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

Parenting an 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 has oppositional defiant disorder, this article is intended to give you a solid start on how 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 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, 4^th Edition,” published by the American Psychiatric Association, 2000.

There are two different medication approaches to ODD:  one treats it as a form of attention deficit disorder; and one treats 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 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.html,  Anthony Kane, MD 

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 may have tried everything and nothing has worked.  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 Encylopedia 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, just remove the blankets 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.  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 ‘disability’ that can seriously affect 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 enforcement, things get worse at first - Defiant behavior tends to increase once your family system is changing.  See 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

Treat your child like another adult who has an equal say in how things are done.  Treat your home as a democracy, where everything must be fair and equal.  Answer your child’s accusations by offering explanations that show how reasonable you are.

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

Avoid thinking about 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.

Make a rule and only enforce it once in a while, or have the consequence come much later (Famous example: ”I’ll tell your father when he gets home.”).  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.  Make long explanations to a three year old about why you’ve set a certain rule.

Persist with logical, rational justifications for your rules and expect 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 doing things that don’t make sense.

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

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 stuck in paranoia:  “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 ODD child.   I WISH YOU THE BEST!

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

---

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.