All children have problems with obeying their parents all the time especially if they view what is asked of them as unreasonable and will on occasion not comply with parental rules or requests. However 6 % of children will develop a defiance disorder which requires greater understanding as the parental approach is specific. The prevalence is up to 60 % in children with ADHD.
Noncompliance is defined by the following 3 categories
1. Failure to initiate behaviour requested within a reasonable time ie 10 seconds.
2. Failure to sustain compliance to a command until fulfilled.
3. Failure to follow previously taught rules.
Essentially these children are non-compliant to an extreme degree in order to avoid unwanted parental interactions and task demands. Certain factors contribute to the development and persistence of this disorder.
Major contributors to ODD
1. Child characteristics (Head strong temperament, underlying ADHD, underlying mood disorder)
2. Parent characteristics (As above)
3. Situational or contextual factors (Disagreement on discipline, marital difficulties, single mother)
4. Coercive theory (Who ever makes the other person more uncomfortable wins)
ODD has 3 distinct dimensions
Emotional (Inherent in the child - often exacerbated)
Part of the oppositionality is a mood disturbance of impatience, irritability, quickness to frustrate or be annoyed, as well as anger and hostility often with reduced fear and diminished sensitivity to punishment. Much of this can be attributed to the child’s temperament or a psychiatric disorder that disrupts normal emotional regulation like ADHD, child bipolar, anxiety or depression.
Defiant behaviour or social conflict (Basic attitude - can be untaught)
This consists of being headstrong, a propensity for rule breaking, stubbornness, noncompliance or a direct refusal to obey, often ignoring the requests of others such as their parents. This becomes worse the more altercations occur and so becomes a familiar way of being.
Hurtful (Deliberately harming others)
This consists of spiteful and vindictive behaviour and is purposely aimed at harming others. It can be seen as a precursor to Conduct disorder if it is more physical in nature.
Children with ADHD are at risk of developing ODD
Children with ADHD are forgetful and slow to respond and so get into trouble more often. They have a problem doing things they don’t see purpose in as well as a problem with self-control so will often respond impulsively to an instruction from a parent leading to an argument and ultimately a battle of wills. This places children with ADHD at a higher risk of developing ODD. All parents of children with ADHD should be aware of it as their natural parental response to developing poor behavior will often cause ODD to develop. The idea is to avoid it altogether by instituting more effective discipline from the start.
The problem of childhood defiance very often results from the parent’s lack of instituting consistent, effective and immediate consequences for bad behavior when it first arises, often around the age of 6. Without a strategy, defiance is often responded to emotionally resulting in a similar response from the child. Ultimately both parent and child make it as unpleasant as they can for the other hoping that the other will back down in order to get what they want. This “coercion theory “ is the single most important reason ODD persists.
The Treatment
No one can make anyone else do anything. The only one who can make your child do something is him or herself. The only tool you have to convince your child to comply with either your request or an established home rule is your ability to enforce consequences.
Because the hallmark of effective parenting in this group of children is to be fair and consistent,
it is important for all rules and their specific consequences to be written down and shown to your child so they know what is expected of them and what the consequence will be. Get them to sign the list so they acknowledge it and feel part of the decision process.
A token system can be used to encourage compliance in the following scenarios.
In the case of getting them to comply to a request a token can be offered and given if the child does something the first time they are asked.
If they refuse to do something that is necessary, a token can be removed but only after an opportunity is given to comply.
In the case of a stipulated home rule being broken, the agreed number of tokens can be removed without warning or another previously specified punishment can be applied.
An example of a token system is a marble jar where each marble (token) has a value and is added up at the end of the week to determine the reward eg 30 Marbles means more screen time , a milkshake or has a rand value.
Only breaking stipulated rules can result in a removal of a token. Summarily removing a hard-earned token at your own will, no matter the severity of the behaviour, will be construed as unfair, evoke a meltdown and quickly lose their buy in to this system leaving you with no bargaining tool. Any new infringement can always be added to the rule list with a specified consequence should it be repeated.
The following 9 points are important to remember when applying a token system:
Any system needs to be well explained and followed through fairly and consistently.
Regularly remind them of home rules and specified consequences.
To be perceived as fair, all siblings need to be included.
Only start removing tokens after the first week.
Removal of a token must always be preceded by a warning unless a stipulated rule is broken.
Don’t reward bad behaviour (giving a token so they don’t make a scene).
Remove tokens without showing emotion to avoid triggering a defensive response.
Recording the awarding or removing of tokens must be immediate and consistent.
Rewards must be enticing enough to encourage compliance and paid out weekly.
For young children time out can be used to manage any recurring problem behavior. Duration must be one minute for every year of age. Here the child is taken away from the environment and made to stand quietly against the wall. Failure to comply fully can result in more time or a threat to remove a token.
As many as 60 % of children with ADHD will at some point temporarily fulfill the criteria for ODD. However, their symptoms will be more emotional and argumentative, mostly without the blatant defiance. Should this emerging disorder not be actively addressed the defiant element, if not already there, may emerge and progress to vindictiveness with reversal becoming less likely. It is for this reason that any signs of ODD be managed aggressively with parental strategies and if necessary medication.
Comments