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How to manage defiance and oppositional defiant disorder
Troubled children and teenagers who are pathologically defiant have a brain condition with many possible causes or diagnoses. Whether they are overtly aggressive or “passive-aggressive,” parents have options for reducing symptoms of defiance and limiting the stress they bring into the household.
If your child is defiant to a degree that affects their life functions, this is what’s happening in their brain. The pink color of this curving central region indicates intense electrical activity. This is the brain scan of a 13-year-old boy with severe oppositional defiant disorder (ODD). Hyper-charged activity in this region can also be responsible for obsessive compulsive disorder (OCD), unstoppable rages, pathological gambling, chronic pain, and severe PMS.
It is called the anterior cingulate gyrus (ACG), which allows a person to shift attention to different subjects and think flexibly–something defiant kids don’t do well. Nor do they regulate emotions, something the ACG also does. 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.
Typical traits of children with oppositional defiant disorder.
They act younger than they are. Don’t expect them to mature quickly.
They live in the here and now, and can’t think about the past or future. They don’t see how their actions result in a series of consequences. They can learn sometimes, but only if it is pointed out immediately after an incident.
They don’t notice their effect on others. Sometimes you can ask one of the others how they feel immediately after an incident, or you can gently report how it makes you feel.
Their brain is easily overloaded, and they have a hard time with changes. And yet, you can use this overloading problem to your advantage (more below).
They cannot follow your reasoning, so don’t try.
Defiance may be a strength in their future. With mature skills, they’ll better resist negative things they’ll face in life.
Unrelenting defiance is a true disability that negatively affects a child’s life and future. I’ve seen highly intelligent defiant or ODD diagnosed children experience academic failure or enough suspensions or expulsion to hold them back a grade. This is a can’t-win-for-losing path that really sucks, doesn’t it?
Two different psychiatric approaches to defiant behavior and ODD
Treating it as a form of attention deficit disorder;
Treating it as form of depression and obsessive-compulsive disorder.
The attention deficit approach uses therapy in combination with medications, such as Straterra (chemical name is atomoxetine), Ritalin (methylphenidate), Risperdal (risperidone, an antipsychotic), Adderall (amphetamine) and Depakote or divalproex (a mood stabilizer). This is not a complete list because new compounds are being formulated to reduce side-effects.
The depression & obsessive-compulsive approach combines therapy in combination with serotonin-based antidepressants such as Prozac (fluoxetine) or Zoloft (sertaline), and Anafranil (clomipramine, for anxiety). Again, this is not a complete list.
Treatment must also include holistic or ‘lifestyle’ approaches.
These are absolutely essential. No amount of medication or therapy will help a child whose physical body is in poor shape! The brain is an organ too, like the heart or liver, and needs the right nutrients and oxygen delivered through the blood.
Avoid foods that cause mood extremes and limit cognitive functions (such as memory and processing speed) such as: food fried in oils other than olive oil, refined sugars and starches (flour, white sugar), saturated and hydrogenated fats, diuretics like caffeine, and any other foods that have dyes or nutrients removed by processing (for example, apple filling in pastry instead of actual apples).
Get more sleep and exercise – these have an immediate and direct impact on brain health! In even one day, a brain will under-perform if there’s been inadequate sleep or exercise. Sleep restores brain function and memory, and exercise pumps oxygen to the brain and causes the release of positive hormones and neurotransmitters.
Drink water (sports drinks are OK too if they don’t have caffeine)
Defiance and ODD often include symptoms of other disorders
50-65% of defiant children also have ADD or ADHD
35% 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 also have learning disorders
—Anthony Kane, MD
Other conditions can cause oppositional defiant disorder
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
Endocrine system problems such as a hyperactive thyroid
Infections such as encephalitis and post-encephalitis syndromes
Inability to regulate sugar, resulting in rapid ups and downs of sugar in the blood
Systemic lupus erythematosus, Wilson’s disease
Side-effects of 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
Autism spectrum disorders
PANDAS – an acronym for a strep infection-caused disorder that can make a previously normal child violently resistant. (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)
If your child has these traits, it will be easier to reduce defiant or ODD behavior
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.
Parenting that works for ‘normal’ children does not work for defiant children or teenagers.
First, be kind to yourself; this is hard. Get enough sleep, maintain your supportive relationships (spouse or partner, children, friends), schedule breaks and getaways, and guard your physical and emotional health. Don’t expect quick results because success may take weeks or months.
Address just one issue at a time, then strengthen yourself for running a marathon.
Find something positive to do together. Your child needs for closeness and appreciation and joy, like everyone. Ask your child what positive activity interests them most, or try new activities until one brings about a good chemistry between you and your child.
