Chelsea is a middle-school child whom outsiders consider quiet and polite. At other people’s homes, she is well mannered and helpful. But within the confines of her own house, she quickly transforms into a screaming, resistant terror.
Her mother, Anna, has tried grounding her, cajoling and pleading to get her daughter to cooperate, but to no avail. To her mother’s requests, Chelsea typically responds by shouting, “I don’t have to! You can’t make me!”
When Carrie’s son Jordan didn’t get his way, he would slam doors, push chairs and throw a fit. The 8-year-old’s outbursts occurred almost daily, severely disrupting the family of five.
“He just seemed angry and upset all the time,” Carrie says. “He’d talk back and blame everyone else for anything that was wrong. I was so irritated and frustrated with him that I felt detached from Jordan and didn’t want to be around him.
“The weird thing is that at school they thought he was the perfect child.”
It’s not unusual for any child to occasionally defy a parent’s requests to follow up on chores, or to get angry and blame others for his problems. For some children, however, this hostile, disobedient and defiant behavior continues day after day for six months or more, leaving their parents exhausted and frustrated in their attempts to change the behavior.
Mental health professionals call the condition oppositional defiant disorder (ODD). It is more prevalent in boys than girls and is believed to be present in about 16 to 22 percent of school-age children. The onset is at about age 8, although many psychologists believe that the behaviors can be seen in some form from infancy.
“The core feature of ODD is noncompliance, often in the form of arguing, defying, refusing to do what they are told and temper outbursts,” says Ross Greene, a psychologist specializing in the treatment of inflexible-explosive children at Massachusetts General Hospital, Boston, and author of “The Explosive Child” (Harper Collins, $24).
Greene emphasizes that ODD is unplanned and unintentional behavior. These are kids who “have wonderful qualities and tremendous potential,” yet they have deficits in two key areas: flexibility and frustration tolerance.
These aren’t simply kids with bratty behavior, agrees Dr. John Lavigne, chief psychologist for the department of child and adolescent psychiatry at Children’s Memorial Hospital, Chicago. “ODD kids are intense and persistent and can make their parents’ lives very difficult.”
A large part of the population experiences what psychologist James D. Sutton calls “good kid disorder,” where good kids basically shut down and refuse to cooperate.
However, says Sutton, author of the book “If My Kid’s So Nice, Why’s He Driving Me Crazy?” (Friendly Oaks Publications, $23.95), “some kids scream and yell at their parents to almost the extreme of being volatile and dangerous.”
Children with ODD resent authority. They actively defy adults and refuse to accept their requests or rules. They blame others for their mistakes and behavior and are touchy, easily annoyed, spiteful and vindictive. These children also are moody, easily frustrated and have a low opinion of themselves, according to psychiatric experts at Cornell Medical Center, White Plains, N.Y.
Parents try — and fail — in nearly every attempt to discipline the ODD child. Time-outs don’t work. Neither does ignoring, pleading, threatening, bargaining or anger, Sutton says.
Although the cause of ODD is under debate, a Chicago-based study recently found a link between ODD and sleep deprivation. A team of researchers led by Lavigne has found that children who sleep less than 10 hours in a 24-hour period may be more likely to have behavioral and/or psychiatric problems (such as hyperactivity, noncompliant behavior and aggression) than kids who get more sleep.
The team followed 510 children ages 2 to 5 years old for five years. The study found that children who got less sleep had about a 25 percent greater chance of developing a psychiatric disorder such as oppositional defiant disorder (characterized by tantrums, defiance and disobedience) and attention deficit disorder (marked by difficulty concentrating and hyperactivity).
Cornell Medical Center specialists cite four more theories being investigated regarding the source of ODD:
– That a predisposition to ODD is inherited in some families.
– That there may be neurological causes.
– That the child may have a chemical imbalance in the brain.
– That it may be related to a child’s temperament and the family’s response to it.
It is important to note that children with ODD may have other underlying medical conditions. The conditions co-exist, yet one is not the cause of the other, Lavigne says.
“It may be that the child is anxious or depressed, for example. But treating those conditions may not stop the ODD.”
Treatments for children with ODD vary, depending upon the therapist or mental health professional.
Lavigne’s research team is studying whether nurses in pediatricians’ offices can effectively teach parents interventions to help their ODD children.
“We’re trying to determine whether parents would benefit from the training or whether the kids still would need to see a psychologist because of the severity of ODD.”
Treatments through parent training programs already are under way in Seattle, under the guidance of nurse Carolyn Webster-Stratton at the University of Washington, Lavigne says.
“Her approach is to lay down a good strong foundation for a parent-child relationship, focusing largely on play,” he says. “She spends a lot of time teaching parents to play as an opportunity for positive interaction between the child and parent. Then she moves into different kinds of disciplines. The disciplines won’t work without first laying the effective foundation.” Jordan is improving after having been treated like that for two years.
Greene has a different approach. He believes that rather than focusing directly on a child’s compliance, the treatment should deal with the issues that give rise to the noncompliance.
“Fix what’s broke,” he says. “If you believe a kid isn’t compliant because he’s a lousy problem solver, teach him how to problem solve. If a kid isn’t good at complying because he’s too irritable to deal with life, do things — sometimes including medication — that get him to be less irritable.”
Greene believes there is no “one size fits all” approach to treating kids with ODD, so the goal is to match the treatment to what the individual child needs.
“When parents come to me with kids who are explosive and volatile and aggressive, they’re pretty desperate,” he says. “They’ve already found that the typical standard of care was either ineffective or made things worse.”
Greene teaches the frustrated parents a new approach: how to create a “user-friendly environment” to prevent a child’s meltdowns before they occur. He shows them how to help their children to think, communicate, negotiate and compromise.
“When parents have a new understanding of what these kids are about, they will be better able to help them,” he says. “The problem with these kids is not poor motivation. Compliance is a skill that simply doesn’t come naturally to all children.”
CHARACTERISTICS OF OPPOSITIONAL DEFIANT DISRODER
Although experts differ as to what gives rise to ODD behaviors, psychologist and author Ross Greene says the conventional wisdom is that poor parenting is a big factor. “It is thought that poor parenting ultimately teaches the child that if he makes his parents miserable, they will capitulate to his wishes.”
Greene says the poor parenting tag is too narrow a perspective, however. He believes the following child characteristics also contribute to ODD:
1. Difficult temperament.
2. ADHD (attention deficit hyperactivity disorder), which involves thinking deficits that block a child’s ability to shift his mindset when the environment demands it.
3. Mood disorders. “If you are a chronically irritable kid, your capacity to respond to the world in an adaptable, compliant fashion is going to be compromised,” Greene says.
4. Language processing issues. “Kids who are linguistically compromised may have difficulty doing what they’re told instantaneously,” Greene says.
5. Non-verbal learning disability. “These kids aren’t good problem solvers,” he says, “but rather black-and-white, concrete thinkers who don’t see the grays in things and have trouble with compliance.”
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For more information, or to link to an oppositional defiant disorder support group, go to www.conductdisorders.com.
