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Parenting Kids with ODD: The Do's and Don'ts

The best way to treat a youngster with Oppositional Defiant Disorder (ODD) involves behavior management techniques, using a consistent approach to discipline, and following through with positive reinforcement of appropriate behaviors.

Here are the Do’s and Don’ts:

Do's—

1. Do apply established consequences immediately, fairly and consistently. Be consistent and set down specific rules, because changing the rules mid-stream can be confusing to the ODD youngster. Be sure that BOTH parents are on-board with the same rules.

2. Do explain why you are disciplining the ODD youngster. Kids need not only to understand what they did wrong – but why it was wrong and what they should have done right. This also needs to be conveyed to them in a way that they will grasp. This allows the youngster to grow and not just stop the immediate behavior that is in front of you.

3. Do limit the time ODD kids can watch television, play video games, and listen to music. Sticking to these rules allows time for the kids to think on their own and to use their creativity.

4. Do think about how the consequence will affect you and the rest of the family. If you have a youngster who likes to control you or others in the family, choose consequences carefully. Be sure that the consequence ONLY affects the youngster who misbehaved and not anyone else. Do not say, "We are not going until you clean your room." If you are going somewhere he wants to go, this threat may work. If he does not want to go, you have just given the youngster a lot of power. No one can go until the room is clean. You are giving this youngster control over the entire family! What do you do with a youngster who is not permitted to go somewhere with the rest of the family? Get a baby-sitter and then go and have a good time. Your youngster will learn that his misbehavior will not prevent the family from having fun.

Dont's—

1. Don’t allow electronics to become a babysitter for your ODD youngster. Moms and dads often wonder how to take TV privileges from one youngster. If they have to shut off the TV, the other kids will be punished too. That's true. Do not shut the TV off because one youngster is restricted. That punishes everyone. Watch TV as usual. The youngster who is being disciplined should go in another room WITHOUT TV or games. If no one can watch TV because he/she cannot watch TV, you are giving your youngster control over the entire family. Who is being punished?

2. Don’t play "Let’s Make a Deal" with the ODD youngster, "If you clean your room, you can go to the movies tonight." Too many moms and dads use this approach to get the youngster to do something, and bargaining becomes a way of life. The mother or father is constantly caught in a struggle to make the deal. Instead, enforce predetermined consequences and apply intermittent reinforcement for good behavior. A reinforcer is anything that the youngster likes or desires. Examples of reinforcers can include praise, spending quality time together, or going to a movie to name a few. Once you have issued a rule or instruction, you shouldn’t back down. The primary rule is that the youngster must obey the parent!

3. Don't allow the youngster to manipulate you. Kids with ODD are very cunning at getting their own way.

Parenting Children with Oppositional Defiant Disorder

What is Antisocial Personality Disorder?

Antisocial Personality Disorder (APD) is specifically a pervasive pattern of disregarding and violating the rights of others. Diagnostic criteria for this disorder state that this pattern must include at least three of the following specific signs and symptoms:

• A lack of feeling guilty about wrong-doing
• Disregard for personal safety or the safety of others
• Failure to think or plan ahead
• Lack of conforming to laws, as evidenced by repeatedly committing crimes
• Persistent lack of taking responsibility, such as failing to establish a pattern of good work habits or keeping financial obligations
• Repeated deceitfulness in relationships with others, such as lying, using false names, or conning others for profit or pleasure
• Tendency to irritability, anger, and aggression, as shown by repeatedly assaulting others or getting into frequent physical fights

Other important characteristics of this disorder include the following:

• it can’t be diagnosed if the individual only shows symptoms of APD at the same time they are suffering from schizophrenia or when having a manic episode
• it isn’t diagnosed in kids younger than 18 years of age, but the affected individual must have shown symptoms of this diagnosis at least since 15 years of age
• it tends to occur in about 1% of females and 3% of males in the United States

What is the difference between Antisocial Personality Disorder and psychopathy?

