Category Archives: discipline

Defying ODD: what it is, and ways to manage.

Defying ODD: what it is, and ways to manage.
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Parenting a defiant ODD child or teen could be your hardest job ever. 

Not only is it exhausting, but you must continually find the compassion and forgiveness to be nurturing, and the energy and doggedness to be consistent.

ODD is caused by abnormal electrical activity in the brain, it is not in the character or ‘soul’ of your child or teen, and not something they can control.  If your child could do better on their own, they would.  You are the one who can make the most difference.

If you think your child or teen’s defiance is oppositional defiant disorder, you have practical ways to manage your child’s exasperating condition.  This information comes from psychiatric, psychological, and child behavior resources– information to help you work effectively with mental health providers or teachers.  You’ll need to ask them focused questions to learn everything they know about ODD.  Professionals pay better attention to knowledgeable parents (which shouldn’t be the case, all parents deserve attention).  Go in armed with knowledge.

This is what ODD looks like.  The pinkish curving region in the center of the 3-D brain image below represents hyper-charged electrical activity in a 13-year-old boy with severe oppositional defiant disorder.  This feature is typical of ODD, but also typical in individuals with obsessive compulsive disorder (OCD), “Road Rage,” pathological gambling, chronic pain, and severe PMS.

The name of this region is anterior cingulate gyrus (ACG), and scientists believe this area is responsible for enabling a person to shift attention and think flexibly, traits which are deficient in ODD kids.  It is also the brain region known to regulate emotions.  Children with a hyper-charged ACG have “a pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which 4 or more of the following are present:

  • Often loses temper
  • Often argues with adults.
  • Often actively defies or refuses to comply with adults’ requests or rules.
  • Often deliberately annoys people.
  • Often blames others for his or her mistakes or misbehavior.
  • Is often touchy or easily annoyed by others.
  • Is often angry and resentful.
  • Is often spiteful and vindictive.” 

–From the “Diagnostic and Statistical Manual of Mental Disorders, 4th Edition,” published by the American Psychiatric Association, 2000.

There are two different medication approaches to ODD:

  • treat it as a form of attention deficit disorder;
  • treat it as form of depression and obsessive-compulsive disorder.

–         The attention deficit approach may use Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal or risperidone (for patients with low IQ), and Depakote or divalproex (a mood stabilizer).

–         The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).

At the end of this article are a list of other medical conditions that can cause disruptive behavior.

Unfortunately, oppositional defiant disorder usually includes other disorders, so you may be coping with more than defiance.  Below are common disorders that combine with ODD:

  • 50-65% of these children also have ADD or ADHD
  • 35% of these children develop some form of depressive disorder
  • 20% have some form of mood disorder, such as bipolar disorder or anxiety
  • 15% develop some form of personality disorder
  • Many of these children have learning disorders

–From http://addadhdadvances.com/ODD.htmlAnthony Kane, MD 

Other medical conditions that can cause disruptive behavior like ODD:

  1. Neurological disorders from brain injuries, left temporal lobe seizures (these do not cause convulsions, no one can tell these are happening), tumors, and vascular abnormalities
  2. Endocrine system problems such as a hyperactive thyroid
  3. Infections such as encephalitis and post-encephalitis syndromes
  4. Inability to regulate sugar, rapid increases and decreases of blood sugar
  5. Systemic lupus erythematosus, Wilson’s disease
  6. Some prescription medications:  Corticosteroids (anti-inflammatory and arthritis drugs such as Prednisone);  Beta-agonists (asthma drugs such as Advair and Symbicort)

–From Peters and Josephson.  Psychiatric Times, 2009.

ODD is a disability.  It isn’t easy to manage, but you can do it.  Your child may need multiple medications and a large variety of approaches to therapy and behavior modification.  You will need patience as teachers, doctors, or specialists try different approaches until they discover one that improves your child’s behavior, so hang in there!

Some good news, if your child has these traits, it will be easier to improve or overcome ODD behaviors:

  • A normal IQ
  • A first born child
  • An affectionate temperament
  • Positive interactions with friends their age
  • Nurturing parents who can consistently set clear behavioral limits

–From the Journal of American Academic Child and Adolescent Psychiatry, 2002.  Author J.D. Burke.

