Coping with Oppositional Defiance
S. L. Crum, B.S., M.S., Ph.D.

Does this sound like your child?
Often loses temper
Often argues with adults
Often actively defies or refuses to comply with adults' requests or rules
Often blames others for his or her misbehavior or mistakes
Is often touchy or easily annoyed by others
Is often angry and resentful
Is often spiteful and vindictive

Causes and Consequences:
It seems that oppositional defiant disorder arises out of a circular family dynamic. This is not to say that you caused your child to have ODD. It is to say that there are characteristics about your child that resulted in an unhealthy family cycle of interaction. An infant who is by nature more difficult, fussy, and colicky, may be harder to soothe and thus cause parents to become frustrated and to lack confidence in their parenting skills. If they perceive their child as basically unresponsive, they may begin to anticipate that the child will be unresponsive or noncompliant and set up a self-fulfilling prophecy. As a result, the parent’s anticipating failure, may unresponsive or unreliable in return and inadvertently add to the child's feelings of irritability, helplessness, neediness, and frustration.

As parents attempt to assert control by insisting on compliance in such areas as eating, toilet training, sleeping, or speaking politely the child may demonstrate resistance by withholding or withdrawing or tantruming. As a child grows increasing negativism, defiance, and noncompliance become misguided. But, these habitual ways of dealing with adults that persists long after the “terrible twos."

The more defiant and provocative the child’s behavior, the more negative feedback is elicited from the parents. In their attempts to teach their child to behave properly, parent or authority figures try reminding their child, lecturing them, removing privileges, berating, and physical punishment, nagging and negotiating. Unfortunately, these behaviors give the child a sense of control and therefore tend to increase the rate and intensity of non-compliance. Ultimately, it becomes a tug of war and a battle of wills with everyone loosing.

Because parents are so frustrated dealing with their child, their system of discipline becomes inconsistent. At times they may be calm and assertive. Other times they may explode in anger. At still other times, they may withhold appropriate consequences which soon become hollow threats. As the child continues to provoke and defy, parents often lose control. Then, feeling sorrow and guilt, especially if they’ve become verbally or physically explosive, parents may overcompensate with excessive rewards or leniency in order to undo what they now perceive to have been excessive discipline or punitive consequences.

When a child starts school, this pattern of passive aggressive, oppositional behavior tends to provoke teachers and other children as well an often begins a cycle of being denied recess, getting detentions or suspensions; which further aggravates the problem

In many cases, oppositional disorders coexist with attention deficit/hyperactivity disorder. In this case, the impulsivity and hyperactivity of ADHD can greatly amplify the defiance and uncontrolled anger of ODD. Symptoms of ODD can also appear as part of major depressive disorder, obsessive compulsive disorder, or mania. Some children with separation anxiety disorder may also evidence oppositional behaviors.

So, what do we do?

Unfortunately, there are no simple solutions. But, here are some of the key approaches.

Parent Training Programs Some parents are helped through formal parent training programs. The benefit of these programs lies in both parents learning to use the same techniques and to do so consistently. It involves parents learning to set the same standards and apply the same consequences day in and day out so that oppositional and defiant children cannot pit once against the other or push parents into over or under reacting and then feeling guilty for their own behaviors. Parents learn to communicate expectations and consequences clearly to their child, to enforce the rules calmly but firmly, and to use positive reinforcement whenever they catch their child being good so they can increase the frequency of occurrence of desired behaviors.

Individual Psychotherapy Finding a psychologist or play therapist with whom your child can develop a good relationship can be very valuable. Often children with ODD feel as if they don’t live up to their parent’s expectations and this frustration exacerbates their disorder. When a therapist provides unconditional acceptance, the therapist is in a position to help your child learn some effective anger management techniques that decrease defiance and naturally lead to more positive parental feedback. The therapist may also employ cognitive behavioral techniques to help your child learn effective problem solving skills that will improve social interactions inside and outside the home. The support gained through therapy can counterbalance the frequent messages of failure to which the child with ODD is often exposed.

