Excerpts from Your Adolescent on Oppositional Defiant Disorders
At times, all teenagers are oppositional argumentative, and inattentive. Absorbed in their own thoughts and concerns and more interested in their peer group, teenagers frequently turn a deaf ear to the adult world. Even when the demands are reasonable, a teenager may respond with belligerence or passivity. Because the thrust toward separation is especially intense, adolescence is a time when oppositional behavior is sometimes expected.
Disrespectful, defiant, and hostile behavior, however, must be carefully examined in a teenager when it begins to affect the youngster's social, family, and academic life or seems extreme compared to the teen's peers.
Identifying The Signs
It's not always easy to distinguish oppositional defiant disorder (ODD) from normal, age appropriate Oppositional behavior. Symptoms of the disorder tend to mirror, in exaggerated form, problems common to most families with teenagers. In addition, different families have various levels of tolerance for negative behavior. In some, a minor infraction of the rules produces major consequences, while in more tolerant homes, oppositional behaviors are largely ignored unless they cause practical difficulties.
In teenagers with ODD, there is a pattern of uncooperative, defiant, and hostile behavior toward authority figures that seriously interferes with their day‑to‑day functioning. They regularly lose their tempers, argue with adults, actively defy adult rules, refuse adult requests, and deliberately annoy others.
Blaming others for their mistakes, these may appear touchy, angry, resentful, spiteful, or vindictive, even to their peers. Although aggressive behavior tends to be limited, some youngsters engage in mild physical aggression, and their language tends to be more aggressive and obscene than the average teenager’s. Though particular stresses, of adolescence may significantly increase oppositional behavior, the symptoms represent a behavioral style that has been present for many years.
Teenagers with ODD were, in many, instances, fussy, colicky, difficult to‑soothe infants. During the toddler and preschool years, when a certain degree of oppositional attitude is considered normal, ordinary points of contention in the family became battlegrounds for intractable power struggles. These oppositional episodes were typically centered around eating, toilet training, sleeping, and speaking. Temper tantrum, were usually extreme.
In childhood and then in adolescence youngsters with ODD consistently dawdle and procrastinate. These teens may agree to perform tasks but later claim ignorance of the responsibilities, much to their parent, chagrin and frustration. They may say that they do not hear and, as a result, are often, referred for hearing evaluations, only to be found to have normal hearing. The issue is so listening rather than hearing by adolescence, parents and their oppositional teen usually have established patterns of interaction that contribute to stress and problems at home.
During these years, struggles with teens commonly center on keeping their rooms neat, picking up after themselves, taking baths or grooming appropriately, using obscene language, complying with curfew, doing homework, and attending school. In all instances, winning becomes the most important aspect of the struggle for the teen. At times a teenager with ODD will forfeit cherished privileges rather than lose the argument.
In milder forms of ODD, open conflicts are limited to the home environment, while at school, the adolescent may be quietly resistant and uncooperative. More severe forms involve overt defiance toward other authority figures such as teachers, coaches, and other adults in the community. Teenagers with ODD may get into trouble with police - most often for a disrespectful, provocative, or belligerent attitude.
Teenagers with ODD typically have little insight and ability to admit to their difficulties. Rather, they tend to blame their troubles on others and on external circumstances. They are always questioning the rules and challenging those perceived to be unreasonable.
Before puberty, the rate of ODD is higher in boys than in girls. In adolescence, the incidence of the disorder is roughly the same.
Causes And Consequences
It appears that oppositional defiant disorder arises out of a circular family dynamic, A baby who is by nature more difficult, fussy, and colicky may be harder to soothe. These parents often feel frustrated and as though they are failures. Parents who perceive their child as unresponsive or "bad" may come to anticipate that the child will be unresponsive or noncompliant. They may then become unresponsive or unreliable in return, adding to the baby's feelings of helplessness, neediness, and frustration.
As parents attempt to assert control by insisting on compliance in such areas as eating, toilet training, sleeping, or speaking politely, the young child may demonstrate resistance by withholding, withdrawing, or refusing to cooperate.
As a child matures, increasing negativism, defiance, and noncompliance become misguided ways of dealing with normal separation issues. In this way, the disorder may represent unresolved separation anxiety, a tenacious drawing out of the "terrible twos."
The more a child reacts in defiant, provocative ways, the more negative feed back she elicits from the parents. In an attempt to achieve compliance, the parents or authority figures remind, lecture, berate, physically punish, and nag the child, But far from diminishing oppositional behavior, these kinds of responses toward the child tend to increase the rate and intensity of noncompliance. Ultimately, it becomes a tug‑of-war and a battle of wills.
