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Oppositional Defiant Disorder?

2014

Hello all, 
 
I am seeking any and all advice for effective strategies that people have used with working with school aged (around 9-11) boys with ODD. I am not a huge fan of jumping on the ODD diagnosis train, as sometimes I fear that it is a harsh label too easily placed on some children with circumstantial behavioural experiences. Anyhow, I am currently working with a young man who I genuinely believe this time around, has ODD, perhaps the most severe form that I have seen. 
 
I have slowly inch by inch found moments of connection with him through humour, providing choices, and reacting non-emotionally to any behavioural issue, but am seeking more resources or front-line suggestions. I am working with him in a school-based environment which can be tricky at times because there is such a clear line of dealing with behavioural misconduct (e.g. inappropriate behaviour, principals office, staying in the office all day etc.)
 
So far I have been firm but also lenient. When he tells me to go away or leave his desk, as long as he can phrase it respectfully and stops standing or flipping on furniture, I abide and give him space. When he tries to be malicious and hurt my feelings, I often create space for humour and catch him smiling and leave the conversation in a lighter manner (although I fear that if school administrators knew that I didn't immediately react with a 'principals office' 'indoor recess approach' they would be disappointed). At this point it appears that the whole student's career has been principal, isolation from the rest of the class, punishment - repeat. So I am looking for any suggestions or stories from others that have found success in similar situations. 
 
Although I have found small moments of connection, 95% of my time with him is still quite heavy and oppositional - and will most likely continue in this way for quite some time until a relationship can be solidified or that he leans in to the novel experience that I am trying to engage with him in. 
·         Excessive arguing with adults
·         Often questioning rules
·         Active defiance and refusal to comply with adult requests and rules
·         Deliberate attempts to annoy or upset people
·         Blaming others for his or her mistakes or misbehavior
·         Often being touchy or easily annoyed by others
·         Frequent anger and resentment
·         Mean and hateful talking when upset
·         Spiteful attitude and revenge seeking
All of the above are characteristics are relevant to this young man, most of them happening multiple times throughout one school day. 
 
Any and all suggestions welcome! 
Mariel Ridgeway
... 

 
Hi Mariel,
 
I had a boy last year in the Grade 8 District Behaviour Program that I work in that sounds very similar to your little guy. It can be so hard to work with kids who seem to want nothing more than for us to go away, but there are a few things that I found to be effective.
 
First, I found it very important that our relationship was on his terms, or at least he had the illusion that it was on his terms. For example, if we passed one another in the school hallways and I said hi to him, he would ignore me. However, if I did not say hi to him, he would approach me and ask for a high five. I found this type of interaction to be much more pleasant.
 
Second, I found it very important to give him space, both emotional and physical. There were quite often times when he needed to be removed from a classroom situation, or he was in the principal's office and was exasperating all of the office staff, and he came to hang out with me in my office. When that happened I would give him ample cooling off time - 30 minutes or so when he could just chill out and I would work on something else and not talk to him. After he was calm, we could have a productive conversation. If, however, I tried to converse without this cooling off time, it would only escalate into an argument.
 
This brings me to my third point, which is to avoid arguing at all costs. I heard really great advice at a workshop that I try to remember at all times, and that is that children with ODD feel powerful based on how they can make us feel. If we can avoid heated exchanges and keep our cool, they do not get that feeling of power and we therefore avoid a power struggle. You mentioned that you like to use humour, and I find this is a great tool for working with kids with ODD.
 
Finally, but perhaps most importantly, try to find positive ways to build a relationship whenever you can. My student was actually really great when one-on-one with an adult, so I would take him for coffee or for lunch and would learn a lot about him, which was very beneficial for both of us. I also found it was really important to start off every day positively; instead of having my first interaction of the day be confrontational, I would make an effort to ask how his morning had been or how he was enjoying the new video game he told me about. Those 2 minutes of positive interaction were  crucial.
 
Well, that was very long-winded, but I hope you find something of value in there. Good luck, you are doing good work!
 
Tamara Dueckman
Vancouver, BC
...
 
Hello Mariel,
 
It sounds like you are doing a wonderful job; creating a therapeutic relationship through humour and consistency. I empathise with your position of working with the school board (since I too work at a school) and recognize that the cycle of principal, isolation, punishment, repeat is an all too familiar and useless cycle that takes place in most schools.
 
My thoughts on this are that as long as stigma and misinformation about mental health problems in young people exist, this cycle will perpetuate itself. I think that what is needed is a recognition by school staff and administration that mental health problems do indeed exist in young people and that behaviours are not all just willful, but sometimes present because of a mental health problem which has developed over time. An understanding that mental health problems are not only psychological but emotional too (due to many factors) may help staff to empathise and understand the importance of the therapeutic relationship. Having written this, we also need to recognize that teachers and other school staff are under a tremendous amount of pressure to impart curriculum and there are many time constraints that exacerbate the punishment cycle.
 
You express that you are concerned that staff won't approve of the way that you are dealing with situations. What I would suggest is that if you have a staff member you are comfortable discussing this with, open up about why you think it is important to establish a therapeutic relationship with this boy, and talk about the successes you have had so far. Also, there should be some things that you absolutely do not compromise on (whichever you and the school consider serious), and talk to the boy about these. List the things that are definite issues, for example swearing, and tell him that for these, there will be consequence, and then consequence when he over steps the mark. It is only fair that your expectations are absolutely clear to him. Otherwise, continue doing what you are doing; connect through humour, be flexible (sounds like you are) and respect his personal space, stay calm (non emotional - sounds like you are), and try to catch him doing something "right" as often as you can.
 
