Marsha B. Sauls, Ph.D.

770-668-0350 x 221

Child rearing has to be the toughest job around. The rewards are unmatched to be sure, but the hours are unrelenting and the stress can be overwhelming. And sometimes, despite parents’ best, most loving efforts, children’s behavior can create chaos in the family.

Almost all children practice asserting their independence at various times as they grow up. Most have some resistance to becoming socialized to be neat, punctual, conscientious and responsible, pleasant, to share, to delay gratification, and to defer their will and wants to those of others.

Most parents, when faced with a child's behavior that is displeasing to them and others, find themselves reading books on discipline, taking parenting classes, and/or discussing discipline strategies with other parents. Parenting books and classes generally help parents devise structures for behavior based on consistency, rewards and punishments, and cooperation. The basic premise for most of these self help remedies is that children have a desire to fit in, get rewarded, care about how others perceive them, and want to "grow up" and take responsibility for their own behavior. The difference between a child that is misbehaving and a child with oppositional defiant disorder is that children with ODD are not at all motivated by a need to be accepted or to please others.

Almost all training or discipline programs use consequences to teach children that they can control whether positive or negative things happen to them by their behavior. These discipline plans presuppose that children are both willing and able to defer immediate desires and responses-to be and do what is necessary to be rewarded.

Encouraged to believe that children can and want to follow the rules, parents usually double their efforts when "tried and true" methods fail. They become more severe, autocratic, and threatening and remove more and more positives from their child's life. They use the "Dare to Discipline," approach with "The Strong Willed Child" and practice "tough love." Fortunately, these long-held parenting techniques eventually work with most children. With children who have oppositional defiant disorder (ODD), however, these approaches fail.

Children with ODD are persistently stubborn, unwilling to compromise or negotiate with adults or peers, and blatantly resistant to taking directions. When confronted or disciplined, these children will have temper tantrums, persistently argue, and blame others or circumstances for their failure.

It is estimated that anywhere from 2-16% of children suffer from this disorder. ODD usually manifests itself before age eight. Boys are more prone to developing the disorder before puberty; after puberty, the occurrence rates are equal for boys and girls. ODD children are not typically aggressive or physically cruel, although they may develop these behaviors if they do not receive treatment.

Children with ODD live outside of normal family rules and expectations. Let's say, for example, that a parent is trying to teach a 10year-old to clean her room and take more responsibility for herself. The parent sets a clear expectation- "By 2 p.m. Saturday your room needs to be straightened up and vacuumed." A reasonable reward is offered for compliance and a reasonable consequence is offered for non-compliance. In most situations limits are tested and some consequences are given, but after a time or two the child will meet the expectation. In a family with a child with ODD, there is no compliance and there is a fight about taking the consequences. The difference between a child that is misbehaving and a child with oppositional defiant disorder is that children with ODD are not at all motivated by a need to be accepted or to please others.

Parents dealing with these kinds of behavior problems typically begin asking less and less of their children and making more and more excuses for their behavior. They may find themselves subtly arraning for special or sheltered activities for their child because he or she cannot "get along" with other kids.

In determining whether a child has oppositional defiant disorder it is necessary to determine if their inability to prioritize others' needs, delay gratification, and take responsibility is caused by another problem. A child with attention deficit hyperactivity disorder may be unable to control him or herself well enough to be able to conform to some rules. Excuses for this might sound like a lack of willingness to take responsibility when actually the child is out of control. Depression, a mood disorder, or family stress may also cause a child to lose his temper often, and just not have the emotional strength to follow others' wishes. A child with a learning, hearing, sight or communication disability might also appear to be extremely oppositional. When assessing adolescents, it is necessary to rule out alcohol or drug use, which can generate many characteristics common to ODD. Lastly, there may be a combination of factors causing the behavior. Discovering what is causing the symptoms can be an extremely perplexing task.

It is important for parents who think their child mav have a behavior disorder to seek an assessment from a psychologist or psychiatrist who specializes in working with children and/or adolescents. An accurate diagnosis and early treatment will prevent the child from having to overcome the negative feelings and reactions of family, peers and authorities. Without treatment, ODD can continue into adulthood.

Usually by the time children with ODD begin getting help, many negative events have occurred in the family. Parents are feeling dis-empowered and angry, siblings are frustrated and dislike their brother or sister, ability to relate with peers is stunted, and school progress may be impeded. The child and family need an individualized and family-specific plan to overcome what has occurred and move forward in new ways. Family and individual therapy can be very helpful in reducing family chaos and helping parents and child feel more in control.

Treatment for ODD consists largely of re-education. Parents can learn strategies for reducing the level of confrontation necessary and how to disengage from power struggles. One technique for this involves having parents review with their child each day the plans and expectations for that day. This task allows requests for behavior to be low key, not on demand, and not perceived as special requests. This technique can be helpful because children with ODD sometimes have difficulty making quick transitions from one activity to another.

A child with ODD can learn to handle negative feelings in constructive ways that can result in more rather than less say so in what goes on. They can be coached on how to get in touch with and express their feelings to adults and be heard. They can be taught ways of saying "no" that are likely to be more favorably accepted by adults or peers. They can also be taught to leave the room to discharge negative feelings.

Family members can learn what they can and cannot do to help the situation and thereby reduce feelings of helplessness.  Families with a child with ODD can learn to function with fewer struggles and less interruption to daily living. It is not easy and requires professional help, a willingness to learn new ways of doing old things, and consistency. The rewards, however, can be great. Family members can feel hopeful, like each other, and have more time to focus on positive activities.

MARSHA B. SAULS, Ph.D., is a licensed psychologist in private practice.  Atlanta Network for Individual and Family Therapy. She is a supervisor and clinical member of the American Association of Marriage and Family Therapy. She the President of the Georgia Psychological Association. Dr. Sauls works with adolescents, adults, couples and families.

  Her office is located at 1864 Independence Square, Suite AB, Dunwoody, GA 30338, telephone: (770) 668-0350.