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CHILDREN WITH OPPOSITIONAL DEFIANT DISORDER
A note about clinical diagnosis: There is considerable disagreement about the meaning of psychiatric diagnoses. Basically, a diagnosis refers to a pattern of behavior; some of these patterns have been very closely correlated with discernible biochemical or neurological markers, while others have not. For example, we see clear biological differences in the blood chemistry of certain kinds of depressive people, while there is (so far) no such biological basis for obsessive-compulsive behavior.
Also, psychology and psychiatry evolved in a time when the medical model of behavior was the dominant view. Therefore, diagnosis came about as a way of attempting to identify what the patient “had,” as if it were a disease like measles, mumps, or cancer.
Nowadays, we are more aware of social conditions which might induce various patterns of behavior, so we aren’t quite as definite that there is something “inside” a person that makes them act the way they do.
But, if we didn’t have some way of categorizing patterns of behavior, we’d be starting from scratch each time someone came to see us, and would have no basis on which to decide what kind of treatment could be effective, whether medication might help, etc. So diagnoses serve some purpose, even though the idea of categorizing a human being is objectionable to us. The important thing is, to see each person as an individual (in fact, to “start over” every time a new client walks in the door), and to use the diagnosis as a useful but not all-defining tool to help make sense of things- as far as it goes.
The discussions of clinical patterns/syndromes/diagnoses are presented on this website in that spirit.
*For an interesting discussion of the realities of diagnosis, see The Dictionary of Disorder: How one man revolutionized psychiatry, by Alix Spiegel in the January3, 2005 New Yorker magazine.
Oppositional Defiant Behavior
“I hate you, you’re such a bitch, I am too going to wear my red dress! You promised me yesterday, and if I can’t wear it today, I’m not getting ready for school!” Molly had been arguing about the dress for the past forty-five minutes. It was 8:05, mom was running late, and the dress was filthy. That overwhelming exhausted feeling enveloped mom and, once again, she caved.
“Go ahead and wear it,” she screamed.
All children are oppositional from time to time, particularly when tired, hungry, stressed or upset. They may argue, talk back, disobey, and defy parents, teachers, and other adults. Oppositional behavior is often a normal part of development for two to three year olds and early adolescents. However, openly uncooperative and hostile behavior becomes a serious concern when it is so frequent and consistent that it stands out when compared with other children of the same age and developmental level and when it affects the child's social, family, and academic life.
For some children, there is an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with the youngster's day to day functioning. Symptoms of ODD may include:
Frequent temper tantrums.
Excessive arguing with adults.
Active defiance and refusal to comply with adult requests and rules.
Deliberate attempts to annoy or upset people.
Blaming others for his or her mistakes or misbehavior.
Often being touchy or easily annoyed by others.
Frequent anger and resentment.
Mean and hateful talking when upset.
Seeking revenge.
The symptoms are usually seen in multiple settings, but may be more noticeable at home or at school. Five to fifteen percent of all school-age children have ODD. The causes of ODD are unknown, but many parents report that their child with ODD was more rigid and demanding than the child's siblings from an early age. Biological and environmental factors may have a role.
A child presenting with ODD symptoms should have a comprehensive evaluation. It is important to look for other disorders which may be present; such as, attention-deficit hyperactive disorder (ADHD), learning disabilities, mood disorders (depression, bipolar disorder) and anxiety disorders. It may be difficult to improve the symptoms of ODD without treating the coexisting disorder.
Treatment of ODD may include some of the following methods: Family Psychotherapy and parent training Programs to help manage the child's behavior and to improve family communication, individual psychotherapy to develop more effective anger management and to assist problem solving and decrease negativity, and social skills training to increase flexibility and improve frustration tolerance with peers.
A child with ODD can be very difficult for parents; because of the high demand children with ODD make on the adults responsible for them, parents and family often considerable need support and understanding. Parents can help their child with ODD in the following ways:
Adopted from, The American Academy of Child and Adolescent Psychiatry (AACAP)
Dealing With Oppositionality
1. Pick your battles. Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do. If you give your child a time-out in his room for misbehavior, don't add time for arguing. Instead, if he argues with you, just say: "Your time will start when you go to your room."
2. When you sense the conflict taking hold, change the subject.
3. Walk away from the conflict. Take a time-out or a break if you are about to make the conflict with your child worse, not better. This is good modeling for your child. Support your child if he decides to take a time-out to prevent overreacting.
4. Do not to take what your youngster says personally.
5. Do not try to defend yourself or try to convince him you are right.
6. Tell him, in an unruffled rational manner, that he has two choices. If he wants to stay around, he can change the subject and stop complaining; or he can go to his room if he chooses.
7. Use the two powerful words which can cut through any argument: “regardless” and “nevertheless.” For example, “Nevertheless, this is how it is going to be…” Use them repetitively (like a broken record), in a calm unemotional manner.
8. Focus on consequences that do not require cooperation of the child. For example, “If you continue arguing with me, I will not take you to basketball practice. You choose whether you’d like to argue, or go to basketball.”
9. Rules and consequences must be clear, and in writing to provide clarity for both child and parent before the conflict occurs.
10. Build on the positives, give the child praise and positive reinforcement when he shows flexibility or cooperation.
11. When the conflict condition is off, show love, and soothe and nurture your child.
Louis R. Levin, Ph.D.
Clinical Psychologist
NM #598
2078 Calle Contento, Santa Fe , NM 87505 (505) 473-3719
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