Hope this helps and keep up the good work!
 
Delphine Amer
 
P.S. I was wondering whether you have had any exposure to CPS (collaborative problem solving). It is used for explosive children and can be quite effective if done correctly. The trick is to use the method PROACTIVELY; in other words, have the CPS conversations when the boy isn't being oppositional. There are two books : Lost at School and The Explosive Child by Dr Ross Greene which you might want to pick up and read.
...
 
Firstly, you have to work with the diagnosis regardless of how you feel about it. Working with the diagnosis of ODD helps you to understand particular behaviours. 
Just because you may or may not disagree with the label your job is to use the label to better help you understand the behaviours.
 
I am a Spec Ed Behaviour Teacher(Central) and a former CYC. The link below -  info on behaviour analysis (functions of behaviour) - will give you a better idea on how to create something positive for this student. I truly do not believe that a student wakes up in the morning and says "How can I make school a living hell for my teachers today?" 
 
http://cecp.air.org/fba/problembehavior/text.htm#identify

Your student seeks power(ABA). He engages only in power struggles  and regardless of consequence he knows he’s going to win. The reasons why... might be to avoid a skill deficit. He can not do always do the work or the task the he is asked to do.
 
·         What settling is this student in? 
·         Does this student have an IEP? 
·         What does it say are his strengths?
·         What does it say about his weakness?(This usually academic based)
·         What are some things that he does right throughout the day?
 
Although the behavior sounds deliberate it is not... behavior is learned so try not to take it personally.
Create a behavior mod program for him, using immediate rewards then gradually include a long term incentive. 
When creating look for things like transitions (frequency).
Task should be 5 mins or less.
 
When he is reacting or exploding ask yourself what you believe he is trying to gain from the behaviour? 
 
Going home means he doesn’t do work. Going to the Principal's office means he doesn’t do work. Being defiant means he spends time arguing and doesn’t do work. 

Yo
...
 
Hi Mariel,

It is clear that this young person is challenging you in so many ways. 

I am also not a fan of diagnoses and labels. The moment you say a child "has" ODD, then I fear the battles is lost at that stage, because then you have already defined the problem in a way that cannot be resolved.  Of course, we work in environments where diagnoses and labels are simply the "reality" that we have to deal with, it doesn't make it easy for us.

I believe that every behaviour, no matter how oppositional, has a positive intention - even if it is not obvious.  So one thing you can start to ask yourself is "what is the positive intention of the behaviour?".  It might not be obvious, and in many ways it so obvious, because very often the positive intention is simply protection. 

One thing I would suggest is that you work towards is establishing mutual ground for your working relationship, i.e. clarifying what he could gain from this working relationship.  It would have to be something that resonates with him, something that he really wants.  Until he sees some benefit to himself from working with you, you will continue to have try and "convince" him to work with you.  This might not be easy, but I believe that it is the starting point of any successful counselling relationship.  Only if and when he considers the relationship worthwhile for himself, will he be motivated to work with you. 
I have been taught (lime many of us) that building a trust relationship is an important prerequisite to successful counselling, but I have since learned that a truly mutual relationship IS the counselling, it is not something that we do in order to begin the work of change, it IS the change work.  The relationship is everything, and so the young person must see a benefit in this relationship for himself in order to become invested in the process.  His behaviour of pushing you away at times might just be an indication that it is how much relationship closeness he is able to tolerate at the time.  But when people want something, they quickly learn to tolerate a lot more. 

I think I am starting to ramble on now, so I am going to stop. This is my bottom line:  Even if ODD is real and even if he fits all the criteria, it is still not useful to you to see him as someone with ODD, because that will limit what you see, and it will limit your own flexibility in being able to respond in ways that others have not yet been able to do.  Work from the assumption that there is a positive intention behind the behaviour, find that positive intention, and then use that positive intention to build the relationship which becomes the blueprint for his future relationships.

Hope my ramblings make a little sense, and good luck!

Werner van der Westhuizen
South Africa
... 

I like what you are doing. In my experience go out of your way to catch him doing something "right" even if it's small; give him opportunities to help someone or you and to be successful. I have found that these kids have heard their whole lives that everything they do is wrong so ODD is a protective mechanism. "You are gonna tell me I'm a screw up anyways so I might as well beat you to the punch." Reframe and rephrase as they will bait you into fulfilling their prophecy.

Good for you for being creative and trying to avoid all those trips to the Principal's office as that just reinforces the ODD. PBS, positive behavior support, focus on the positive.

Also, I forgot about "indoor recess" which is the dumbest thing a school, teacher, admin ever came up with!!!! These kids are angry. Exercise and movement are a great way to reduce anger, to learn to self regulate. Yes, "so lets keep them in at recess, make them sit at a desk. They will learn who's boss and behave for the rest of the afternoon"???!!!! Right?

Do you have any opportunities to take him out to throw a weighted medicine ball, or run/walk  up some hills? Maybe use these as a break for 5-10 minutes twice a day?
:-)

Cynthia Brodowski
...

Hi Mariel
Given the behaviours you have described I think it is wonderful that you have been able to connect with him. This clearly speaks to the potential he possesses for connecting with others. I agree with your reservations about ODD which for me is merely a catch phrase for "otherwise disruptive behaviours" and used when professionals are stumped by such behaviours. From a treatment  perspective these behaviours can be a result of a myriad of underlying issues that cannot be defined without completing a comprehensive assessment that involves the child's and family's social history. The behaviours you have described can often be indicative of fetal alcohol spectrum disorder, trauma and attachment disorders.

Donicka Budd
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