ODD and Child Defiance

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Two Case Studies
The following are case studies that demonstrate typical oppositional defiant disorder behavior in children with both ODD and ADHD.

Emma, who is 4 years old, has been diagnosed with ODD and ADHD.

Emma's parents had thought that by the age of 4 she would have grown out of the defiant behavior, but that was not the case. Emma's behavior got worse. She often gets up early and makes a lot of noise until the rest of the family gets up. Despite her parent's explanations of how much this annoys them, she continues to be deliberately defiant.
Breakfast is always a battle. Her parents are in a rush to get off and start the day, but this makes her more resistant and she refuses to eat.
 
She is very demanding when alone with her mother for the day, needing constant attention and reassurance. When she asks for play dough, which her mother makes, she instantly wants something else as soon as she is given it. Emma often goes to pre-school with her grandmother or aunt for a few hours a day so that her mother can get some basic things done around the house.
 
At pre-school Emma is generally well behaved getting on with other children - as long as she is in charge. She is occasionally defiant towards the teacher and usually does not do what she is told. She does not, however, have temper tantrums at pre-school.
 
At home, though, the story is quite different. Family members use the time out routine by placing her in a quiet room to calm down. The room is empty because she breaks all the toys and damages the furniture during the course of a temper tantrum.

Saying "No" to Emma, is enough to trigger a temper tantrum. When she can't do or have what she wants, she screams and becomes violent. The tantrums are extreme and violent. Though some are over pretty quickly, a half an hour, others last longer.
 
When visiting family members such as her Grandma she will tell her about the tantrums, but from her own perspective. She will say that her parents locked her in her room because she was playing on the computer. When she was a little younger Emma's grandmother used to believe these stories, which caused tension between her and Emma's parents.

Once Emma's parents discovered her manipulative behavior when she said she wasn't hungry at dinner time because her grandma had given her sweets. When her mother confronted her grandmother about it, and the grandmother denied it, they all realized Emma had been lying.
 
Emma's family rarely takes her out knowing that her behavior will make outings difficult and embarrassing. Her mother goes out only when she is at preschool.
Jack is 10 years old and has been diagnosed with ODD and ADHD
 
Argument's start first thing in the morning when Jack is getting ready for school. Jack has a list of things he is and isn't allowed to take. This list was drawn up after Jack brought a knife to school on day. This consequently led to a serious discussion between his parents and his teacher.

It is hard to get Jack to school on time. He drags his feet, deliberately delays and is defiant. This happens less now, though, as his pocket money is reduced for each minute he delays.

Because Jack is quick to start fights with other children, especially those who tease or bully him, his parents drive him to school rather using the school bus, which has been the ground for many fights.
 
His class work and behavior is improving, especially since getting his pocket money depends on how good he has been and taking his ADHD medication. Previously he would have shouted and sworn and upturned his desk at the slightest provocation.

Playtime is difficult. He has no real friends because of his bossy behavior. When he does join in a game at the teacher's insistence he refuses, for instance, to pass the ball.
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Homework used to be a real controversial point. Jack would be defiant and refuse to work breaking pencils and doing all he could to get out of it. Now his parents hire a tutor who goes through the homework with him and with whom he is much more cooperative.

After homework, about 4.30, Jack's mother starts to make supper. It is at this time when he most starts to demand her attention. Jack usually winds up throwing a tantrum about one thing or another and is consequently sent in for time out to his room.

After supper his father takes over and they play. But there can be another tantrum when it is time to stop.
Both Emma and Jack have ODD. What will happen to them in the future depends greatly upon what their parents do now. The most important thing that parents of ODD children can do is to enroll in a parent training program. There are many programs available, but it is extremely important that whatever program their parents choose be designed specifically for ODD children. A parenting program for regular children will not address the specific issues that these children need.

A second requirement is that the program be an ODD treatment program for children under twelve. When a child becomes a pre-teen, his entire mental development changes, so that your approach as a parent must be different. There are excellent ODD teen behavior programs available. You should avoid the "one size fits all" approach that lumps younger children and teens together and treats them the same way.

One more thing you should realize- Many therapists, psychologists, and social workers offer programs locally to help parents of ODD children. These programs are effective, but they tend to be quite expensive. A recent study demonstrated that a home study parenting program for ODD was just as effective as using a program offered by a local health care professional and could save parents hundreds if not thousands of dollars, as well as give them the freedom tailor the program to fit their own schedule.

What ever you decide to do, it is critical that ODD behavior be addressed. It will usually not go away by itself.

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Anthony Kane, MD is a physician, an international lecturer, and former director of special education. He is the author of a book, numerous articles, and... more »

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