In contrast, psychopathy, although not a mental health disorder formally recognized by the American Psychiatric Association, is considered to be a more severe form of APD. Specifically, in order to be considered a psychopath, the person must experience a lack of remorse of guilt about their actions in addition to demonstrating antisocial behaviors. While 50%-80% of incarcerated people have been found to have APD, only 15% have been shown to have the more severe APD-type of psychopathy.

Psychopaths (also called sociopaths) tend to be highly suspicious or paranoid, even in comparison to people with APD. The implications of this suspicious stance can be dire, in that paranoid thoughts tend to lead the psychopathic individual to interpret all aggressive behaviors toward them, even those that are justified, as being arbitrary and unfair. A televised case study of a psychopath provided a vivid illustration of the resulting psychopathic anger. Specifically, the criminal featured in the story apparently abducted a female and sexually abused her over the course of a number of days in an attempt to prove to investigating authorities that his step-daughter's allegations that he sexually abused her were false.

What causes Antisocial Personality Disorder?

One of the most frequently asked questions about APD is whether or not it is genetic. Many wonder if it is hereditary. If this were the case, kids of antisocial parents would be highly expected to become antisocial themselves, whether or not they live with the antisocial mother/father. Fortunately, people are just not that simple. Like all personality disorders, and also most mental disorders, APD tends to be the result of a combination of biologic/genetic and environmental factors.

Although there are no clear biological causes for this disorder, research on the possible biologic risk factors for developing APD indicates that the part of the brain that is primarily responsible for learning from one's mistakes and for responding to sad and fearful facial expressions tends to be smaller and respond less robustly to the happy, sad, or fearful facial expressions of others. That lack of response may have something to do with the lack of empathy that antisocial people tend to have with the feelings, rights, and suffering of others. While some people may be more vulnerable to developing APD as a result of their particular genetic background, that is thought to be a factor only when the individual is also exposed to life events (e.g., abuse or neglect) that tend to put the person at risk for development of the disorder. Similarly, while there are some theories about the role of PMS and other hormonal fluctuations in the development of antisocial personality disorder, the disorder can, so far, not be explained as the direct result of such abnormalities.

Other conditions that are thought to be risk factors for APD include:

• a reading disorder
• attention deficit hyperactivity disorder
• conduct disorder
• substance abuse

Individuals who experience a temporary or permanent brain dysfunction (also called organic brain damage) are at risk for developing violent or otherwise criminal behaviors. Theories regarding the life experiences that put individuals at risk for APD provide important clues for its prevention. Examples of such life experiences include:

• a history of childhood physical, sexual, or emotional abuse
• a parent who is either antisocial or alcoholic
• associating with peers who engage in antisocial behavior
• deprivation or abandonment
• neglect

How is Antisocial Personality Disorder diagnosed?

There is no specific definitive test (e.g., blood test) that can accurately assess whether an individual has APD. Professionals conduct a mental-health interview that looks for the presence of the symptoms previously described. Due to the use of a mental-health interview in making the diagnosis and the fact that this disorder can be quite resistant to treatment, it is important that the professional know to assess the symptoms in the context of the person’s culture so that particular individual is not assessed as having APD when he/she doesn’t. Unfortunately, research shows that many professionals lack the knowledge, experience, and sometimes the willingness to factor cultural context into their assessments.

What are the treatments for Antisocial Personality Disorder?

While it can be quite resistant to change, research shows there are a number of effective treatments for this condition. For example, teens who receive therapy that helps them change the thinking that leads to their maladaptive behavior has been found to significantly decrease the incidence of repeat antisocial behaviors.

On the other hand, attempting to treat APD like other conditions is not often effective. For example, programs that have tried to use a purely reflective approach to treating depression or eating disorders in individuals with APD often worsen rather than improve outcomes in those persons. In those cases, a combination of firm - but fair - programming that emphasizes teaching people with APD the skills that can be used to live independently and productively within the rules and limits of society has been more effective.

While medications don’t directly treat the behaviors that characterize APD, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious people who also have APD may benefit from antidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.

