What is Oppositional Defiant Disorder and How Can I Help my Child with ODD?

A Review of Dr. Gina Antencio-McLean, PsyD Book “Overcoming Oppositional Defiant Disorder: A Two-Part Treatment Plan to Help Parents and Kids Work
Together”

By: Maria Barcelos, MA, Executive Director The Gatehouse

How Can I help My Child when they are diagnosed with Oppositional Defiance Disorder (ODD)? As a parent, being able to help my children feel safe, manage difficult emotions, adapt to life transitions and build self-confidence, and resilience is of utmost importance to me. Many parents struggle with shame-based thinking of not being good enough in general, and intensified shame at not being a good enough parent. These thoughts are further exacerbated when your child presents with additional needs, such as ODD. Having a child with different needs requires us to do some unlearning of unhelpful behaviours and learning of healthier ways to respond to be better able to support our children. This article is a brief review of Dr. Gina Antencio-McLean’s book “Overcoming Oppositional Defiant Disorder: A Two-Part Treatment Plan to Help Parents and Kids Work Together.” As a parent, I highly recommend this resource for any caregiver who is struggling to find other ways to respond and support their child.

Ramke (n.d.) noted that all children can be oppositional or defiant at times. However, what distinguishes ODD from normal oppositional behavior is how severe it is, and how long it has been going on for. A child with ODD will have had extreme behavior issues for at least six months. ODD is usually diagnosed around early elementary school ages. Children with ODD have a well-established pattern of behavioural responses, which can include:

  • Being unusually angry and irritable
  • Frequently losing their temper
  • Being easily annoyed
  • Arguing with authority figures
  • Refusing to follow rules
  • Deliberately annoying people
  • Blaming others for mistakes
  • Being vindictive

Dr. Antencio-McLean reminds every parent that children with ODD are not bad kids. They are doing the best they can. Children with ODD may have increased challenges being flexible and adaptable to changes in their environment. This is why you might notice that your ODD child behaves differently at school then they do at home.  As a parent, educating yourself on what inspires your child is a critical step in learning valuable life skills. It is important to emulate positive reinforcement for whatever behaviour you are trying to encourage them to change. For example, loading the dishwasher may start with the child taking their plate and placing it on the kitchen counter. Acknowledging them for their help with the dishes is a good start. Many behaviours may be difficult for your child. However, it is important to reinforce for yourself as a parent, that your child is a good kid and has the capacity to learn. They may need more time, positive reinforcement and patience to do so. Opportunities for positively reinforcing favourable behaviours involve recognizing them when they are making small changes. Small changes lead to bigger changes over time.

Furthermore, identifying which skills your child needs to help them meet their goals is critical for your child to feel supported, heard and validated. Dr. Antencio-McLean reinforces that children need to learn how to regulate their emotions and how to self-soothe. This is a foundational goal in helping children with ODD to regulate emotional states.

Identifying feelings is the first step in the emotional regulation process. We learn to self-soothe from our own parents or other caregivers as children. As survivors of childhood sexual abuse, we may have been further presented with unhelpful modelling behaviours by our parents. For example, not being able to talk about our feelings, being judged or criticized. It is important that we also continue to work on our own responses to trauma to further be able to model healthier responses for our children.

Dr. Antencio-McLean reminds us that some children need further help to calm themselves. Children with ODD may be more sensitive and need further support to self-regulate and soothe unhelpful sensations they are experiencing. She highlights behaviour change takes time and practice and that practicing in those times of calm will be most beneficial to helping our children learn to regulate emotions as our brains learn best when we are calm.  

For example, identifying a feeling and rating its intensity can be quite helpful for you and your child to identify what is happening for them in the moment. Using deep breathing or identifying some items in the home or school environment to help distract them to these items that are safe may help. E.g., How are you feeling? What level of intensity 1 low to 10 high? Let’s shift our focus to something colourful in our home that we like. How many blue things do you notice in the living room? Name one green item that you can see. Another helpful strategy can be to pass an ice cube from hand to hand to refocus on the cold sensation and minimize the emotional intensity. Regular exercise and socialization with friends help them stay present in the moment, which can be helpful for self-regulation. This is not an exhaustive list. Dr. Antencio-McLean noted that not every tool will be applicable to every person.

