Oppositional Defiant Disorder

Oppositional Defiant Disorder: The War At Home

When Hunter was a baby, Pat never imagined parenting him would mean becoming trapped in an argument that would last 15 years. From the time he was old enough to express himself, it seemed that he was looking for a fight with her.

"He's a very strong-willed person," says Pat, her polite demeanor belying an obvious understatement. "He's manipulative, and he learned at a very young age how to make that work for him to get what he wanted."

The simplest things always seem to turn into huge problems because Hunter simply refuses to do what he is asked to do, whether it was brushing his teeth at age five, or raking the yard at age 15. The word "no" lights his fuse, especially when in response to something he wants to do. "He's always doing these irritating things," Pat explains, "as if he enjoys bothering you."

Getting out of bed in the morning is the issue around which Hunter and his parents argue the most. "We've had the worst time in the world getting him up in the morning and into the shower. I know this is unbelievable, but he gets in the shower, stretches out in the bottom of the tub with the water beating on him, and goes back to sleep. From that moment on, we have to micromanage his morning to get him to the bus stop."

Recently, Hunter was diagnosed with Oppositional Defiant Disorder, and Pat finally has a name for the behavior that's been exhausting her all these years. Now, she needs a solution. How does a parent stop the arguments with a child whose primary way of communicating is arguing?

James Lehman: A day with a child who has Oppositional Defiant Disorder is a series of battles in an undeclared war. It starts when they wake up, continues at breakfast, intensifies when they have to get dressed, and doesn't end until they fight with you over bedtime.

Kids with ODD lose their temper quickly and often. They're easily annoyed and frustrated by other people, resentful and hostile with adults, bossy and pushy with other kids. They blame everyone else for their difficulties and make excuses for their inability to cope. They gravitate toward negative peers and tend to be sulking, angry adolescents.

Unrestricted free time is a breeding ground for aggressive behavior for these children. In an unstructured environment, they become annoying, threatening or destructive to kids around them and to adult authority figures. They will use this time to deliberately antagonize anyone they see as "in charge."

As a parent, you can't satisfy a child with ODD, since their thinking is irrational. They clamor for your attention and then tell you to leave them alone. The sad truth is, kids with ODD aren't very likeable. Parents often feel guilty about the fact that they love their kids, but don't like being around them.

Parents get blamed for their child's oppositional behavior and tend to heap even more blame on themselves. The parent of a child with ODD often feels incompetent and isolated. They live with the self-imposed shame that other people think they're bad parents, and that humiliation grows larger as their world gets smaller. Left untreated, Oppositional Defiant Disorder can lead to Conduct Disorder, a more serious pathology that is a precursor for anti-social behavior and criminality.

Of course, for many parents, ODD is not the primary issue. Rather, they are dealing with continuous, low-level defiance that is not incendiary and aggressive, but is aggravating, annoying and disruptive to the family. Whether the defiance has turned into a diagnosis of ODD or has not, the parent's approach should be the same.

How to Stop the War and Restore Peace at Home

Most parents lack the tools to deal with oppositional defiance. So they generally respond to this behavior with a range of responses that includes negotiating, bargaining, giving in, threatening and screaming. The problem is when you scream, argue or negotiate, you are giving your child's defiance even more power.

Everyone from the school psychologist to your mother-in-law will tell you what this child needs is "structure." But no one really shows you what kind of structure and how to put it in place. It's not as simple as giving the child a time out. A child with ODD won't use the time out to change his thinking. He'll use it to plot revenge. Parents need to change their parenting style and method of operation with the child.

Children with ODD need structure with an aggressive training component that is built around learning how solve the problems that trigger their defiant behaviors. Your child becomes oppositional when he is confronted with a problem and he can't figure out how to fix it. The problem can be anything from not wanting to get up in the morning (as in Hunter's case) to not wanting to do homework. Screaming at the child to get out of bed won't work. You need to show the child that he has a problem that has to be solved and address it as such. Example: "Lying in bed after your alarm goes off won't solve your problem. It makes you late and you miss the bus. What can you do to solve your problem?"

The focus of treatment should be on developing compliance and coping skills, not primarily on self-esteem or personality. ODD is not a self-esteem issue; it's a problem solving issue. There's no evidence that self-esteem leads to compliance, and emotions are not, in and of themselves, a way to kids to cope with their problems. Kids get self-esteem by doing things that are hard for them.

Children with ODD need a lot of strong praise and support as well as realistic rewards. They don't benefit from a pat on the back for doing something that's easy for them to do. They should be praised for doing things that are challenging to them. Don't create false situations for which to praise them to make them "feel better." Parents need to learn several different parenting styles that meet the needs of this child. You need to be less of a "cheerleader" and more of a trainer and coach.

Avoid senseless power struggles. Pick your battles with your child carefully and win the ones you pick. Many times you can win fights with this child by not arguing back. When you argue, his resistance gets stronger. Instead of arguing, set limits in a businesslike way and expect compliance.

Have a plan for managing your child's behavior. When you're going to the mall, know what you'll do when he acts out in the car. It's important to lay out the rules ahead of time, when things are calm. For instance, before you go to the mall, tell the child, "When you lose it in the car, it becomes dangerous for me and for everyone because it's distracting. So if you lose it in the car, I'm going to pull over for five minutes, and I'm not going to talk to you. You'll have five minutes to get your act together. If, after five minutes, you have not regained control of yourself, then we're not going to the mall. We're going to turn around and go home. Have a plan you'll use if he throws a tantrum in the store or if he acts out at a family gathering. And be willing to follow through on the plan until the child learns defiance doesn't get him what he wants.

Parents dealing with ODD need a powerful mix of determination and strength. You can have a child with ODD and a peaceful home. The key is to decide: Are you going to change the world for your child or teach him to cope with it? It's not practical or effective to try to change the world for your kid. But by setting limits consistently, concisely and clearly, you will teach your child to cope with the world and succeed in it.

Copyright 2007. EmpoweringParents.com

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For three decades, behavioral therapist James Lehman has worked with troubled teens and children with behavior problems. His practical, real-life approach to managing children has been taught to parents in private practice and now through The Total Transformation Program, a step-by-step program that teaches James' techniques and helps parents change their children's behavior. http://www.TheTotalTransformation.com/Articles5.htm