What happens if Antisocial Personality Disorder is not treated?

Some societal costs of APD (e.g., the suffering endured by victims of the crimes committed by individuals with this disorder) are clear. However, when individuals with APD are the charismatic leaders of religious cults, the devastation they can create is often not known unless and until a catastrophe results (e.g., the mass suicide that occurred at the command of the Reverend Jim Jones in Guyana in 1978).

People who suffer from APD have a higher risk of abusing alcohol and other drugs and repeatedly committing crimes. Imprisonment is a potential consequence. Individuals with APD are also vulnerable to the following:

• dying from homicide, suicide, or accident
• having other personality disorders (e.g., borderline and narcissistic personality disorder)
• mood problems (e.g., major depression, anxiety, bipolar disorder)
• self-mutilation and other forms of self-harm

APD tends to make virtually any other condition more problematic and difficult to treat. Having APD makes people who also have a substance abuse problem more difficult to help abstain from alcohol or other drug use. Individuals who have both APD and schizophrenia are less likely to comply with treatment programs and are more likely to remain in an institution like prison or a hospital. These risks become magnified if APD is not treated. Statistics indicate that many individuals with APD experience a remission of symptoms by the time they reach 50 years of age.

Antisocial Personality Disorder Summary—

• A personality disorder (PD) is a persistent pattern of thoughts, feelings and behaviors that is significantly different from what is considered normal within the person's own culture.

• Although APD can be quite resistant to treatment, the most effective interventions tend to be a combination of firm but fair programming that emphasizes teaching APD people skills that can be used to live independently and productively within the rules and limits of society.

• APD is likely the result of a combination of biologic/genetic and environmental factors.

• APD is specifically a pervasive pattern of disregarding and violating the rights of others and may include symptoms such as breaking laws, frequent lying, starting fights, lack of guilt and taking personal responsibility, and the presence of irritability and impulsivity.

• Diagnoses often associated with APD include substance abuse, attention deficit hyperactivity disorder, and reading disorders.

• If untreated, individuals with APD are at risk for developing or worsening a myriad of other mental disorders. APD individuals are also at risk for self-mutilation or dying from homicide or suicide.

• Many individuals with APD experience a remission of symptoms by the time they reach 50 years of age.

• Personality disorders are grouped into clusters A, B, and C based on the dominating symptoms.

• Psychopaths tend to be highly suspicious or paranoid, even in comparison to people with APD, which tends to lead the psychopathic person to interpret all aggressive behaviors toward them as being arbitrary and unfair.

• Psychopathy is considered to be a more severe form of APD. Specifically, in order to be considered a psychopath, the person must experience a lack of remorse or guilt about their actions in addition to demonstrating antisocial behaviors.

• Research indicates ethnic minorities tend to be falsely diagnosed as having antisocial personality disorder, inappropriately resulting in less treatment and more punishment for those people.

• Since there is no specific definitive test that can accurately assess the presence of APD, professionals conduct a mental-health interview that looks for the presence of antisocial symptoms. If the cultural context of the symptoms is not considered, APD is often falsely diagnosed as being present.

• Some theories about the biological risk factors for APD include dysfunction of certain genes, hormones, or parts of the brain.

• Theories regarding the life experiences that put individuals at risk for APD include a history of childhood physical, sexual, or emotional abuse; neglect, deprivation, or abandonment; associating with friends who engage in antisocial behavior; or having a mother or father who is either antisocial or alcoholic.

• While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions like depression, anxiety, and mood swings that co-occur with this condition.

Parenting Children with Oppositional Defiant Disorder

Parenting Oppositional Defiant Children and Teens: How to Pick Your Battles

What's often tricky in parenting a defiant youngster is figuring out the "is this worth fighting for?" part – especially if you have to think fast. Defiant kids and teens often make a “game” out of getting into battles with their moms and dads, and if the parent gets tricked into playing this game, she finds herself in an endless stream of warfare.