When such patterns typify parent‑child relationships, discipline is often inconsistent. At times, parents may explode in anger with efforts to control and discipline. At other times, they may withhold appropriate punishments and consequences so that these soon become hollow threats. As the child continues to provoke and defy, parents lose control. Then, feeling regret and guilt, especially if they've become verbally or physically explosive, the parents may become excessively rewarding in order to undo what they now perceive to have been, excessive discipline or harsh consequences.
When a child starts school, this pattern of passive‑aggressive, oppositional behavior tends to provoke teachers and other children as well. At school the child is met with anger, punitive reactions, and criticism. The child then argues back, blames others, and gets angry.
By the time a youngster with ODD reaches adolescence, she may have had years of difficulty at school, Her behavior and attitude regularly cause disruption in the classroom and interfere with social and academic functioning. When her behavior and defiance affect her schoolwork and behavior, she will have experienced school failure and social isolation. This, coupled with chronic criticism, can lead to low self‑esteem. Usually, ODD youngsters feel unfairly picked on. In fact, they may believe that their behavior is reasonable.
In many cases, oppositional disorders coexist with ADHD. Symptoms of ODD mav also occur as part of a major depressive disorder, obsessive‑compulsive disorder, or an attack of mania. In some teenagers, ODD may represent a remnant of separation anxiety disorder, in which oppositional defiance reflects a reaction to feelings of ambivalence and anxiety that arise from the developmental move toward independence. There also seems to be a correlation between ODD in a teen and a history of disruptive behavior disorders, substance abuse, or other emotional disorders in family members.
How To Respond
Although ODD is often diagnosed in childhood, there are many youngsters who continue to have behavioral difficulties well into their adolescent years. If you are concerned that your adolescent may have ODD, you should seek a professional evaluation. This is important as a first step in trying to identify the various factors that may contribute to ODD in your adolescent.
During the evaluation process, parents recognize the interactive aspects of this disorder and begin to look for new ways to relate to their teen. Books and parenting work shops given under the auspices of churches, schools, and community agencies may also help parents respond better to the needs of their youngsters. Once ODD has been diagnosed, the child and adolescent psychiatrist or other professional may recommend a combination of therapies for ODD. Among the options your clinician may recommend are the following:
Parent Training Programs Some parents are helped through formal parent training programs. In these sessions, parents learn strategies for managing their adolescent's behavior. These are practical approaches to dealing with an adolescent with ODD. The emphasis is on observing the adolescent and communicating clearly. Parents are taught negotiating skills, techniques of positive reinforcement, and other means of reducing the power struggles and establishing more effective and consistent discipline.
Individual Psychotherapy The therapeutic relationship is the foundation of successful therapy. It can provide the difficult adolescent with a forum to explore his feelings and behaviors with a nonjudgmental adult. The therapist may be able to help the youngster with more effective anger management, thus decreasing the defiant behavior. The therapist may employ techniques of cognitive‑behavioral therapy to assist the teen with problem‑solving skills and in identifying solutions to interactions that seem impossible to the teenager. The support gained through therapy can be invaluable in counterbalancing the frequent messages of failure to which the adolescent with ODD is often exposed. When conducted by a child and adolescent psychiatrist, individual psychotherapy may be accompanied by the use of antidepressant and antianxiety medications.
Family Therapy Problems with family interactions are addressed in family therapy. Family structure, strategies for handling difficulties, and the ways parents inadvertently reward noncompliance are explored and modified through this therapy. This approach can also address the family stress usually generated by living with an adolescent with ODD.
Cognitive‑Behavioral Therapy Behavioral therapy may help adolescents control their aggression and modulate their social behavior. Teenagers are rewarded and encouraged for proper behaviors. Cognitive therapy can teach defiant teens self control, self‑guidance, and more thoughtful and efficient problem‑solving strategies, especially as they pertain to relationships with their peers, parents, and other adults in authority.
Social Skills Training When coupled with other therapies, social skills training has been effective in helping teens alter their difficult social behaviors that result from their angry and defiant approach to rules. Social skills training incorporates reinforcement strategies and rewards for appropriate behavior to help a teenager learn to generalize positive behavior, that is, apply one set of social rules to other situations. Thus, following the rules of a game may be generalized to rules of the classroom; working together on a team may generalize to working with adults rather than against them. Through such training, adolescents can learn to evaluate social situations and adjust their behavior accordingly. The most successful therapies are those that provide training in the teen's natural environments‑such as in the classroom or in social groups as this may help them apply what they learned directly to their lives.
Medication Medication is only recommended when the symptoms of ODD occur with other conditions, such as ADHD, OCD, or anxiety disorder. When stimulants are used to treat teens with attention deficit/hyperactivity disorders, they also appear to lessen oppositional symptoms. There is no medication specifically for treating symptoms of ODD when there is no other accompanying emotional or behavioral disorder.