Praise is a powerful tool for managing disruptive behavior. Make an effort to inject positive energy into your relationship with your child or teen. It’s likely that this relationship has become mostly negative over time. Caution: don’t expect thanks when you praise your child. They are typically self-absorbed and not thinking about you.
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, Handbook for Parent Training, 1998
Actively ignore – 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 a temper tantrum, whining or sulking, baiting or teasing, or making continuous demands or loud complaints. Pretend you don’t care and even turn your back if possible. Give attention only after their behavior is ending or over.
Make the behavior uncomfortable.
Example: If your kid swears, test them, “C’mon, you can do better than that, be creative, I’ve heard all those things before.” They can get frustrated when they aren’t getting the reaction they want from you, and defy you by giving up.
Another example: Your teen refuses to get out of bed for school. Don’t nag or repeat, repeat, repeat. Remove the bed covers and set them far enough away that your child has to get out of bed to retrieve them. (“Managing Resistance,” John W. Maag)
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. (from “Managing Resistance,” Maag)
Use reverse psychology: it’s a good kind of manipulation. Insist or pressure your child to do something they think you don’t want them to do, so they will defy you and do it… which is indeed what you wanted in the first place. Pretend to agree or disagree with a behavior or choice so that you get the outcome you want.
A mother I know did this with her 14 year old daughter who’d threatened to cut off all her hair and self-tattoo her face. The mother said she “went ballistic” over the idea of her daughter’s beautiful hair being cut (she knew it would grow back, whereas a tattoo would be permanent). The results were exactly what the mother wanted. Her daughter totally butchered her hair, and the tattoo idea never came up again.
Offer unexpected rewards – On random occasions, reward appropriate behavior with something they like. They are more likely to do a desired behavior if they expect something they want and aren’t sure when it will be offered.
Redirect their attention. If you’re entering a situation where you know your child will become defiant, distract them. Make yourself a list of actions or behaviors you can do that are distracting during times when their defiance should not be tolerated, such as when there’s a threat to safety.
Don’t treat your home like a democracy or try to be fair and equal. Be a benevolent dictator. A troubled child should not have an equal say in how things are done. To keep your authority and power in the household, tell your defiant child that you’ll listen and consider compromise, but make no promises.
Never justify your decision or provide reasons. Reasoning does not work; it only promotes endless arguments. As your child ages into adulthood, an adult child will continue to require limits, and limits will still need enforcement. To a parent, it will feel like you’re treating your adult offspring as a child. YOU ARE and you should be, and this is the interesting part: they won’t notice.
Allow some aggression. When it’s appropriate and safe, ask your child to do more of what they’re already doing so that they turn around and defy you by stopping the behavior. Example: your child refuses to take a direction and throws a book on the floor in anger.
Parent: “There’s only one book on the floor. Here is another one, now throw this on the floor.” (Child throws book down.)
“Here’s another one. Throw this down too.” (Child throws book down.)
“And here’s another, throw this down, too.” (Child stops throwing books in defiance.)
Be a marshmallow. Show no resistance. Instead, listen and respond to how they feel, not what they say. Show them you are open talk later when the stress dies down.
Teen: “I hate you f- -king b- -ch!”
Parent: “Sounds like you’re really angry.”
Teen: “Shut up you stupid c – -t!”
Parent: “Can you tell why me you’re angry so I can do something about it?”
Teen: “Leave me alone f- -k face! Stop patronizing me!”
Parent: “OK, I hear you don’t want me to patronize you. I feel this is stressful for both of us, so let’s take a break and talk about it later.”
Teen: F—k you! I’m not talking to you ever. (Well that’s not true, but they may ‘defy’ you by avoiding the behavior.)
Call their bluff.
Child: “I’m going to run away!”
Parent: “OK, if you do, call me, and I’ll bring your stuff and maybe a snack. Here’s the runaway hotline phone number if you don’t want to call directly.” Then walk away. If they do run and call, you’ll know where they are and can fetch them or call the police.
Child: I’ll kill myself! (This rarely true if shouted in anger and defiance. Your child may be throwing out threats to see how you react and get you to back down.)
Parent: “If you really mean that, this is serious and means we need to get you to a hospital! Let’s get ready and go because you need to get assessed.”
Warning, once you make progress regaining authority and reducing defiance, a honeymoon phase will be followed by a huge backlash… but this is a good sign!
It’s proof your work is having an impact. Extreme resistance to behavioral change is a common response called an “extinction burst;” see diagram below. Pressure builds because it’s exhausting to try and control an urge to misbehave, and they eventually explode. This as predictable so plan ahead. The extreme “burst” is evidence the ingrained behavior is ending or going extinct. There may be more bursts that test your resolve. Eventually, your child likely stops defying at least one rule. Pick the most critical behaviors that need extinguishing and keep up the effort. Eventually, they back off again, and the pattern continues until it’s just not worth it to defy these rules anymore.
