Making Peace, Part 2
The therapist should screen your child for anxiety, depression, and bipolar disorder. Each can cause oppositional behavior, and each calls for its own form of treatment. The therapist may also recommend cognitive therapy for the child, to help him cope effectively with difficult situations.
Carrots and sticks
In most cases, however, the treatment of choice for ODD is parent management training, in which the family therapist teaches the parents to change the ways they react to their child's behavior - both good and bad. Between weekly sessions, the parents practice what they've learned, and report to the therapist on their progress.
"Basically, parent training is about carrots and sticks," says Brady. "On the carrot end, you work on giving your child praise and rewards for cooperating. On the stick end, you lay out clear consequences for misbehavior, usually involving a time-out or the removal of a reward."
Parent management training is often highly effective, with the child's behavior improving dramatically in four out of five cases. Parents who undergo the training typically report greater marital satisfaction, as well as improved behavior from their other children.
While some parents balk at the notion that they are the ones in need of training, "they have to learn how to stop getting into the arena with the child and descending to the level of squabbling," says Silver. Parents often feed the problem by delivering overly harsh or inconsistent discipline. Instead, parents must reassert their authority by setting up well-defined rewards and punishments, and then implementing them consistently and dispassionately.
"My most important rule is that parents should not take ODD behavior personally," says Riley. "Remain calm and friendly whenever you intervene. Oppositional kids have radar for adult hostility. If they pick up your anger, they're going to match it."
Riley recommends a "two free requests" approach: "The first time you ask your child to do something, give him two minutes to respond. If he doesn't obey, calmly tell him, 'I'm now asking you a second time to pick up your coat. Do you understand what I'm asking you to do, and what the consequences are if you don't? Please make a smart decision.' If you have to ask a third time, the prearranged consequence kicks in - the TV goes off for an hour, or the video game is taken away."
Rewarding good behavior or punishing bad behavior isn't a revolutionary concept, but with oppositional kids, it's easier said than done. Parents must rein in their impulse to yell or spank. At the same time, they must learn how to substitute "non-aversive punishments" such as time-outs or the loss of privileges.
Many parents of oppositional children are so focused on bad behavior that they've stopped reinforcing positive ones. Yet positive reinforcement is the heart and soul of parent management training.
"Invariably, parents come to treatment with the idea of suppressing, eliminating, or reducing problem behavior," writes Alan Kazdin, Ph.D., in Parent Management Training, a manual for therapists. But according to Kazdin, director of Yale University's Child Study Center in New Haven, Connecticut, parent training emphasizes the concept of "positive opposites" instead. "For example," says Kazdin, "parents are asked what to do if they want their child to stop screaming, slamming the door, or throwing breakable objects. The answers involve reinforcing talking quietly, closing the door gently, and handling objects with care and not throwing them."
Kazdin maintains that helping parents learn to praise good behavior is one of the toughest challenges therapists face. He says parents are often "hesitant to praise a behavior or to use reinforcers in general because they feel the behavior ought not require any intervention. 'My child knows how to clean up his room, he just refuses to do it,' is a typical parental comment."
When parents do offer praise, they should be enthusiastic. "An unenthusiastic statement of 'Good' is not likely to change child behavior," says Kazdin. Praise should specify the praiseworthy behavior and, ideally, include some non-verbal gesture. For example, you might say, "It was wonderful the way you played so quietly while I was on the phone!" and then give your child a kiss.
Appropriate rewards and punishments vary from child to child. The more creatively you tailor your program to your child's specific abilities and needs, the better. But as Russell Barkley, Ph.D., professor of psychiatry at the Medical University of South Carolina in Charleston, writes in Your Defiant Child, "Creativity is always an asset to child-rearing, but it can't hold a candle to consistency. Consistency in the way you treat your child — the way you set rules, convey expectations, pay attention, encourage good behavior, and impose consequences for bad behavior — is the key to cleaning up your child's act."
Never lose sight of the fact that oppositional kids usually have a great deal to offer, once their behavior is under control. "Oppositional kids are also often quite engaging and bright," says Riley. "They tend to be optimistic and very much their own person, with their own way of looking at the world. Once you work through their defiance, there's a lot there to like."
To share parenting tips, visit the Parents of ADHD Children support group on ADDConnect.