As survivors of childhood sexual abuse, we can be hard on ourselves and further reinforce the “I am not good enough belief” in times of stress. This is an opportune time for us to redirect our attention to the fact that we are trying to help our child (and sometimes at the same time, our own inner child who is struggling with the very difficult emotions of confusion, grief or sadness that our children struggle with).

Be kind to yourself and your child. Changing behaviour is not something that happens overnight. It takes time, patience and repetition.

As parents, we have firsthand experience and awareness as to what problematic behaviour our child is displaying. Awareness is key to identifying what behaviours are needing change. Take some time to reflect on what behaviours your child is displaying that may be unhelpful in the family dynamic. What resources can you access to help you learn different strategies to help you learn other ways to respond to your child’s behaviour?

Dr. Antencio-McLean reinforces that when supporting children with ODD to reflect on the fact that there are recognizable skills gaps in ODD children including emotional, cognitive thinking and distress tolerance. It is important to highlight that ODD children have a more difficult time with engaging with others, following social cues and understanding how our actions impact others. She mentioned that they may struggle in interpersonal relationships and social interactions. These experiences may leave them feeling confused, and they might not understand why people are responding negatively to them.

Furthermore, Dr. Antencio-McLean noted that cognitive thinking may be underdeveloped. This is not about intelligence. ODD children may be lacking in regulating their feelings, and decision-making abilities. However, with more awareness of their thoughts, feelings, behaviours and proactive and positive reinforcement, they can gain the capacity to respond to distressing emotions and bodily sensations and enhance their social skills.

Children with ODD need to learn strategies to manage distress. ODD children may struggle with regulating their feelings and often cannot identify internal experiences. For example, they feel uneasy and jittery unless they learn other ways to respond, they might resort to throwing items or yelling.

Remind yourself that your child is sincerely trying. My child is doing the best they can. Dr. Antencio-McLean emphasized that in their most difficult moments, they are acting out to try to get their needs met.

Dr. Antencio-McLean’s Strategies to Help Manage and Change Behaviour in ODD Children

Inflexibility – ODD children struggle with adapting to unexpected circumstances (difficulty managing change, disappointment, and uncertain expectations). As a parent it is important to provide some notice of upcoming changes, and why they are being made. For me, making this simple change has helped shift how my teenagers respond to changes such as stop playing video games and help with some chores. Additionally, it might be helpful for your child to learn how to identify their own feelings and thoughts so they understand how these impacts their situations. They must understand their emotions first.  Your child may be struggling with how to identify their feelings and likely struggle with feeling safe enough to share their feelings.  E.g. The more you demand for your child to hurry up and get ready for school, the more defiance you might experience from them. Clarifying what your child is feeling might help to understand what they are responding to. For example, they might take extra time in the morning because they do not want to be separated from you. Easing their anxiety by setting up more time to spend together at another time might help them feel more at ease.

Tolerating Distress. This is vital as children need to strengthen ability to sit with discomfort. E.g., shifting from one task to another – games to homework, learning to plan ahead. Difficulty stopping impulsive behaviours. Teaching them how to PAUSE before acting, helps them develop decision better making ability. Focusing on the breath and how it fills the lungs may help them to pause and notice what they are experiencing in the moment.

Practice. Dr. Antencio-McLean reminds us to practice when our child is in a calm state. Dr. Antencio-McLean noted that inflexibility is often related to unregulated emotions. To help them deal with these experiences, teach them to properly label their thoughts, feelings and bodily sensations. For example, I am feeling frustrated, and there is tingling in my arms. Expressly state how their behaviour impacts you. For example, when you hugged me it made me feel happy. When you yelled at me it made me feel sad. The goal is to increase self-control and tolerate distress. Calm down by breathing for two minutes, calm down using a stress ball, or exercising. Be patient, behaviour change takes time. If possible, prepare your child ahead of time of upcoming changes to routine. This can help decrease emotional burden when shifting from one task to another.

