Assessment and Treatment of Oppositional Defiant Disorder

Children with Oppositional Defiant Disorder (ODD) are expressing behavior that was normal at 2-3 years of age. When we observe 2 and 3-year-olds discover the magic of language it becomes clear that their opposition to authority helps them to develop their sense of self. They discover the power of their words, especially how “no” can affect reality and cause reactions in others. By withholding compliance they discover “choice” and independence. They feel they possess something powerful and wanted by others. By saying “yes” they learn that “giving” compliance can prove to be socially valuable and rewarding to them. They exercise “choice,” to comply or not comply creates a separation between themselves and the parent. In defiance, they learn that for every action there is a reaction. These early lessons prepare them life in unique ways. The early lessons require parents to guide and not control in protective and emotionally secure ways. By forcing early compliance, the child may lapse into passivity and dependence, or angry disobedience. They may rely on being forced or punished in order to get their needs met. By being overly indulged, the child may become too independent, believing they alone determine what is right for them and gradually lose respect for authority, developing a sense of entitlement.

When oppositional and defiant behavior outgrows the normal functional period and the child becomes 5 and 6 years of age when we expect more compliance with “rational” authority, parents begin using rewards, loud reprimands, threats, “time-outs,” and tangible consequences such as taking away privileges or corporal punishments to achieve compliance. When these consequences fail, we begin to diagnose ODD.

Formal psychological testing can determine whether the child is failing to comprehend instructions which may surprise the parent of a normal-looking child. They may be distracted or fail to pay attention. When these conditions explain the behavior parents often realize they are punishing behavior the child cannot understand or control and that they need other interventions to obtain their goals. When children have ODD, the normal rewards and punishments often fail for the lack of consistency between parents, or the connection between the parent’s goal or the methodology is not logically conceived (such as being angry when a child refuses to pick up his toys but believes doing so would be an act of weakness, or spanking a child for being too aggressive with their younger sister).

Interventions for ODD

Play Therapy

Play therapy is often a very successful intervention for children with ODD because it permits a period of bonding between the child and the therapist on a non-verbal level, through play. The child learns that the therapist is safe to interact with and that they associate play with learning and success. With rapport, the child begins to open up and disclose the feelings they have regarding many of their interactions with peers, family, teachers, and others. They are more responsive to questions about their view of the world, their personal experiences and possible traumas.

Behavior Therapy and Parent Training

Parent training involves teaching parents the science of parenting. We discuss, teach and model “time-out” procedures, cost-response and positive reinforcement, how to give instructions and praise effectively, the problems with corporal punishment, and much more. Often parent-training involves helping parents resolve differences in their parenting philosophies, reduce their own negativity and work better as a team.

Reality Therapy

Based on the teachings of William Glasser, who posited that we all have four basic needs, the need to love and be loved, the need to be accepted, the need for power (through winning, learning or achieving), and the need for freedom, independence, and autonomy with a sense of responsibility. In this approach children explore how their behavior may be ineffective in pursuing their needs. They explore the control they have over meeting or failing to meet their needs.

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