Social Skills Training Coupled with other therapies, social skills training has been effective in improving social behaviors that result from a child’s angry, defiant approach to rules. Incorporating reinforcement strategies and rewards for appropriate behavior helps children learn to generalize positive behavior. Social skills training, can help children learn to evaluate social situations and adjust their behavior accordingly. Metaanalyses of research on social skills has shown that the only successful social skills training interventions are those that provide training in the child's natural environments (home and classroom) – so that generalization is built in. To accomplish this you will need your child’s Individualized Education Plan (IEP) from school to include Community Based Instruction using social skills training.

Medication is only recommended when the symptoms of ODD occur with other conditions, such as ADHD, obsessive compulsive disorder (OCD), or anxiety disorder. When stimulants are used to treat attention deficit/hyperactivity disorders, they also appear to lessen oppositional symptoms in the child. There is no medication specifically for treating symptoms of ODD where there is no other emotional disorder. In lieu of medication, you might wish to investigate EEG neurofeedback, a nonpharmacological intervention which is effective at teaching children to self-calm, thereby increasing their adaptability and decreasing oppositionalism that results from poor adaptability. In addition, if your child is often moody and angry, you may ask your pediatrician to explore the possibility of prescribing transcranial electrotherapy for your home. T his involves the use of a portable unit called Alpha Stim, which generates low voltage alpha waves (the kind of waves the brain generates when it is calm and focused). You child can wear this noninvasive devise for 20-30 minutes per day, to induce a relaxed, peaceful state without need for medication.

Practical Suggestions for Parents

· Enlist others to help you: You need help on a consistent basis. This means you need to speak with your parents, your siblings, your husband’s parents and siblings, your neighbors and let them know that your child has a disorder which is difficult to control and very demanding on you as a parent. Therefore, you need help on a regular basis from now until your child is grown. Ask each to commit to help in some concrete fashion. This might mean that someone watches your child every week so you can go grocery shopping without a hassle, it may mean that grandma has the kids for dinner every Saturday so you and your spouse can have a meal and a conversation without interruption. It might mean that Uncle Mike takes you son for a bike ride on Sunday’s after church so you and your husband can pay your bills. You decide what you need, and ask each person in your support network to make a specific commitment to help you. In short, do everything you can to share the burden of parenting. This includes asking all interested parties to learn about your child’s disorder(s) and IDEA and to participate in IEP meetings with the school district.

· Set up an appropriate school program: If your child is not already classified, make a written referral for your child to be evaluated for special education. Request a Functional Behavioral Analysis as part of the evaluation process. Once eligibility is determined, you want to advocate for an IEP that include a Behavioral Intervention Plan with positive behavioral supports to reduce the occurrence of oppositional and defiant behaviors. You also want this plan to stipulate that in or out of school suspensions may not be employed as a disciplinary measure with your child, and that your child may not loose recess. It is also important to have weekly counseling sessions with the school psychologist as part of your child’s IEP with goals to develop relaxation and anger management skills, along with problem solving and coping mechanisms. Additionally, insist on having monthly parent training sessions in behavior management in your child’s IEP so that you can carry over any effective interventions the school is employing to the home environment. Be certain that the IEP also indicates your child will be staying after school for aftercare and that a staff member is to utilize this time to assist your child in completion of all homework assignments and projects. This component is important because it will eliminate a major source of conflict at home. Finally, don’t forget to make certain that the IEP includes community based instruction at home and other locals your child frequently visits using social skills training.

· Access community services: Consider putting your child in daycare before and after school. Insist that homework is completed in the afterschool program so that this source of conflict is eliminated from the home environment. For weekends and holidays and summer vacations, consider having your child participate in programs offered by Big Brother and Big Sisters or Boy Scouts/Girl Scouts. Summer camps provide an excellent opportunity for your child to “start over” with adults and children who don’t know their history of defiance and who will expect and therefore automatically reinforce compliance. They also provide you much needed time to self-nurture so that you will replenish your own reserves and be better equipped to deal with your child when s/he arrives home from camp. Don’t forget to ask for help from your local religious organization. Someone from your church or temple may be equipped to provide some spiritual counseling for your child. This can be important as prayers have been documented as an effective method of stress management and anger control. Additionally, there may be someone who is able to assist concretely by providing some much needed tutoring, or picking up your families’ groceries while they pick up theirs or even picking up.

