Does your child argue with you until you are “blue in the face?” If you often have a reasonable request and somehow it turns into a power struggle; and if you cannot get your adolescent to accept responsibility for any misbehavior--they may be defiant and oppositional. If their negative hostile attitude makes you want to avoid conflicts and their anger, and are filled with resentment and spitefulness almost daily--they may have oppositional and defiant disorder. When they seem to enjoy annoying others and try to “get even” for any wrongs they perceive, or if these beliefs, behaviors and reactions affect them at school, at home and socially then your child has more going on than the typical stubborn “I want to be independent” attitude.
All children can act stubborn, respond with temper tantrums, argue or become oppositional at times, especially around the times when they are becoming more independent in their life. Usually between two and three years old and during adolescence these reactions peak and eventually subside. However, when the behaviors are hostile, fierce or out of the range with their peers, this may affect their ability to develop friendships, experience success in school and a have a calm home life.
The American Academy of Child Adolescent Psychiatrists report up to sixteen percent of children and adolescents have Oppositional Defiant Disorder (ODD). Parents with children who have ODD report their child “has always been this way; that is rigid, demanding, and difficult from the time they were born” when compared to their siblings. They don’t grow out of it.
Why Would a Child or Adolescent have ODD?
There are many factors involved in this problem: biological, psychological and social. Some of the biological factors that make them susceptible to ODD are:
* if they have a parent with a history of attention-deficit/hyperactivity disorder (ADHD), ODD, or CD,
* a parent with a mood disorder (such as depression or bipolar disorder),
* parent has a problem with drinking or substance abuse,
* an impairment in the part of the brain responsible for reasoning, judgment, and impulse control,
* a brain-chemical imbalance,
* their mother smoked during pregnancy, or
* if they have been exposed to toxins or poor nutrition.
The psychological factors that make them susceptible to ODD are:
* if they have poor relationship with one or more parent,
* if they have a neglectful or absent parent, and/or,
* if they have difficulty or inability to form social relationships or process social cues.
The social factors include:
* poverty,
* living in a chaotic environment,
* abuse,
* neglect,
* lack of proper supervision,
* uninvolved parents,
* inconsistent discipline, and/or
* family instability (such as divorce or frequent moves).
A complete evaluation is important as other mental health disorders like Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, mood disorders (depression, bipolar) and anxiety may exist with along with ODD. They need to be treated together for the best results. The earlier a child or adolescent receives treatment the better the outcome; even in preschool these behaviors may be present. The statistics show that thirty percent of children with ODD develop more a more serious disorder called Conduct Disorder.
Treatment Options for Parents and Children/Adolescents
There are opportunities to turn their behavior around and create a more peaceful home environment.The most effective treatment plan will be individualized to the needs of each child and family. Specific treatment depend on his or her age, how severe problem behaviors, the resources available to the family. Treatment often involves the child/adolescent participating in individual therapy and family therapy. It may call for coordination of services with the child's teacher or school.
Two types of evidenced-based treatments are problem-solving skills training and family interventions in the form of parent management training. Interventions focused on helping the child acquire new problem-solving skill and family interventions include training in effective discipline techniques and age-appropriate supervision. Often treatment is offered on an outpatient basis. If more intense services are needed, in home services may be needed. In few cases residential treatment is consider in a few cases when at school and in home services are not effective.
Parent support and training is essential for treating ODD as parents have the most effect on their children. Help for parents to provide consistent reasonable age appropriate limits and consequences that are enforceable, teaching parents to pick their battles, finding any positive behaviors to reinforce and praise, especially when being flexible and cooperation. Parents must notice when they need a time out, so not to get overly stressed. Things often get worse rather than better when a parent is unable to model good behavior and self control. Enlist the help of others and encourage support from coaches, teachers, and your spouse. Parenting and ODD child takes a great deal of time and energy in your life. Take care of yourself, healthy lifestyle choices like exercise and relaxation is important to have the energy to deal with your child.
There are several options for problem solving skills training in the community. Mental health professionals vary on the particular types of models or programs used to guide their interventions. Many interventions are effective, from play therapy to “talk therapy.” It is important to find a counselor or therapist with experience in the age group of your child, skills, and specialized training with this type of issues.
Treatment may also include the use of medication, although medication alone would rarely be considered an adequate or appropriate intervention for children with ODD. Medication may be a useful component of treatment to help address specific symptoms or to treat co-existing conditions (e.g., depression, ADHD, or anxiety disorders).
Resources:
Academy of Child Adolescent Psychiatry (aacap.org)
American Academy of Pediatrics (aap.org
The Explosive Child by Ross Greene and Center for Collaborative Problem Solving
http://www.aacap.org/galleries/eAACAP.ResourceCenters/ODD_guide.pdf
Janet Vessels is a mental health practitioner and a licensed professional clinical counselor. As the owner of the Center Child and Family Counseling, PLLC, she has practiced professional counseling for over fifteen years with children, adolescents and families. Her practice specialties are play therapy and a variety of trauma therapies including Eye Movement Desensitization and Reprocessing (EMDR).