Bruce Alan Kehr, M.D. is the Founder and President of Potomac Psychiatry, ranked “Best Psychiatry Care Provider in Maryland” in 2020 by Global Health & Pharma. He has been named a Washingtonian Magazine “Top Doctor” for each of the past eight years. Dr. Kehr is a best-selling author whose works have been read by over 800,000 people in 206 countries. In 2020, Dr. Bruce Kehr’s blog was ranked #2 in the nation among mental health-related blogs. Dr. Kehr’s book, Becoming Whole: A Healing Companion to Ease Emotional Pain and Find Self-Love, is an Amazon Best Seller in the self-help categories: Happiness, Counseling, Healing, and Self-Esteem.
An Authority Figure is someone who has the power to give orders or make decisions, or the power to control someone or something. It is inevitable that each of us will encounter authority figures throughout our lives. Some of us choose to be in a position of exercising authority over others, while others function more effectively when led or managed by someone else in authority. Typically, if we have developed emotional maturity, we comfortably move back and forth between each of these positions. However, for children and adolescents struggling with Oppositional Defiant Disorder (ODD), relating to an authority figure is fraught with conflict.
Looking through the ODD lens
A child with Oppositional Defiant Disorder struggles with parents, teachers, supervisors and any other perceived or real authority figure. Many of these kids will resist compromise, be easily annoyed or angered, refuse to comply with rules, be hostile toward others, and struggle with accepting responsibility for their behavior. Children and adolescents with this condition may begin to exhibit problems with academic achievement and difficulties with building and maintaining healthy relationships.
Many of them feel justified in their defiance because they perpetually characterize themselves as a victim. It becomes difficult for them to develop empathy and they may also have problems recognizing and appropriately responding to social cues. This can make them more likely to become singled out for negative attention and bullying by others. They live in a continual state of negativity and hostility that is disruptive to their lives as well as the lives of those around them.
For 14 year-old “Sally,” ODD has meant longstanding challenges with academic achievement, an absence of close relationships, defiance toward people in authority, frequently being bullied, bullying others, all of which has contributed to her suffering from deep depression. Sally was adopted at age four and began to exhibit emotional and behavioral problems from the beginning. At first she was diagnosed with Reactive Attachment Disorder (RAD), but as she progressed through childhood into early adolescence she increasingly manifested signs of Oppositional Defiant Disorder. There are some overlapping signs and symptoms between RAD and ODD, and earlier in life the defiance is primarily seen in the relationship with parents, while later it generalizes to others in authority. For Sally, she does not seem to have formed an attachment to her parents at all, and she also struggles with others in both school and treatment settings.
Sally has also displayed an inability to regulate her emotions and exhibits impulsive behaviors when angry or sad. She has pounded her fists on walls and floors, thrown objects at family members, and is in a constant state of conflict with others, particularly her parents and therapists. She will make new friends, but if they get too close or are perceived as exercising any form of control over her, then Sally cuts off all emotional ties. Sally is largely unaware of her emotions and is unable to acknowledge any problems with her reactions or behaviors. Her emotions are so poorly regulated that she lacks control over most of her responses to how she is feeling.
“Did I cause my child’s problems?”
Parents with children like Sally begin to question what has caused their child to react in such abrasive and aggressive ways. Not uncommonly they ask themselves, “What did I do to cause these problems?” or “How did we end up here?”
There are multiple causes for ODD as well as coexisting diagnoses that can make the ODD symptoms more intense.
- Genetic influences: Scientific research has demonstrated that children from families that have a history of substance use, mood disorders, or learning disabilities, are more susceptible to developing ODD.
- Neurobiology: Brain imaging studies of children and adolescents suffering from ODD have revealed an impairment in the part of the brain responsible for reasoning, judgment, and impulse control. These studies also found deficiencies in an area of the brain that regulates sensitivity to fear and punishment, which may hinder one’s ability to associate maladaptive behaviors with possible negative consequences. Executive functioning was also impaired in these children, which could account for the poor regulation and over-reactivity to their emotional states.
- Psychological/Social Factors: ODD can be influenced by poor relationships with one or both parents; or parental neglect or absence, resulting in a lack of appropriate supervision. Sociocultural factors can also contribute (e.g. poverty, chaotic surroundings, physical or sexual abuse).
- Additional Coexisting Diagnoses: Children and adolescents that suffer from ODD are often diagnosed with a mood disorder, and/or ADHD. They may also be more susceptible to substance abuse, and have a tendency to engage in high risk behaviors.