· The last step is respite foster care on a regular basis: If your child becomes too demanding and it begins to impact on your own physical or mental health, consider respite foster care. This might mean your child spending one weekend a month with a foster family in order to provide a break for you to nurture not only yourself, but also other children in the home, and your marriage. Many parents indicate that they would feel like complete failures if this became necessary. In reality, this is a healthy effective way to equip yourself to handle your child’s special needs over the long haul.

· Make consequences relevant to the offense: Avoid using generic consequences such as time out or grounding. Instead, customize the consequence to the offense. For instance, if your child throws a shoe and break your favorite crystal piece. Then, assign your child an hourly wage, and have him work over the next several (days, weeks, months) to earn the money to replace that item. Each day when it is time to do the extra chores, give a reminder that helps the child connect the behavior to the consequence. For instance, “Joey, it is time to rake the lawn to earn some more money towards paying for the crystal that broke when you choose to throw the shoe”. If you child steals something, then the consequence might be a visit to the police station, witnessing some criminals in cells and a discussion with a police officer about what happens to children who steal. If your child, lies then the consequence might be to do a research report on the value of honesty.

· Discover what your child is truly interested in: Some children devote so much time to being disruptive that they never develop any appropriate interest. This is another way that camps can be of help. For instance, you might try a few sports camps, or a music camp, or an art camp and in the process your child may discover something that truly interests them; which can be used as a reward and a motivator during the remainder of the year. If you haven’t the funds for camps, try your local YMCA as most will offer scholarships based on financial needs. The YMCA and Big Brothers or Sisters and Scouting all offer positive activities for your child to be involved in during the school year along with opportunities to interact socially with nondisabled peers who may provide good behavioral role models. These organizations all teach values that include respecting parents and giving back to the community, and thereby reinforce the values you are trying to teach your child.

· Residential Schools: If your child’s behavioral problems grow to the point that you and your child’s school have difficulty dealing with them, consider a therapeutic residential school. This can be a win-win-win situation. It alleviates the need for your ill-equipped local school to address your child’s behavioral needs, it provides, you, your spouse and your other children extended periods of normalcy, and it provides your child the structure and therapy that are needed in a situation where they can no longer alienate those closest to them. Additionally, when your child does come home for weekends, holidays and vacation it is always an opportunity to start off on a positive note with a clean slate. Moreover, relationships can be fostered while your child is at school through letters, emails, on-line photo albums and phone calls without having to deal with day to day conflict.

· Someone to talk to: Whether it is a friend, relative, friend, pastor, or a counselor, you need to be able to talk to someone on a regular basis; and most especially when things are going badly. Issues you may need some help with are:

· Carving out time for your marriage
· Nurturing siblings of your difficult child
· Communicating your child’s home and community needs to the IEP team
· Issues that need to be addressed in your child’s behavioral intervention plan
· Thinking about a residential school
· Having a plan to deny privileges to a defiant child without denying siblings (i.e. someone to stay home with child when s/he doesn’t deserve to go the movies but the other children do.
· Considering respite foster care
· Dealing with constant lying
· Dealing with thefts
· Coping with your child’s physical aggression
· Dealing with crimes that your child engages in
· Disagreeing with your spouse about how to handle behaviors
· Grieving the loss of the child you hoped for
· Seeing the school system write off your child’s needs
· Behavior management techniques
· Effective advocacy within the educational system

Some parents feel uncomfortable in face to face counseling. For others the only time they can squeeze in for sessions is in the evenings when their child is asleep by which time most therapists’ offices are closed. Others don’t want weekly assistance, but they’d like a familiar person they can contact when the need arises. In these situations, internet special needs coaching sessions may be a good alternative. You schedule these at your convenience when you need them and address your then pressing issues from the comfort of home. To schedule this type of session go to www.specialeducationsupport.org and select the schedule tab.

How to begin dealing with your child’s behavior

· Start at ground zero. Tell your child that his/her behavior has not been acceptable and that the whole family is going to start over. Develop a list of expected behaviors and consequences for noncompliance. Post these in a predominant spot. Then, develop a list of your child’s responsibilities and privileges that can be earned by completing those responsibilities without a hassle or reminders. Start with only essentials being provided: bedroom, basic food, clothing etcetera. Make it so that your children need to earn TV time, computer time, having friends over, visiting others, trips to the library or bowling alley, and extra half hour later bedtime, and so forth. The children in your family without oppositional and defiant behavior will follow the same rules and as they are already compliant should have no problems earning their privileges and setting a good role model.