Don’t blame your child. It’s easy to think they’re being bad on purpose because they’ll act like it, and show amusement when they’re bad or belittle you. Keep in mind that their behavior is no one’s fault, and your child would not choose to behave like they do if they understood what it meant.
Don’t ignore other challenges that might be responsible for their behavior. They may face bullying at school, lack of sleep, or stress from things at home for example.
Always enforce your rules as immediately after the fact as possible. Why: If enforcement comes later or only occasionally, the child does not connect the broken rule with the punishment. They really don’t, even when you explain it quite clearly.
Don’t direct anger at your child. If you do, apologize.
They can use your reaction against you, and tease or bait you to get you angry again
Don’t model that anger is an OK response to stress.
Do model that apologies are a proper response
Avoid explaining and justifying rules. Defiant children and teenagers are not able to reason once their emotions take control. They will only resist harder and pelt you with arguments. (What’s interesting is I’ve observed parents trying to reason with young children (4 or 5), too young to be reasonable in the first place, or with young adults (early 20’s) who have a long track record of being unreasonable.
Don’t interpret everything as pathological defiance or oppositional defiant disorder. Some rebelliousness is normal for children. It’s especially so if parents are over-controlling.
Don’t keep trying the same things that still don’t work. Like yelling or repeating yourself over and over (Don’t be embarrassed; we’ve all done this).
It helps to lower your expectations for your child’s behavior and progress. What you want may be totally unrealistic, and more than you and your child can handle.
I once saw a bumper sticker that said “I feel much better now that I’ve given up hope,” and found it strangely comforting.
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.” Is this really what you want?
Two training approaches that help parents like you:
Parent Management Training: this is an intensive educational program that has been proven to help parents handle extremely difficult children, including those defiance and ODD. PMT teaches parents precisely how to assert consistency, keep interactions predictable, and promote pro-social behavior in their child. A good explanation can be found at this link: Encyclopedia of Mental Disorders. Examples of parent management training include: the Total Transformation and the Incredible Years.
Collaborative Problem Solving: CPS teaches how to negotiate with a defiant or resistant child. This may seem like giving in, but it depends on how one negotiates or comes to a compromise. If defiance is a result of something the child needs but can’t express appropriately, a CPS approach helps the parents hone in on the underlying need, which may be simple and easy to address. A great place to find out more is on the Think:Kids website.
Find the energy and doggedness to be consistent, and the compassion and forgiveness to be nurturing.
This is a heroic endeavor.
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Mothers and Teenage Daughters: a School Counselor’s Story
I’m a high school counselor, which means I work with parents every day. Because I’ve made a career out of my work with adolescents, I see what a parent might be seeing for the first time. This includes a long list of unfortunate life events.
Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices.
As a parent, I have a lot of empathy for other parents. It’s not easy, especially when you’re going through something for the first time. My life, on the other hand, is a little bit like Groundhog Day. In a sense, I’ve never left high school. Every school year I see the same things. Different kids, but the same behavior: alcohol, drugs, tobacco, bullying, kids running away from home, pregnancy and something new: sexting.
Take an adolescent boy with an underdeveloped prefrontal cortex, which by definition means he is incapable of fully contemplating notions such as consequence; take this teenager raging with sex hormones and give him a tiny device that he will carry with him everywhere, a device capable of sending messages instantly to anybody, anywhere in the world, and install a camera in that device. What do you imagine might go wrong?
When you and I were adolescents, we were no less reckless, no less idiotic with our choices, no less eager to use our bodies as grownups. The difference is that our stupidity has been forgotten by history. Back when we were teenagers, there wasn’t a massive network of servers positioned strategically across the globe to capture and record, forever, the embarrassment of our adolescent choices. Sexting changes everything.
Over the last seventeen years in my work of mentoring adolescents and partnering with their parents, I’ve seen a lot of parenting styles. I’ve learned some important strategies in dealing with the situations teenagers present–strategies the average parent doesn’t have the time, through repetition, to learn. I feel confident telling you that there are some really good ideas out there. And some really bad ones, too.
Because I’m a writer, it occurred to me to write it down, what I’ve learned over the years. I’m a parent. I know it just as well as you do. We need a little grace in our lives.
Excerpt from SEXTING AT SCHOOL:
The police called the sexting child pornography. So I understood Nicole’s concern: she wanted to talk to me about her daughter. Jessica was fourteen and three years younger than her boyfriend. He had been distributing images of Jessica through his phone. Nicole was worried; she was scared, and understandably so.
Jessica still thought she was in love.
“He calls her a bitch,” Nicole told me. “I read the texts. He says horrible things to her.”
“And she still wants to be with him,” I said.