You try everything but nothing works.  People’s natural instincts for parenting do not work with an ODD kid—they need completely different techniques than ‘normal’ children.

How to reduce ODD behaviors

First, prepare yourself for the intensity of parenting a defiant kid because you are about to run a marathon.  Get enough sleep, maintain your other important relationships (spouse or partner, children, friends), schedule breaks or getaways, and guard your physical and emotional health.  Don’t expect quick results with these techniques; it may take weeks or months.

Parent Management Training – PMT refers to intensive educational programs that are “evidenced based,” proven to help parents gain the skills they need for extremely difficult children, especially those with ODD.  These programs are intensive, but substantiated interventions in child mental health.  PMTs help parents assert consistency and predictability, and promote pro-social behavior in their child.  A good explanation can be found at the Encyclopedia of Mental Disorders.  Examples include:  the Total Transformation and the Incredible Years.

Find something positive to do together.  Your child has normal needs for closeness and appreciation and joy.  Ask your child about their interests, and if their ideas don’t work for you, try new activities until one brings about a good chemistry between you and your child.

Praise is one of the most powerful tools for managing disruptive behavior.  Take responsibility to inject much-needed positive energy into your relationship with your child or teen.  It’s likely that this relationship has been almost 100% negative, yes?

Set limits – “Consistent limit setting and predictable responses from parents help give children a sense of stability and security.  Children and teens who feel a sense of security regarding the limits of their environment have less need to constantly test it.”  (Webster-Stratton and Hancock)

More praise – ‘Catch’ them doing something good.  Offer praise and make it sound genuine even if they respond in anger, then let it drop.  Spend as much time praising as disciplining!  And don’t expect thanks, it’s not about you.

Active ignoring – This works for best with children between the ages of 2 and 12.  It involves purposefully withdrawing your attention away from your child when they are misbehaving, such as in a temper tantrum, or when whining or sulking, or when making continuous demands or loud complaints, etc.  Pretend you don’t care and even turn your back if possible.  Give attention only after the behavior is over.

–Find out more at http://www.sosprograms.com/chapters/p_eng_chapters/EngParents03.pdf.

Make the behavior uncomfortable for the child/teen.  Example:  If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.  Don’t be a copy cat.”  They can become frustrated when they aren’t getting the reaction they want from you, and give up.  Example:  your teen refuses to get out of bed for school.  Don’t nag or repeat, repeat, repeat.  Remove the blanket and set them far enough away that your child has to get out of bed to retrieve them.  (“Managing Resistance,” John W. Maag, jmaag1@unl.edu)

Give multiple instructions at once, where at least one of the instructions is what they want to do, and one is what you want them to do.  “Close the door while you’re yelling at your sister and don’t forget the light.”  Your child will be overloaded as they try to figure out which thing they’re supposed to defy.  Kids tend to get flustered by the mental effort and comply without knowing they’re doing it. (“Managing Resistance,” see above)

Reverse psychology:  Yes, this works, and it’s OK when important.  Example:  your child is bouncing on the furniture.  You turn on music and say “hey, try this, see if you can bounce to the beat, but I bet it’s harder to do on the floor.”  This is a good kind of manipulation.

Surprise rewards – Reward appropriate behavior with something they already like (that is acceptable to you).  They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.

At the end of this article is a list of things to do to make ODD worse.  Avoid these!

“Why should I have to do this when it’s my kid’s responsibility to behave?”

It’s your responsibility as a parent to do what you can to help your child be successful.  ODD is a genuine disability that negatively affects their life and future.  I’ve seen highly intelligent ODD kids experience academic failure, or enough suspensions and expulsions to hold them back a grade, a can’t-win-for-losing consequence that worsens their behavior.  Wouldn’t this suck?

