Samaritan Behavioral Health

Solutions to Oppositional Defiant Disorder

“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.

If your child has been diagnosed with oppositional defiant disorder (ODD), this scenario may sound much too familiar. According to the Diagnostics and Statistical Manual of Mental Disorders, fourth Ed., oppositional defiant disorder can cause clinical impairment in social, academic, or occupational functioning, and is characterized by a recurrent pattern of negativistic, defiant, disobedient and hostile behavior toward authority figures which persists for a period of at least six months.

Since children 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. Nine year-old Molly appears driven to defeat adults, is relentless in her pursuit of proving adults to be wrong, stupid, or both, and her thoughts revolve around defeating anyone’s attempt to exercise authority over her. She typically turns every interaction with adults into win/lose situations and is vigorously intent on winning.

Oppositional defiant children share many of the following characteristics:

  • They possess a strong need for control, and will do just about anything to gain power.
  • They typically deny responsibility for their misbehavior and have little insight into how they impact others.
  • The ODD child is socially exploitive and very quick to notice how others respond. He then uses these responses to his advantage in family or social environments, or both.
  • These children 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.

Besides oppositional defiant disorder, children like Molly may also have another psychiatric disorder. ODD is frequently a co-morbid condition with attention-deficit/hyperactivity disorder. It can also be diagnosed along with Tourette Syndrome, obsessive-compulsive disorder, anxiety and mood disorders, Asperger’s, language-processing impairments, sensory integration deficits, or even 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 child is affected by one of these disorders, it is critical to keep in mind that ODD can create additional problems for you and your child.

Many authorities on parenting have indicated that oppositional behavior is more prevalent when structure in the home is out of balance – when there is either too much structure or not enough. In an overly structured environment the parenting is rigid and inflexible. These parents “micromanage” and come down hard on their children, controlling every aspect of their lives. This particular style of parenting only serves to create more opposition and defiance. On the other hand, structure that is too loose can also cause difficulties. Children can exhibit oppositional defiant behavior when parents do not provide enough structure by setting appropriate boundaries, or establishing and following through with consequences for misbehavior. These parents usually give in to all of their child’s demands, either out of fear of the child, or in an effort to keep themselves in the child’s good graces. In order to prevent or reduce oppositional defiant behavior parents should aim towards a firm and loving parenting style in which the structure is balanced. Parents 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 child feel protected, loved and soothed.

How well the parents get along, whether married or divorced, is another factor to consider in preventing oppositional behavior. When couples are unhappy or oppositional in themselves, they frequently disagree on parenting issues, significantly limiting their success in changing the behavior of their child. Molly is an expert at dividing her parent’s authority, and will most certainly take advantage of exploiting rifts between her parents. Couples counseling may be in order to decrease the hostility and conflict between parents and set the stage for united, successful parenting.

Another factor to consider is how the family is affected by ODD. This can be one of the most stressful conditions a family faces and, when it is secondary to another neuro psychiatric 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 parents.

Once marital and family issues are addressed, parents can begin to train both themselves and their child. If Molly’s mother continues to respond to her quarrelsome behavior as she always has, Molly will continue to tune her out, escalate the arguments, and push mom’s buttons. Most adults engage in an argument with concern for the outcome. The adult’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 parent, from your perspective, if you have determined the outcome of the argument, you are the one in control. For the oppositional child the process of creating an argument is more meaningful to her 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 oppositional child’s goal is to escalate the conflict until you are no longer the one in control. What is important to her 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 oppositional defiant youngster attempts to determine the topic and direction of the conflict, and seems to instinctively know when you are feeling most vulnerable and your energy is low. She will bring up conflict-laden issues during these times, aiming towards pushing your buttons and diverting you from issues in which you are likely to be attempting to exert your authority over her. When your ODD child finally pushes your buttons, in her mind, she has gained control of you and your emotions. At this point she has now successfully taken over your position of authority. Furthermore, when you lose control of your emotions, your child’s anxiety level rises along with her defensiveness. When her defenses increase she becomes more oppositional which is her main defense mechanism. As she becomes more oppositional, the situation escalates and we are caught in an endless cycle of conflict.