The pain I felt for her was communicated in my voice. As a teacher, I see the scenario every year, but Nicole was experiencing this for the first time. Jessica was her daughter. Not long ago she was her baby. I could only begin to imagine the suffering the situation provoked. Nicole was in no position to hear how common this was.
Why do girls throw themselves at boys who treat them badly?
In Jessica’s circumstance there was a tremendous amount of grief. She had barely processed the loss of her dad. He was killed in an accident over the summer.
“I can’t stop her from being with him. I’ve tried. I took away her phone. I grounded her. She sneaks out of the house. I drop her off at school, and she ditches to be with him.” The mascara was now running beneath Nicole’s cheekbones, “Last night, she told me that she wished it was me who was dead. He was waiting for her out front. I saw her get into his car.”
“I can’t imagine what that’s like,” I told her. “I’m sorry.”
“Unless I physically restrain her, she will find a way to get back to him.”
I allowed for a long silence, as I thought there might be more Nicole needed to say.
“What did I do? What did I do wrong?”
I didn’t answer her question. And I didn’t dismiss it. I sat with her in it.
* * * * *
My role with Nicole is not all that different from my role with Jessica. It doesn’t matter whether you’re fourteen or forty, what you need is for someone to listen. What you need is for someone to understand.
Jessica and I talked later the same day.
“She went through my phone,” Jessica was angry. “She read my texts.”
I let her know that I understood her frustration.
“She won’t let me leave the house.”
“She’s trying to keep me from him.”
“Have you told her that you love him?”
“She hates him. She doesn’t want me to see him.”
“Why does she hate him?”
At this Jessica paused. We had already talked about the pictures. She had told me stories about the boy. The way he had flaunted his sexual conquests. He was in my English class, and I had seen it firsthand: there were countless other girls.
After a long silence, she answered my question, “She thinks he’s not good for me. Is he?”
It was ground we had already covered. In past conversations Jessica told me that she respects her mom for trying to protect her. I handed Jessica a box of tissues. She wiped the tears and told me, “No. He’s really, really mean.”
I listened to her cry for several minutes. I was thinking about her father. I knew the man well. I liked him. I was thinking about her mother. I was thinking about my own daughter. It was true for all of us. What we need is empathy.
“I’m sorry,” I told her. She questioned me with her eyes.
So I answered it, “I’m sorry you’re so alone.”
Jessica’s whole body shook when she sobbed.
* * * * *
The last time Nicole was in my office she asked me if she should return Jessica’s phone. We had a similar conversation the day she asked me if she should call the police.
“What do you think?”
“I think Jessica needs to figure this out for herself. I’ve tried to protect her, but I can’t. I just can’t protect her from everything.”
“Does that mean you’ll give it back?”
“No. She’s not ready for that.”
“I don’t know the answers to the particulars,” I told Nicole, “but I know this. You’re a good mom. Jessica needs you right now. She needs you to be confident in your role.”
I saw the tears washing through the mascara, gave Nicole the box of tissues, and kept on going.
This is universal: the teenager wants desperately to have her independence, and she is terrified of it.
“Jessica loves you, and she knows that you love her. Jessica is not aware of the fact that she is conflicted about this. She’s just a kid. As much as she pushes you away, she wants you to be strong, to love her.”
* * * * *
I talked to Jessica again a week later.
“Do you still see him?” I asked.
She was embarrassed, “Yeah.”
“Is he good to you?”
“How about last night?”
She hesitated then said, “Last night he left me in a parking lot. I had to borrow a phone and call my mom to come pick me up.”
“Why’d he leave you?”
“To hook up with someone else.”
“Will you see him again?”
“I have a vision for you,” I said.
Jessica smiled, like she had heard lines like that from me before.
But that didn’t deter me. I have an advantage over most parents of teenagers: I’ve made a career out of the adolescent. Their behavior can be alarming, infuriating and even demoralizing, but after seventeen years of guiding teenagers as they come of age, I have established proven routines.
I have a pretty good idea of how many repetitions it will take, of how many times I’ll have to say it before Jessica can even make sense of the words, of how many more times I’ll have to repeat it before she begins to adopt the language as her own.
So I told her again, “In my vision of your future, you will love yourself too much to let a boy treat you badly.”
* * * * *
The story above is a composite of a dozen mothers and a dozen daughters I’ve work with over the years. In my FREE e-book, I analyze that narrative–elucidating what I believe to be the important parenting considerations.
Find out more at: SEXTING AT SCHOOL, a FREE download at Goodreads.com, or if you’re feeling generous, you can buy it for $0.99 at Amazon.com.
About Benjamin Dancer:
Benjamin is a high school counselor at Jefferson County Open School where he has made a career out of mentoring young people as they come of age. He wrote the novels PATRIARCH RUN, IN SIGHT OF THE SUN and FIDELITY. He also writes about parenting and education. You can learn more at: