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The oppositional child

Monday, January 12, 2015

Written by: Michael J. Swaney, M.D.

Most experienced parents will tell you that a certain amount of defiance basically comes with the child-rearing territory. It is not uncommon for a child to express opposition from time to time. After all, children are individuals with their own unique opinions and preferences. And occasionally, they will push back simply to get a rise out of Mom or Dad. However, when those occasional expressions become the norm instead of the exception, it's time to take action.

All of us, including children, go through periods of emotional ups and downs. When children are struggling with their emotions, they may react in a more negative way — especially at challenging times like divorce or a move to a new neighborhood. But when a pattern of oppositional response extends over a prolonged period of six months or more, something else may be occurring: a child may be experiencing oppositional defiant disorder (ODD), a disorder that affects between 5 and 10 percent of kids.

What are the symptoms of oppositional defiant disorder? From a clinical perspective, I look for specific behaviors that include: exhibiting frequent outbursts, arguing with adults frequently, getting on people's nerves deliberately, acting angry or resentful, being easily annoyed, avoiding responsibility, blaming others for mistakes and behaving in a disrespectful way toward authority figures.

At school, a child with ODD may get into trouble for talking back or may get suspended for unruly behavior. In other social settings, he or she might have a conflict with a Scout leader or may get kicked off the sports team for talking back to the coach. ODD behavior is typically observed in more than one setting, but is most often seen at home — sometimes it is seen only at home.

Children usually exhibit characteristics of ODD at a young age — somewhere between kindergarten and fifth grade — but it can also come on later as an adolescent. This disorder is likely brought about by a combination of genetics, temperament and adverse interactions in family or social settings. While it may be challenging to identify exactly what triggers ODD, many believe that ODD is brought about and promoted through a negative reinforcement model.

In this model, parents, who may be too controlling or too passive, try to get a child to comply with their requests. The child, on the other hand, becomes hostile and increasingly defiant and unruly until he or she escapes the parents' demands. This can result in an ongoing cycle of power struggles between the child and parent. In essence, the parent's behavior can contribute to the child's negative response.

As mental health professionals, we address the situation at both the individual and the family level. In addition to individual therapy for the child, family therapy is of utmost importance. Parents learn to alter their behavior, such as reinforcing and praising appropriate behavior while ignoring inappropriate behavior

Oppositional defiant disorder often coexists with at least one other condition. For example, nearly half of all children with ODD also have attention deficit and hyperactivity disorder (ADHD). By nature of their hyperactivity and impulsivity, children with ADHD often exhibit oppositional and defiant behaviors as part of their difficulties.

Mental health providers working with a child with a diagnosis of ODD should strive to identify a potential underlying or coexisting disorder, such as major depressive disorder, Asperger's disorder, bipolar disorder or an anxiety disorder. Bipolar disorder, for example, could account for the symptoms of oppositional defiant disorder. Of course, identifying other disorders will affect the prescribed treatment.

Any child is going to be defiant at times, no matter his or her age. But if opposition impairs a child's functioning or if parents are uncertain how to handle a child's behavior, it may be time to seek support and guidance from a mental health professional. With the right help, oppositional defiant disorder can be treated, so children and their parents can return to healthy and productive lives.

Dr. Michael J. Swaney is a board-certified general psychiatrist and board-eligible child and adolescent psychiatrist with Presbyterian Psychiatric Associates in Charlotte.

Dealing with an oppositional child? These tips can help

•Always build on the positives. Give the child praise when he shows flexibility or cooperation.

•Take a time out or break if you are about to make the conflict with your child worse. Support your child if she decides to take a time out to prevent overreacting.

•Pick your battles. If you give your child a time out in his room for misbehavior, don't add time for arguing. Say "your time will start when you go to your room."

•Maintain interests other than your child with ODD, so managing your child doesn't take all your time and energy.

•Manage your own stress with healthy life choices such as exercise and relaxation.

Source: American Academy of Child and Adolescent Psychiatry.

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