Tag: ODD

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

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

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, there are practical ways to manage your child’s exasperating condition.  This information comes from psychiatric, psychological, and child behavior resources and can 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.

anterior cingulate gyrusThis 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).  This is not a complete list because new compounds may come into the market.

The depression & obsessive-compulsive approach may use serotonin-based antidepressants such as Prozac (fluoxetine), and Anafranil or clomipramine (used to treat OCD).  Again, this is not a complete list.

Oppositional defiant disorder often includes symptoms from 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

Anthony 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. Side-effects of 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 his or her 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.

** Let’s face it, consistently enforcing and reinforcing limits, over and over to exhaustion, isn’t possible 24/7.  You are only human.  Take a break; let some things go.  Forgive yourself for not being perfect.

People’s natural instincts of parenting do not work with an ODD kid.  They need completely different techniques than normal children. 

How to reduce ODD behaviors

Shield yourself.

First get a shield, then 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… years.

Tips from professionals that may work for you:

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 a powerful tools 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 been close to 100% negative, yes?   Caution: don’t expect thanks or joy from your child once they’re praised; it’s not 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

ignore childActive 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.

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.”  They can get frustrated when they aren’t getting the reaction they want from you, and give 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, 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. (from “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, it’s harder to do on the floor.”  This is a good kind of manipulation.

Unexpected rewards – Occasionally 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.

“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.  This is a can’t-win-for-losing path sucks, doesn’t it?  Just do what you can the best that you can.

Warning, once you notice some success with enforcement, things get worse at first – Defiant behavior will increase once your parenting changes.  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 eventually 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 these particular rules anymore.

extinction burst

–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.


Tips for effective parenting of an ODD child through adulthood

supreme rulerDon’t treat your home like a democracy, where everything must be fair and equal.  You must be the supreme ruler, the benevolent dictator.  Your child does not have an equal say in how things are done.  Parents must keep their authority and rightful power in the household, tell your ODD child that you make the important decisions, and your decisions may not always seem fair. Tell them you’ll listen to what they have to say but make no promises. Once you’ve made a decision, avoid explaining your reasons when they challenge you. This helps you keep your power and limits endless arguments and accusations that drag you down. As your child ages into adulthood, you must still hang on to your power. The adult child will continue to require limits, and limits will still need enforcement. To a parent, it will feel as if 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.

Don’t blame or belittle your child-–this goes for all children–but a difficult child can bring out the worst in an exhausted parent. 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 ODD is no one’s fault, and your child would not choose to have ODD if they understood what it meant.

Don’t ignore your child’s unique challenges that have nothing to do with ODD.  They may face bullying at school, lack of sleep, stress from a chaotic home, or other challenges… like any other child.

teenage mouseAlways enforce rule breaking 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 describe it clearly.  Or, they believe they can still get away with breaking a rule and then talk their way out of consequences later.

Don’t let your stress turn into anger directed at your child.

  • They can use this against you by teasing or baiting to get you angry again!
  • You’ll be modeling that anger is an OK response to stress.

Take care of your emotional wellbeing. Check in with yourself if you feel you are losing control. All parents with troubled children need to work extra hard at maintaining a level head. It’s a good skill to have anyway.

Avoid justifying your rules or offering explanations. Children with ODD are not able to reason when they turn defiant. They will only resist harder and use your words to argue more with you. Even if they can understanding your reasoning in a calm moment, this will vanish once they become defiant again.  (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 ODD-defiance.  Some rebelliousness is normal for children, especially if parents are over-controlling (and why wouldn’t you be–who wants another battle).

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

Don’t jump to conclusions that demonize the child.  It hurts you as much as it hurts them. 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?

Find the energy and doggedness to be consistent, and the compassion and forgiveness to be nurturing.

 


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