Warning, once you start consistent enforcement, things get worse at first – Defiant behavior tends to increase once your family system is changing.  This as a good sign—you are regaining your authority!  Your child’s backlash is a common human psychological response, and it’s called an “extinction burst.”  (see diagram below)  As parents change their approach to handling inappropriate behavior, the child becomes more defiant to test their resolve.  View this as predictable and plan ahead.  It won’t last and they will begin to comply with this one rule.  They then find another rule to defy and ramp up their defiance.  As you enforce it, they back off again, and the pattern continues until it’s just not worth it to defy rules anymore.

 

–From “Behavioral Interventions for Children with ADHD,” by Daniel T. Moore, Ph.D., © 2001, http://www.yourfamilyclinic.com/shareware/addbehavior.html .  The author requests a $2 donation through PayPal to distribute his article or receive printed copies.


How to make ODD worse -or- DON’T TRY THESE AT HOME

Don’t treat your child like another adult who has an equal say in how things are done.  Don’t treat your home as a democracy, where everything must be fair and equal.  Don’t answer your child’s accusations by offering reasonable, rational explanations.

Don’t keep finding fault with your child and let them know about it over and over and over.  If they do something positive, let them know it’s not enough.

Don’t ignore your child’s unique needs or the challenges they face everyday, such as bullying at school, or fear of abandonment, or stress from a chaotic home.  Just pretend they have no reasons for their behavior.

Only enforce rules once in a while, or have the consequence come later (Famous example: “I’ll tell your father when he gets home.”).  Don’t get angry about something, then direct your anger to your child and let them know it’s because of the stress they’ve caused you.

Don’t treat your child appropriately for his or her age.  Don’t make long explanations to a three-year-old about why you’ve set a certain rule.

Stop making rational justifications for your rules and stop expecting your child to logically, rationally accept them.  What’s interesting to me when I see parents doing this is that their children can be quite young (4 or 5), too young to be reasonable in the first place, or they can be young adults (early 20’s) who have a long track record of being unreasonable.

Don’t keep trying the same things that still don’t work.  Like making excuses; like screaming.  (Don’t be embarrassed; we’ve all done this.)

Don’t jump to conclusions that demonize the child.  I often hear parents say:  “Why does he keep doing this?, or, “Why doesn’t she stop after I’ve told her not to, over and over again.”  Then they answer their own questions:  “It’s because he always wants his way,” or, “She’s doing this to get back at me.”  As they tell their story, I hear them taking things personally:  “He does this just to make me mad;” “She manipulates the situation because she wants more (something) and I won’t give it to her.”

Good luck with your defiant ODD child.   I WISH YOU THE BEST!

–Margaret   How am I doing?  Please rate this article at the top, thanks.


 

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Filed under ADHD, bipolar disorder, defiant, defiant children, depression, discipline, mental illness, oppositional defiant disorder, oppositional defiant disorder, parenting

For fathers who raise troubled kids

For fathers who raise troubled kids
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Where are the men?

Every year, I attend several conferences around the nation that focus on the families, children, and policies associated with children’s mental health.  The majority in attendance are women.  As part of my job, I also attend many meetings on children’s mental health in social services organizations and advocacy groups where, again, the majority in attendance are women (often 100%).  I’ve facilitated family support groups for 11 years, open to the public, mostly attended by woman:  bio mothers, adoptive mothers, girlfriends, stepmothers, grandmothers, aunts, and sisters involved in caring for a troubled child.  Anyone else notice this?

<At the end of this post are studies and articles on the many benefits caring men provide to troubled children and teens.>

We need the men.  I know they are out there.  I know they are engaged in raising a troubled child and probably alone with their concerns.  They are not just biological fathers, they are stepfathers, boyfriends, adoptive fathers, foster fathers, uncles, and brothers, but I’ll call them all “dads” here.

The recent national “Building on Family Strengths” conference in Portland, Oregon, had a presentation on the subject of dads helping dads.  It was the first time I attended a seminar where mostly men attended.  I asked the panel, founders of Washington Dads, www.wadads.org, “why hasn’t there been a gathering like this before?”  Apparently, panel members tried to find help and it wasn’t there, so they started a support organization for themselves.  They believe it’s the only one like it in the nation.

The messages – One panel member said men feel they are supposed to fix the problem, but they can’t and feel like failures.  Another said that “dads are often not the main caregivers, and perhaps they lack experience,” and after trying what they think will work, are at a loss when it doesn’t.  Another, “we want a quick fix, but a clear concrete fix will do… we want to know how to problem solve.”  That’s a big one, men fix things, they want to get together and hash out solutions.  “Men talk solutions right away instead of talking through emotions.”  They said men like rules or instructions such as Collaborative Problem Solving techniques, the use of technology, and carefully considered plans such as IEPs.

In general, moms tend to feel guilty, but dads tend to be resentful:

  • Of the public nature of the family’s problems
  • Of mom’s leniency towards the child
  • Of the over-the-top attention given to the child
  • Of the loss of quality relationships with all family members

“We’ve been down on our knees in pain for our kids, and we’ve been trying to bring them into society, and it’s a long road.”

Dad’s emotions are there but expressed very differently.  “Some men need to vent aggressively… blow a gasket, but only other men are OK with this.”  Some want to reveal things to each other they wouldn’t share with their wife or partner; “men need to bond without women present” and with personal face-to-face contact.  Men tend to have custody issues too, and often face challenges to their rights to visit their children or maintain relationships with them.

Gentlemen, trust me, moms want you to have support.  Form a group and get yourself some buddies.

Below are previously published articles on the influence of fathers on children’s mental health.  I could not find any articles about issues faced by many fathers, such as custody of the children, disagreements with mom, the influence of their decisions about treatment, or placement, or educational issues, or the need for support in tune with men’s particular cultural and social needs.

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Involvement of nonresident fathers may protect low-income teens from delinquency January/February 2007 issue of the journal Child Development

Many American children live without their biological fathers. A substantial proportion of fathers who live apart from their children have lost touch with them and therefore don’t provide consistent parenting. A new study has found that when nonresident fathers are involved with their adolescent children, the youths are less likely to take part in delinquent behavior such as drug and alcohol use, violence, property crime, and school problems such as truancy and cheating.

The study, by researchers at Boston College, is published in the January/February 2007 issue of the journal Child Development. The research was funded, in part, by the W.T. Grant Foundation, the National Institute of Child Health and Human Development, Office of the Assistant Secretary of Planning and Evaluation, Administration on Developmental Disabilities, Administration for Children and Families, Social Security Administration, and the National Institute of Mental Health.

Researchers looked at a representative sample of 647 youths who were 10 to 14 years old at the start of the study and their families over a 16-month period, gathering information from the adolescents and their mothers. The families were primarily African-American and Hispanic, and most lived in poverty.

Taking into consideration adolescents’ demographic and family characteristics, the researchers found that when nonresident fathers were involved with their children, adolescents reported lower levels of delinquency, particularly among youth who showed an early tendency toward such behavior.

They also found that adolescent delinquency did not lead fathers to change their involvement over the long-term. But in the short-term, as teens engaged in more problem behaviors, fathers increased their involvement, suggesting that nonresident fathers may be getting more involved in an effort to stem their children’s delinquency. This finding was most prevalent in African-American families and contrasts with the pattern in two-parent, middle-class, white families, where parents often pull away and become less involved in the face of adolescent delinquency.

“Nonresident fathers in low-income, minority families appear to be an important protective factor for adolescents,” said Rebekah Levine Coley, professor of applied development and educational psychology at Boston College and the study’s lead author. “Greater involvement from fathers may help adolescents develop self control and self competence, and may decrease the opportunities adolescents have to engage in problem behaviors.”

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Early Father Involvement Moderates Biobehavioral Susceptibility to Mental Health Problems in Middle Childhood

Boyce, W. Thomas; Essex, Marilyn J.; Alkon, Abbey; Goldsmith, H. Hill; Kraemer, Helena C.; Kupfer, David J.;  Journal of the American Academy of Child and Adolescent Psychiatry, v45 n12 p1510-1520 Dec 2006

[my summary in everyday English:  When fathers are engaged in nurturing and parenting a child from infancy, the child develops healthy responses to social situations when they reach the middle childhood years ~age 9.  The father’s engagement actually improves brain function on the emotional level and reduces activity in the stress area of the brain.  If a father is not involved, the child is at a high risk of behavioral problems.  Also, if a mother is depressed in their child’s early years, the child is at an ever higher risk of behavioral problems.]