Collaborative Conversation – Dr. Antencio-McLean noted that collaborative conversations with your child and coming up with a mutual solution to a problem may help with behaviour change. This teaches children that their voice matters. As survivors of childhood sexual abuse, we lost our voice as a child. You are giving your child the gift of validation, self-expression and building their resilience and safety. For example, I’m sick of you turning off the Wi-Fi at 10pm. I am not a little kid; you can’t control me.  Response: I get that you think that 10 pm is too early and understand you feel mad. What time do you think would be reasonable? Child: midnight. Parent: Midnight might be too late. You have school in the morning, how do you feel when you go to sleep late? Child: Not good, tired. Parent: how about we keep the Wi-Fi a little later on weekends and you can stay up until 11?

ODD Toolbox – the ABC’s – Alternatives, Boundaries and Consequences

Dr. Antencio-McLean identified in her ODD Toolbox that addressing ODD relies on the understanding that children act out not because they want to cause trouble but because they don’t have the skills to handle things differently.  She lists alternatives, boundaries and consequences as key areas for parents to consider.

Alternatives. Introducing other adaptive behaviours. E.g., If your child starts yelling if you turn off the television. Your goal is to assist them with recognizing they have better options in managing their emotions. Using some notice prior to changing the activity will help with shifting to an alternative behaviour. For example, in 20 minutes, I would love for us to go out as a family for a walk/go to the park to get some exercise and fresh air. Then set a timer to help with developing awareness of time to shift to the activity.

Boundaries. These are the limits we set as parents to manage expectations. For example, its ok to spend time with friends but not all night. Creating boundaries can be challenging, but doable. Rigid, loose or inconsistent boundaries are unhelpful to your child. These may cause revolt in your child. Realistic boundaries that are consistent will be more helpful to your child. Realistic boundaries help create a sense of order in your home. Once these are identified, the work shifts to reinforcing them and working with your child. If you co-parent, it would be helpful to communicate with the other parent about what the boundaries are.

Consequences. These are any results of a behaviour. Natural consequences work better. These are the ones that happen naturally. E.g., If they forget their favourite toy, then they might feel sad. Implementing actions that will help them remember for next time will be helpful.  Positive consequences, for example offering an extra five minutes of snuggle time for the child that finishes their homework are more helpful than negative consequences. Negative consequences might reinforce oppositional behaviours.  

In terms of punishment, Dr. Antencio-McLean noted that sometimes it is called for. However, for children with ODD, punishment is highly ineffective. The child will almost always rebel. This leads to a cycle of defiance. Punishment tends to increase negative feelings in both the child and the parent. It teaches the child the behaviours not to do. Children with ODD need to know which behaviours to do. If you punish your child by taking away their favourite toy, they might stop talking back briefly. However, this will not be continued for too long. Your child needs to know that the talking back is the behaviour that needs addressing.  For example, ignore complaints, but if they ask politely, positively reinforce how they asked. Asking works better than complaining.

Check out Dr. Antencio-McLean book Overcoming Oppositional Defiant Disorder: A Two-Part Treatment Plan To Help Parents And Kids Work Together on Amazon at https://www.amazon.ca/gp/product/B07P9S2VLY/ref=dbs_a_def_rwt_hsch_vapi_tkin_p1_i0

References

Antencio-McLean, G. (2019). Overcoming Oppositional Defiant Disorder: A two-part treatment plan to help parents and kids work together. Emeryville, California: Althea Press

Ehmke. (n.d.) What Is Oppositional Defiant Disorder? Retrieved from https://childmind.org/article/what-is-odd-oppositional-defiant-disorder/