In Sally’s case, as in most young people who have this condition, there were multiple factors that contributed to her problems. She was born in Sierra Leone and in infancy she lost her parents and her younger sister to AIDS. Sally was raised by an aunt who was physically abusive and who later abandoned her at the age of three by sending her to an orphanage, which lacked structure, nurturance, and care; and where the residents were left to fend for themselves to survive. Sally could recall picking through trash cans to locate enough food just to survive.
When Sally was eventually adopted by her American parents, she had already become accustomed to relying on herself. She did not perceive any value in relating to parents or other family members and often said, “I don’t need anyone, I can take care of myself and deal with my problems on my own. Therapists don’t help, teachers piss me off and I don’t like my parents”. Given Sally’s early experiences of the tragic loss of loved ones, followed by her experiencing abuse, neglect, and abandonment by adults in authority, who could blame her for her deep mistrust of everyone? Despite Sally’s avoidance of any meaningful emotional attachments, her adoptive parents are diligently working to find a treatment plan for her that is effective, and will help her to heal and hopefully become whole.
“Where do I go from here to help my child?”
Parenting a child with ODD can be challenging and create severe rifts within the family. It is important to try and respond to oppositional behavior without anger. When addressing an emotionally reactive child, you will need to work hard to remain as calm as possible. If you are emotionally reactive yourself, arguments will escalate quickly, and you will be modeling and reinforcing the very behavior that you wish to extinguish in your child. When communicating with your child about rules, limits, and expectations, be as clear and consistent as possible while remaining in control of your own emotions and behaviors. A child with ODD may believe that through persistent hostility and defiance they will hopefully wear you down to the point where you will give in to your child’s demands. Try to remember that their noxious behavior is not motivated by their wish to attack your personally – that your child lacks a more mature and effective means of communicating their feelings, wants and needs – and may be filled with deep feelings of sadness, fear, and disappointment over perceived or real betrayals by you or others in authority. When under attack it can be very difficult to resist becoming defensive and getting sucked into a power struggle. Your child may say things like, “I hate you”, “You suck”, “You’re worthless”, and will hit you with as many jabs as possible. This can feel deeply hurtful, particularly when you try so hard to meet their needs. Nonetheless, continue to be consistent in your responses and try to remind yourself that by saying “No” and setting limits you are doing what is best for your child. These are acts of love.
Begin to untangle your child’s life
Children and adolescents with ODD exhibit oppositional, defiant behavior in school, at home and in treatment. Although it can be very frustrating and emotionally draining, seek appropriate professional help and then stick with it. Individual therapy, parenting classes, and family therapy are great places to start. Dr. Mark Novitsky, a child and adolescent psychiatrist at Potomac Psychiatry, notes that “Children with ODD can learn how to gain control of their environment masterfully in order to get what they want. As a parent, it can be emotionally exhausting to be on the opposite end of this struggle, and it is tempting to throw one’s hands up in defeat.” He recommends the following steps to begin to turn around what feels like an impossible situation:
Step 1: In your own mind, reframe your child’s persistence as a strength that can be redirected over time toward learning more constructive behaviors.
Step 2: It is important that both you and your child understand that some of the oppositional behaviors represent an age-appropriate struggle between a child’s desire for independence and an authority figure’s duty to protect and set limits.
Step 3: Create a reasonable list of written expectations for your child – and then convey to them your belief that they have the capability and persistence to be successful in accomplishing these expectations. Write out a list of rewards for behaviors that meet these expectations, and reasonable punishments for refusing to meet them.
Step 4: If your child refuses to follow what is expected, do not take it personally. Communicate in a calm and even fashion that, per the contract, they will have to live with the consequences of their decision.
Step 5: Removing the back and forth emotional escalation can be extremely helpful, especially as your child is given ultimate control over whether they are successful in meeting the expectations you have set forth.
Step 6: Seek out a comprehensive evaluation from your child’s pediatrician, and ask for a referral to a child psychiatrist. Leave no stone unturned in getting to the bottom of numerous possible biological, psychological, social, and environmental contributors to your child’s condition. Early diagnosis and treatment offers your child the best opportunity for success.
Oppositional Defiant Disorder can be very difficult to overcome, but seeking out and sticking with appropriate treatment, including medication management, parent management training, and individual and family therapy, can inject much needed hope into the entire family system, and begin to help your child feel more effective, and feel better about themselves and their prospects.