Objective:  To study how early father involvement and children’s biobehavioral sensitivity to social contexts interactively predict mental health symptoms in middle childhood. Method: Fathers’ involvement in infant care and maternal symptoms of depression were prospectively ascertained in a community-based study of child health and development in Madison and Milwaukee, WI. In a subsample of 120 children, behavioral, autonomic, and adrenocortical reactivity to standardized challenges were measured as indicators of biobehavioral sensitivity to social context during a 4-hour home assessment in 1998, when the children were 7 years of age. Mental health symptoms were evaluated at age 9 years using parent, child, and teacher reports. Results: Early father involvement and children’s biobehavioral sensitivity to context significantly and interactively predicted symptom severity. Among children experiencing low father involvement in infancy, behavioral, autonomic, and adrenocortical reactivity became risk factors for later mental health symptoms. The highest symptom severity scores were found for children with high autonomic reactivity that, as infants, had experienced low father involvement and mothers with symptoms of depression. Conclusions: Among children experiencing minimal paternal care taking in infancy, heightened biobehavioral sensitivity to social contexts may be an important predisposing factor for the emergence of mental health symptoms in middle childhood. Such predispositions may be exacerbated by the presence of maternal depression.

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Devoted dad key to reducing risky teen behavior – Moms help, but an involved father has twice the influence, new study finds  [EXCERPT],  By Linda Carroll, June 5, 2009

Teenagers whose fathers are more involved in their lives are less likely to engage in risky sexual activities such as unprotected intercourse, according to a new study.  The more attentive the dad — and the more he knows about his teenage child’s friends — the bigger the impact on the teen’s sexual behavior, the researchers found.  While an involved mother can also help stave off a teen’s activity, dads have twice the influence.

“Maybe there’s something different about the way fathers and adolescents interact,” said the study’s lead author Rebekah Levine Coley, an associate professor at Boston College. “It could be because it’s less expected for fathers to be so involved, so it packs more punch when they are.”

Dad’s positive effect
Parental knowledge of a teen’s friends and activities was rated on a five point scale.  When it came to the dads, each point higher in parental knowledge translated into a 7 percent lower rate of sexual activity in the teen.  For the moms, one point higher in knowledge translated to only a 3 percent lower rate.  The impact of family time overall was even more striking. One additional family activity per week predicted a 9 percent drop in sexual activity.

Child development experts said the study was carefully done and important. “It’s praiseworthy by any measure,” said Alan E. Kazdin, a professor of psychology and child psychiatry at Yale University.

Why would dads have a more powerful influence?

“Dads vary markedly in their roles as caretakers from not there at all to really helping moms,” Kazdin said. “The greater impact of dads might be that moms are more of a constant and when dads are there their impact is magnified.”  Also, Kazdin said “when dads are involved with families, the stress on the mom is usually reduced because of the diffusion of child-rearing or the support for the mom.”

In other words, dad’s positive effect on mom makes life better for the child, Kazdin explains.

The study underscores the importance of parental engagement overall, said Patrick Tolan, a professor of psychiatry and director of the Institute for Juvenile Research at the University of Illinois in Chicago.  “For one thing, the more time you spend with them, they’re going to get your values and they’re more likely to think things through rather than acting impulsively.”

Coley hopes that the study will encourage both moms and dads to keep trying to connect with their teenage children, even as their kids are pushing them away.  “…it’s normal for teens to want to pull away from the family, [but] that doesn’t mean they don’t want to engage at all,”

Linda Carroll is a health and science writer living in New Jersey. Her work has appeared in The New York Times, Newsday, Health magazine and SmartMoney.

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The Father-Daughter Relationship During the Teen Years – Ways to strengthen the bond  [EXCERPT],  by Linda Nielsen

According to recent research and my own 30 years of experience as a psychologist, most fathers and teenage daughters never get to know one another as well, or spend as much time together, or talk as comfortably to one another, as mothers and daughters.  Why is this bad news?  Because a father has as much or more impact as a mother does on their daughter’s school achievement, future job and income, relationships with men, self-confidence, and mental health.

