Oppositional defiance disorder
Oppositional Defiance Disorder is a mental illness characterized by a history of hostile and defiant behavior. In it’s basic form, Oppositional Defiance Disorder has specific criteria, according to the DSM-IV, the official book of all mental illnesses. The defiance must interfere with the child’s ability to function, first of all, either in school, home, or the community. Secondly, the defiance cannot be happening just because of another problem, such as depression, anxiety, or the more serious Conduct Disorder. Third, the child’s problem behaviors have been happening for at least six months. In these last six months, at least FOUR of the following eight problems have been happening most every day, or almost all the time:
• Losing temper • Arguing with adults • Refusing to follow the rules • Deliberately annoying people • Blaming others • Easily annoyed • Angry and resentful • Spiteful or even revengeful
If the child meets at least four of this criteria, and the rest described above, then he or she technically meets the definition of Oppositionally Defiant.
Treatment
In a clinical setting, typical treatment begins with a careful assessment. Assessment requires that a professional therapist, first of all, take a psychological history and develop a family genogram. That’s a sort of picture of the family, like a family tree, that helps put relationships and resources into perspective. Afterward, the therapist asks questions and listens to the parent and child describe what is going on with the child. This is known as the presenting problem. Experienced therapists will be interested in exceptions to the problem, or times when the child is not defiant, and why that may be. There will also be questions about parenting style, starting back when the child was a baby, as well as school, typical family schedules and routines, and ways that conflict is managed. The clinician will try to rule out another mental illness first, in order to focus the right amount of energy and direction on treating the defiance. Other questions will help to fill in the background necessary to get started. This initial assessment might take about 30 minutes, but is often longer.
The next step is to lay out a treatment plan. This might take a couple of sessions. There are several effective and research-proven ways to treat defiance, but the most effective and research-driven technique is a combination of Parent Management Training and an individualized Behavioral Modification Plan. Although each family is treated uniquely, there are certain qualities to this approach that are the same. With Parent Management Training, most of the energy and work with the therapist is directed at the parents, emphasizing new ways to manage the child. The Behavioral Modification Plan will outline rules of the home and society. It will also include rewards the child can earn for following the rules, and consequences associated with breaking the rules. In those consequences, there will be specific steps to follow to make sure the child is held accountable, learns from mistakes, and is ultimately successful.
Eventually, there will be progress, until the child understands that following the rules is a necessary part of life. Although it is possible to complete this treatment program alone, success is almost always more likely with the help and close support of a professional clinician experienced in the use of Parent Management Training and behavioral modification. Typical treatment of moderate to severe defiance requires four to five months. Several visits are usually necessary to get background and rule out other concerns, explain the process, answer questions, and get ready. At least one visit is necessary to develop and practice the Behavioral Modification Plan. The intensive treatment that follows usually involves two or three weeks in itself. The “maintenance phase” afterward can last from a month or two to six months, although most families are very happy with the results within six weeks, and termination, the final phase, is just one visit. Ward Halverson, LCSW-R, M.Ed. of Herkimer, New York is a recognized local expert on the treatment of moderate to severe oppositional defiance.
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See also
External links
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