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. Walking away from the conflict is another strategy to consider. If you cannot change the subject, or walk away it is important to keep in mind that the ODD child’s goal is to push your buttons. Think about your endurance, how long can you endure really oppositional button pushing? When you get to the end of your rope, what are your options? It is critical not to take what your youngster says personally. As soon as you defend yourself, your child, 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 child. There are two options available for preventing him from drawing you in. 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 somewhere else in the house to complain if he chooses. Should your child choose to escalate, it is time to use two powerful words which can cut through any argument. These words are “regardless” and “nevertheless”. For example, “nevertheless, this is how it is going to be…” Using these words repetitively (like a broken record), in a calm unemotional manner will serve to de-escalate the situation without allowing your child to draw you into the power struggle.

Utilizing effective consequences for the oppositional child 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 midst of their negative behavior will most likely result in more frustration for you. Therefore, it is critical to focus on consequences that do not require cooperation of the child. Rules and consequences must be clear, and in writing to provide clarity for both child and parent before the conflict occurs. Begin by removing reinforcers and allowing your child to earn the items back as a reward for acceptable behavior. Reinforcers include items such as television, stereos, CD’s computers, video games, telephones, bicycles, skateboards, visiting friends, access to favorite clothing, favorite foods, etc.

Once you have successfully avoided having your buttons pushed and gained some control over your child’s behavior, it is time to go on the offensive to soothe her, and help her get back to an even place. Oppositional kids do not like being soothed by their caretakers. This places them back into the role of being a child, and puts you back into the role as the parent. One of the driving forces behind ODD is that, for whatever reasons, a child is trying to grow up too quickly, and considers herself to be equal to her parents. The ODD child may feel less loved due to the amount of conflict going on, and it is difficult to simultaneously feel loved as a child and try to operate on an adult level. Your child may know intellectually that she is loved, but not feel loved. Parents must be able to show love, and soothe and nurture their child. This is not always easy to accomplish, especially when previous negative behavior patterns have become ingrained.

Non-Medical Strategies for Managing ODD

The essence of this group of interventions is to make it impossible for ODD to “work”. It is a way of making sure all the attempts to annoy or irritate others and to cause fighting are not successful.

  • Adults must work together.
  • Children with ODD are quite successful at placing the blame for their behaviors on others, including parents and/or teachers. Thus, adults must come together and challenge anything that the child tells you about how others treat them. In order for this to work effectively, all parties need to talk directly with each other without the child being present.
  • Talk regularly with teachers and principals about the child’s school behavior.
  • Establish a policy at both home and school not to rely exclusively on information your child gives you about what others have done.
  • Sit down with all caregivers (including baby sitters, grandparents, aunt, uncles) to make sure they understand ODD and that they follow the above policy.
  • Do not include the child in these discussions with other caregivers.
  • Have a plan and try not to show any emotion when reacting to the child’s behavior.
  • If you react too emotionally, you may make big mistakes in dealing with the child. Everyone needs to agree in advance on what to do when the child engages in certain behaviors– and then be prepared to follow through calmly.
  • Behavior modification strategies have been used successfully in the therapeutic treatment of ODD, and can also be used effectively in the home. The central premise of behavior modification (or behavior therapy) is that behavior is maintained by its consequences. It suggests that old behaviors resist change unless new behaviors are followed by more rewarding consequences. Many therapists suggest that for the most part, focusing on the positive behaviors and not reacting emotionally to the negative behaviors is the key to getting behaviors to change.

For behavior modification to work, the program must involve certain components:

  • Target only a few important behaviors, rather than trying to fix everything. For example, you may wish to focus on eliminating highly objectionable behaviors such as hitting others, stealing, or swearing.
  • Be very concrete about the expected behavior. Instead of saying, “listen when I am talking,” say, “Sit down and make eye contact with me when we are talking.”
  • Be consistent — no bending of the rules under any circumstances!
  • Rewards for good behavior should not be money or things that are bought. Rather, grant rewards that involve activities that the child enjoys.
  • Rules should be simple and straightforward so as to be easily understood. If your child can read, write the rules and consequences (both negative and positive) into a contract and have the child sign it.
  • Decide which behaviors you are going to ignore.
  • Most children and adolescents with ODD are doing too many things you dislike to include all of them in a behavior management plan. The key caregivers have to decide ahead of time which behaviors will be targeted for change, and which will simply be ignored.