Build on the positives, not the negatives. Create ways for your child to experience positive feedback. This might involve having them participate in a formal volunteer program in the community. Or, it may be as simple as asking them to tutor a younger sibling in an academic area where they have strength and then providing plenty of praise. Creating as many opportunities for positive reinforcement as possible, and in so doing create as many opportunities as possible for your child to help those less fortunate than themselves. This helps combat their feelings of entitlement and begin to understand the perspective and needs of others. It also provides opportunities for you to compliment their hard work in their undertaking. For instance, you might compliment your child for raking a disabled neighbor’s lawn, for collecting recycling, for donating some of their allowance to a charitable organization for children, for volunteering at the humane society, for singing Christmas Carols in nursing homes, think of ways for your child to give back to the community; and praise those behaviors. As a general rule, each day children should hear more positive than negative comments about themselves.

Use teachable moments to your advantage. Kids with ODD would like to do well, but they have been prewired such that they lack the necessary flexibility to adapt easily to environmental demands. You can help your child by teaching adaptive skills. The easiest way to do this is to model adaptive behavior and to verbally mediate your actions. For instance, when someone cuts you off in the Wal-mart parking lot and steals the spot you have been waiting for. You can calmly drive on while saying: “That person’s rude behavior was very upsetting, so I’m going to breathe deeply to recompose myself.” Or, I’m really frustrated that I didn’t receive a promotion at work after all the extra hours I have been putting in. I know Joe got the promotion just because he is friends with my boss. So, I’m going to direct the energy from my anger into looking for a new job with more advancement opportunities. Maybe you can help me print copies of my resume and search the internet for possible openings.” Involving your child in these types of constructive actions can help your child learn to effectively direct their own anger energy into similar constructive activities. Or, you might say, “I’m tired and frustrated and feel grumpy, so I’m going for a walk to refresh myself. Would you like to join me?” Physical activity releases endorphins that improve our moods, so modeling physical exercise as an outlet for anger or frustration is very positive. You can also direct teach. For instance, if you see a peer tease your child, before the situation escalates you can step in and say: “Bob, I heard you teasing Joey. I’m certain that hurt his feelings. Now Joey may choose to ask you to go home, or he can choose to ask you for an apology. Joey what do you want to do?” Bear in mind though, that oppositional children tend to respond more positively to verbally mediated role modeling than they do to direct teaching.

Pick your battles. Most children with ODD are doing quite a few things that you dislike, but if everything is a battle you will get nowhere. If something is simply annoying you might choose to ignore the behavior. For instance, if your child interrupts while you are on the phone you might tell the other party. I need to get off the phone now and I’ll call you back later. Then, when your child requests attention appropriately. Thank him or her for waiting until you were free to speak. Some things you may be willing to occasionally negotiate on. For example, if homework is always to be done before friend’s visit; but a very good friend is visiting from out of town and has only this time to visit you might say to your child: “Since Paul is a special friend and is only here for today, we will make an exception and let you play now and do your homework later. But, if your homework is not completed without hassle by 7pm, then the next time Paul visits, we will not make this special exception.” Some things should never be negotiated: being disrespectful, lying, stealing or being violent must always meet with consistent consequences.

Take a break from the conflict. If you lose your cool, the child will see it and know that s/he has the upper hand. Learn to take time to say. “Right now, I am very angry with you. Go to your room, while I think about how we will deal with this”. Then, call a resource person or do something that helps you calm down. Later, when both spouses are present, address the issue jointly.

Don’t keep your child’s misbehaviors a secret: When your child has chosen to be defiant and have a consequence doesn’t hide it. If they can’t go to the movies with Uncle Mike because they stole something, tell Uncle Mike the full reason. This may bring the reproach of others to back up your position that such behaviors are not acceptable. If your child’s best friend may not come over because your child did not complete his homework, let the friend know: “Joey can’t play today because he hasn’t completed his homework. You may help him with his homework or you may come over another day.”