So, how can you avoid fighting every battle and save your time and energy for the ones worth fighting for? Here are some important tips for knowing which battles to fight – and which ones to let go of:

1. Ask yourself, “Will this battle fight itself?” There are some things that will get addressed by default – and you can stay totally out of it (which saves you from being the “bad guy”). For example, you may be tempted to continue to battle with your defiant child over his poor teeth-brushing habits, even when the two of you have had many past battles over this issue to no avail. Instead, give a final warning: “If you continue to neglect your teeth, you will get a cavity, which will result in a painful toothache and a trip to the dentist.” Then, let go of it. You tried. He will have to learn the hard way.

2. Ask yourself, “Can I live with it?” If something your teenager wants to do isn't going to hurt anyone and won't make you terribly unhappy, then let her do it. Say, for example, "Getting your hair dyed pink is not something I would have done as a teenager, but if it makes a statement, then go for it.”

3. Ask yourself, “Is this battle worth fighting?” Maybe the crumbs on the floor and the toothpaste all over the sink aren't worth fighting over, but the toy throwing and TV obsession need to be addressed. If it helps, you can make a list of what you can tolerate and what you can't.

4. Ask yourself, “When my child leaves the nest, what values do I want her to take away?” Those values are your “non-negotiable” items. Those issues are the ones to talk about most. Those are also ones she is most likely to adopt if you explain why you deem them essential. Remember, moms and dads who raise moral children don’t do so by accident. Be intentional! Explain your beliefs. Don’t deviate from what matters most.

5. Adolescents need their privacy. Just as you’re not going to share everything about your life, they won’t either. So let your adolescent know that you will honor her privacy. No reading her diary or going through her drawers. But those rules are immediately broken if you have any founded concern (i.e., a probable cause) that your adolescent’s safety is in jeopardy (e.g., drugs, illegal activities, suicidal thoughts, etc.). Be concerned if your adolescent becomes suddenly secretive or withdrawn or shows unusual amounts of anger or aggression. Then pick those locks and strip-search that room.

6. Choose rules that work for you. Rules can be arbitrary but they are essential to sanity and safety. In some households, kids only eat in the kitchen. In others, kids go to sleep at 7:00. There will never be universal rules for all kids in all homes. But every home needs a few time-honored rules.

7. Engage in diplomacy. Your 5th grader wants to walk to school alone. You may not feel it is safe, but rather than argue, see if you can come up with a compromise that lets him save face, such as driving him to a point a couple blocks away from school and letting him walk from there.

8. It's important to note that there are certain developmental stages at which children naturally assert their need for independence and individuality (e.g., by dressing like a circus freak). It helps to view the push-back as less about defying you and more about saying "I gotta be me!"

9. Keep your family-values list to a reasonable handful. If it's way long, you're going to be fighting a lot. It might feel like your defiant teenager is carrying a sign that says “I reject every decent thing my mom and dad tried to teach me” when she leaves the house wearing jeans with holes in the knees, a lip piercing, and gothic make-up that is caked-on so thick she looks like Alice Copper. But when it comes down to it, chances are “I want my daughter to dress in the clothing I think looks nice” wouldn't make your list of core values.

10. Refer back to the house-rules. Whatever house-rules you have already established should be reinforced. No ifs, ands or buts about it. Minor infractions that can be part of a larger house-rule should be a battle worth picking. So if one of your house-rules is "No Cussing," then you have a point of reference by telling your youngster, "I said no cussing. That's against house-rules."

11. Say “yes” more than “no”. Too many “no’s” are just as ineffective as too few. Your youngster tunes you out or gives up because he keeps running into roadblocks.

12. Teach your youngster the skills needed to follow the rules. A rule is meaningless if your youngster isn’t getting it. It’s important not to lose credibility. If an “inside voice” is challenging to your youngster, practice with toilet paper rolls to make it fun. If running through stores has become a game, make a few trips to the mall when you have nothing else to do but teach appropriate behavior. And leave as soon as your defiant youngster starts to test your commitment.