicycles, skateboards, visiting friends, access to favorite clothing, favorite foods, etc.) and allowing your youngster to earn the items back as a reward for acceptable behavior.

5. Strategies for avoiding conflict are essential to de-escalate the situation. It is wise to change the subject if your energy is low, or you suspect that the topic of discussion will result in an argument.

6. Tell the ODD child, in an calm rational manner, that he has two choices: (1) If he wants to stay around, he can change the subject and stop complaining, or (2) he can go somewhere else in the house to complain if he chooses. Should your youngster choose to escalate, it is time to use two powerful words which can cut through any argument. These words are “regardless” and “nevertheless” (e.g., “Nevertheless, this is how it is going to be…”). Using these words repetitively (like a broken record), in a relaxed manner will serve to de-escalate the situation without allowing your youngster to draw you into the power struggle.

7. Utilizing effective consequences for the defiant youngster can be difficult since this presents one more opportunity for conflict in which you are likely to lose power. Discussing consequences while you are in the middle of conflict will most likely result in more frustration for you. Thus, it is important to focus on consequences that do not require cooperation of the youngster.

8. Walking away from the conflict is another strategy to consider. If you can’t change the subject or walk away, it is important to keep in mind that the Oppositional Defiant Disorder youngster’s goal is to push your buttons. Think about your endurance. How long can you endure intense button pushing? When you get to the end of your rope, what are your options?

Help for Parents with Oppositional Defiant Children and Teens

Would a “scared straight” boot camp work for a child with oppositional defiant disorder?

Re: Would a “scared straight” boot camp work for a child with oppositional defiant disorder?

The short answer is: not according to the research.

“Scared Straight” is a program designed to deter “bad” teens from future criminal offenses. The teenagers visit inmates, observe first-hand prison life, and have interaction with adult inmates. Since many desperate parents are looking for a “quick fix,” these programs have become very popular.

The basic idea behind these programs is that children and teens who see what prison is like will be deterred from future violations of the law (i.e., they will be frightened into behaving properly). Scared Straight emphasizes severity of consequences, but neglects two other key components of “deterrence theory” — certainty and swiftness. Why is this important? Because teens (in their naiveté) believe (a) “incarceration is never going to happen to me” and (b) “even if I do get incarcerated, it’s not going to happen anytime soon.”

One study investigated the effects of programs comprising organized visits to prisons by teen offenders (officially adjudicated or convicted by a juvenile court) or pre-offenders (kids in trouble but not officially adjudicated as “delinquents”), aimed at deterring them from any further criminal activity.

The selection criteria for the research they reviewed were:
  • Each study investigated had to include a no-treatment control condition with at least one outcome measure of “post visit” criminal behavior
  • Only studies that randomly or quasi-randomly assigned participants to conditions were included
  • Overlapping sample of teens and young adults (ages 14-20) were included
  • Studies that assessed effects of any program involving organized visits of teens or kids at- risk for criminality to penal institutions

Nine trials met the criteria for the study. The researchers’ results indicated that the Scared Straight program to be more harmful than doing nothing. The program effect, whether assuming a fixed or random effects model, was nearly identical and negative in direction, regardless of the meta-analytic strategy.

So, according to the study, the Scared Straight program not only does NOT work, it may actually be more harmful than doing nothing.

Another study showed that the Scared Straight program could possibly worsen Conduct Disorder symptoms. And yet another study showed that the program and similar programs produced substantial increases – not decreases – in recidivism (i.e., chronic relapse into crime).

The Scared Straight program relies on a deterrence-based strategy that fails to consider the driving mechanisms of deterrence. These mechanisms include (a) certainty of receiving a consequence (i.e., negative stimuli following a behavior), and (b) swiftness of the consequence (i.e., temporal proximity of punishment to the unwanted behavior). In other words, an uncomfortable consequence must be presented shortly after the unwanted behavior.



References—

1. Aos, S., Phillips, P., Barnoski, R., & Lieb, R. (2001). The Comparative Costs and Benefits of Programs to Reduce Crime. Olympia: Wash. State Inst. Public Policy.
2. Hale, J. (2010). Interview with Dr. DiMichelle. Via e-mail [accessed Nov.23, 2010].
3. Lilienfeld, SO. (2005). Scientifically Unsupported and Supported Interventions for Childhood Psychopathology: A Summary. PEDIATRICS 115; 761-764.
4. Lilienfeld, SO., Lynn, SJ., Ruscio, J., & Beyerstein, BL. (2010). 50 GREAT MYTHS OF POPULAR PSYCHOLOGY: Shattering Widespread Misconceptions about Human Behavior. Malden, MA: Wiley- Blackwell.
5. Marion, N.E., & Oliver, W.M. (2006). The public policy of crime and criminal justice. Upper Saddle River, NJ: Pearson.
6. Mears, D.P. (2007). Towards Rational and Evidence-based Crime Policy. Journal of Criminal Justice. 35; 667-682.
7. Petrosino, A., Turpin-Petrosino, C., & Buehler, J. (2002). “Scared Straight” and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database Syst Rev. (2): CD002796.