Quality time: When you have a child who is oppositional and defiant you may feel as it all or most of your interaction with that child are stressful and conflict ridden. To counter this, when you child arrives home, make certain you have a full half hour free of other commitments. Devote this time to engaging in an activity of preference with your child. For example, your child might enjoy Webkinz; if so play this with him. Or, your child might like a particular Game Boy or Nintendo Game. If so, learn to play it and have a contest. Or, perhaps you have a child, who likes certain board games, then sit down and share some pleasant time together. It might also be time painting or drawing, or working on a wood working project. The activities don’t matter, as long as your child enjoys it and you get at least a half hour a day of uninterrupted time with your child engaged in a positive activity together.

Additional Advice...

· Don’t take it personally. You child may call you “mean”, but they are really frustrated by their own lack of adaptability and are lashing out at the nearest target. When this happens, just tell your child that even though they are angry with you, you love them and will continue to do what is best for them.

· These children are experts at pushing your buttons, so don't let them. Keep your composure, no matter how difficult. Do not fight with your child. If need be, walk away, take a bubble bath, use the Alpha Stim, do deep breathing exercises. Then, when you are calm, and your child is calm address the issue that gave rise to the conflict.

· Give genuine choices. Give them appropriate control when you can. For example, “Joey, you need to clean your room today. You may do it now and then have the afternoon to play. Or, you can play for just two hours and then stop to do your room. Which do you prefer?” “Or, " Joey, your teacher says your are behind in AR reading. Do you want me to read with you a half hour each night at bedtime, or do you want to read a half hour by yourself every day before going out to play?”

· Connect with what you like about the child. Don’t forget that he or she is a child with many wonderful features. Work on that part of your relationship and help them remember who they are

Overall tips . . .

· Intervention should be as early as possible.
· It should cover as much of the child's day as possible every day
· It should include all caregivers
· It should be consistent across all environments and across time
· It should be maintained as long as needed (basically until your child is grown)
· It should include many different types of interventions and not just focus on one aspect of the problem

ADDITIONAL SITES WITH INFORMATION ON ODD:

http://www.adhd.com.au/conduct.html - Causes and treatments for ODD/CD

http://childparenting.about.com/library/blchildbehaviordisorder.htm - Guide to resources for parents of children with behavioral and mental problems

www.focusas.com/BehavioralDisorders.html - Broad resources addressing a variety of problem behaviors and disorders of children, adolescents and young adults

http://groups.yahoo.com/group/oddparentsroom/ Chatroom for parents with children with ODD

www.haworthpress.com/store/sampleText/J007.pdf - Innovative Mental Health Interventions for Children: Programs that Work

www.ici2.umn.edu/preschoolbehavior/tip_sheets/hostagg.pdf - Preventing and dealing with challenging behavior

www.ici2.umn.edu/preschoolbehavior/tip_sheets/passagg.htm - Dealing with Passive Aggressive Behavior

http://www.klis.com/chandler/pamphlet/oddcd/oddcdpamphlet.htm Overview of ODD, case examples, non-medical strategies for dealing with ODD/CD

www.lifematters.com/4goals.html - An article that addresses the children's underlying goals of typical misbehavior and how adults can recognize them

www.youthchg.com/hottopic.html - Interventions for aggressive behavior in children.

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., rev.). Washington DC: Author.

Carson, R. C., Butcher, J. N., & Mineka, S. (1998). Abnormal psychology and modern life: Tenth edition. New York: Addison Wesley

Longman.

Chandler, J. (2001). Oppositional Defiant Disorder/Conduct Disorder Pamphlet. <http://www.klis.com/chandler/pamphlet/oddcd/treat1.htm>

26 Mar, 2003.

Jabs, C. (1999). Is your child too defiant? Working Mother, Mar. 99. <http://www.conductdisorders.com/FAQ.asp.>03 Jun, 2003.

Kazdin, A. E., & Weisz, J. R. (2003). Evidence-based psychotherapies for children and adolescents. New York: Guilford Press.

Minke, K. M., & Bear, G. C. (2000). Preventing school problems - Promoting school success: Programs and strategies that work.

Bethesda, MD: National Association of School Psychologists.

Quay, H. C., & Hogan, A. E. (1999). Handbook of disruptive behavior disorders. New York: Kluwer Academic/Plenum Publishers.

Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0-8 years). Prevention Science, 2(3), 165-192.

Presented as a community service by,

Susan L. Crum, B.S., M.S., Ph.D.
Special Needs Coach
Able2Learn
Email: Able2learn@live.com
Voice and Fax: 863-471-0281
Website: specialeducationsupport.org