When I ask young adult daughters why they aren’t as comfortable sharing personal things or getting to know their fathers as they are with their mothers, most make negative comments about men.

  • “Because he’s a man, he doesn’t want to talk about serious or personal things.”
  • “Because men aren’t capable of being as sensitive or as understanding as women.”
  • “Because fathers aren’t interested in getting to know their daughters very well.”

If a daughter grows up with these kinds of negative assumptions about fathers, she will not give her father the same opportunities she gives her mother to develop a comfortable, meaningful relationship. As parents, we strengthen father-daughter relationships by teaching our daughters how to give their fathers the opportunities to be understanding, communicative and personal.

Creating more father-daughter time alone – Regardless of a daughter’s age, the most important thing we can do is to make sure fathers and daughters spend more time alone with one another.  Since most fathers and daughters haven’t spent much time together without other people around, they might feel a little uncomfortable at first.  If so, they can start by taking turns participating in activities that each enjoys.  One idea:  The father could choose 15 or 20 of his favorite photographs from various times of his life — as a little boy, a teenager or a young man — and then use the pictures to tell his daughter stories about his life.  The key to the success of this father-daughter time is that they alone are sharing this experience.

Staying involved during dad’s absence – Teenage daughters and fathers can strengthen their relationship during dad’s absence through e-mails, letters, pictures and a touch of silliness.  Before dad departs, for one example, father and daughter can talk about how much their relationship means to each of them and agree to write or e-mail at least twice a week.

Linda Nielsen is a psychology professor at Wake Forest University in Winston-Salem, N.C. Her most recent book is Embracing your Father: How to Create the Relationship You Always Wanted With Your Dad. For more information on father-daughter relationships visit www.wfu.edu/~nielsen/.

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When parents disagree on discipline

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Your primary relationship comes first

Stress can affect the most solid relationships. Families like yours, with a troubled child, have a higher divorce rate than the general population, 50% higher. Coping with your child will bring out any and all relationship issues that may have been manageable under normal circumstances. If your relationship is falling apart, and it was mostly healthy before this period of stress, then it must be a priority over the child for now. Get counseling, if not together than singly. Or ask for help from supportive friends–prayers, cheerleading, or the opportunity to vent. Partners must stand by each other and present a solid front as the family leaders. This is just as important for your child as it is for you. Let this draw you closer together rather than pull you apart.

Stand strong, shoulder-to-shoulder

When you disagree, together make a list of the things you agree on and worry about the disagreements later. This list should include:

  • Focus on your respective strong points.  Each make a list strengths of the other.
  • Never argue in front of the children (or, make a rule for how and where to argue).  This creates many problems that worsen your child’s behavior.  Stress is obvious.  But what about kids who manipulate their parents to get their way with something?  What about those that thrive on chaos?
  • An agreed-upon role for each parent, which is something that they’re good at.  When one parent is competent at handling a specific challenge, the other steps back, and vice versa.
  • Take turns managing the household for a period while the other takes a break.
  • Set aside personal feelings temporarily to co-manage one specific little problem at a time, a problem you both agree on.

Have each other’s back

A true story with names changed: Susan and her daughter Pam were constantly fighting over who hurt who the most by what each said. Jason, the husband and father, was frustrated by these conflicts, but avoided interfering because he knew he’d upset both his wife and daughter. Yet Jason was always able to calm Pam down quickly because their relationship was different. One day, Jason took his wife aside and asked that they try something. He suggested that Susan step back from certain daily interactions with Pam, those which always ended in fights, and let him do the communicating. Susan did not like the idea that Pam had “won” by getting all of her dad’s attention, nor did she like the implication she couldn’t handle their daughter! But Jason came up with idea that if he saw Susan and Pam slipping into a fight, he would use a code phrase, like “Hey dear, can you help me find the _____?”, and Susan would catch herself, save face by stepping out to look for the ____, and let Dad take over. This worked wonders rather quickly. Nothing was ever discussed openly, but after a few weeks, both mother and daughter started to catch themselves starting a fight, and one or both would find some reason to step away from the situation.

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