Posted in Anger Management, Behavior, Emotions, For Nurses, Health, Pediatric Nursing, Positive Parenting, Relationships, School, Social Skills, Therapy

ODD has two components: Emotional and Social

Oppositional Defiant Disorder 

The Types of Behaviors that would qualify as ODD:

  1. Pattern of behaviors that consists not just of defiance, stubbornness, arguing, refusal to obey – These are certainly symptoms of ODD – BUT ALSO 
  2. A Pattern of Anger – Quickness to become upset – Easily Frustrated – Irritable – A child who appears to have difficulties controlling their MOODS (but particularly CONTROLLING their ANGER & FRUSTRATION) 
  • So if you PUT the two together – you have a child who has problems with HOSTILITY & ANGER and coupled with that is SOCIAL CONFLICT piece and that is the defiance and arguing with other people 
  • *** Families may see this type of behavior from time to time in NORMAL children – especially very young children (preschoolers and also in the adolescent years) BUT ODD is a cut above that kind of NORMAL behavior 
  • What differentiates ODD from NORMAL behavior??? How do we tell the difference between the child that is Temperamentally Stubborn and Strong Willed “Pig Headed” and the child that would go over clinically to the distinction of being ODD??? 
  • Answer: Oppositional behavior falls along a CONTINUUM – a DIMENSION with NORMAL behavior – so what separates the clinical disorder from the every day run of the mill??? There are several factors that we look for to make that distinction: 
  1. The first is the FREQUENCY with which these events are happening – it is one thing to have it happen on OCCASION (a few times a week or LESS) But if you are seeing this behavior pattern NEARLY EVERY DAY around various ACTIVITIES that your child has to accomplish, RULES they have to follow, DIRECTIONS or INSTRUCTIONS you give them – then this is ONE discriminating feature – FREQUENCY (Is this happening a lot more than we see in other children???) 
  2. SEVERITY – so that when the bouts themselves take place – when the DEFIANCE occurs or when the ANGER occurs – it is to a GREATER DEGREE than what we would ORDINARILY see even in normal children. So there is EXCESSIVE BEHAVIOR during these episodes 
  3. The Last distinction – which is the MOST IMPORTANT: This level of behavioral disturbance begins to INTERFERE with the child’s ability to succeed – to functional effectively in various major life activities. Those would be things like: Family Functioning, The ability to develop Independence & Self Reliance, Social Relationships with other People (particularly with other children), School Functioning and so on – These are the areas that we look at to see if the behaviors are beginning to affect the child’s ability to function effectively in Life – 
  • Does the Family find that they are spending LESS and LESS time with this child because of all the fighting 
  • Are the parents experiencing marital difficulties – this is another sign that something is happening that is beyond the pale… 
  • Have other families refused your child to visit because of the frequency with which they are ANGRY, AGGRESSIVE or HOSTILE to others
  • Are we hearing complaints from Teachers about this behavior pattern (preschool or elementary) 
  • If you are starting to get feedback “If the environment is kicking back” – then you are getting information that your child is not doing well in these areas and that is when you have crossed the line into a clinical disorder – it is no longer just normal behavior 
  • Basically it is  matter of DEGREE
  • ODD and Conduct disorder – how are they related?? The two are certainly connected to each other. Simplistically Conduct disorder is just a more advanced stage of ODD. 
  • ODD CAN occur by itself – the younger the child the more likely it occurs on its own (especially in the early preschool years ‘terrible 2’s and 3’s’) But as the child gets older if the ODD persists beyond the preschool years – it is the MAJORITY of the TIME – associated with another disorder – ADHD, Conduct Disorder, Depression or Bi-polar disorder (these are the more common ones that link up with ODD)
  • If we looked at a group of preschoolers 50% of them would have a second disorder BUT By the time a child is 8 years of age – 80% of them DO have a second disorder. 
  • ODD alone there is RECOVERY from that disorder – especially when PARENTS CHANGE their tactics, LEARN how to manage the child better, Quell some of the temper tantrums. If it is ONLY ODD then it has a VERY HIGH chance of GOING away within the next 2-4 years BUT if it is linked to another disorder – it is probably going to be VERY PERSISTENT – and one of the disorders it is linked to is conduct disorder. BRIEFLY, Conduct Disorder is a pattern of more severe aggressive behavior, fighting, lying, stealing, running away from home, engaging in antisocial activities (like delinquent activities as we often think of them – adolescents carrying and using weapons, breaking & entering, picking fights with other people) it is a much more severe pattern of social behavior than is just oppositionality or defiance. EVERY PARENTS NIGHTMARE 
  • ADHD connection to ODD – Do the two often occur together and does the treatment for ADHD will that take care of a great deal of the ODD??
  • Answer: The two disorders do go together VERY VERY often. For instance if a child has ODD  – the most common disorder that will be seen with it is ADHD and that is about 40-50% of preschool children with 1 disorder but by the time they get to be 8 years of age 60-80% of them have second disorder – most commonly ADHD and we know that at least 2/3 of ADHD children will go on to develop ODD within 2 years of their onset of ADHD. So the two go together and they increase their risk for each other. One of the reasons for that is that we know that ADHD is a CAUSE of ODD. 

Causes of ODD

  • ADHD is a cause of ODD 
  • Think of ODD as involving TWO SETS of behaviors – TWO DIMENSIONS of behavior that are LINKED to each other 
  1. First dimension that we see in ODD is a problem in REGULATING EMOTION (particularily ANGER, FRUSTRATION, IMPATIENCE, & HOSTILITY) Part of ODD is a MOOD disorder and the mood rather than being Anxiety and Depression which everybody associates that term with (MOOD DISORDER) in this case is ANGER, FRUSTRATION & HOSTILITY – This dimension of ODD belongs to the child – which means that it arises from INTRINSIC factors in that child – it could be due to a second disorder depression, bi-polar disorder or ADHD – it could just be simply a reflection of that child’s personality & temperament – Some children are more difficult, we would refer to them as having an ‘irritable’ or ‘difficult’ temperament – they are quick to anger, to get upset by things, they don’t have good frustration tolerance. ** So there is this EMOTIONAL element of ODD and that BELONGS to the child and ARISES from the child from temperament, personality OR another disorder 
  2. The second dimension of ODD is: SOCIAL CONFLICT – that is the defiance, the refusal, the  arguing, the stubbornness  – that involves TWO people NOT one like the EMOTIONAL DIMENSION does. the SOCIAL piece comes out of PARENTING. It comes out of FAMILY INTERACTION PATTERNS that are inadvertently training the child to use these MOODS and EMOTIONS as a SOCIAL TOOL – as a DEVICE in order to MANIPULATE people. ** Now neither party (the child or the parent) is doing that intentionally but that doesn’t mean the training isn’t occurring and the learning isn’t taking place because it is! Children are learning how to use these NEGATIVE moods that they POSSES in order to AFFECT another person and coerce them into doing as they would like them to do. That is a LEARNED piece and that LEARNING comes out of PARENTING. 

** So we have a social piece and an emotional piece to ODD and they arise from DIFFERENT factors – the EMOTIONAL piece arises IN THE CHILD – the SOCIAL piece comes out of PARENTING. 

** So TWO causes of ODD are the child has a NEGATIVE disposition for some reason that predisposes them to irritability and frustration and there is a LEARNING component to ODD and that arises with in the FAMILY through the way Parents are trying to COPE with their overly emotional child. If you Put the TWO together you are going to GET ODD. 

** ADHD is a contributor to the EMOTIONAL DIMENSION – ADHD children have a SELF CONTROL disorder and part of their difficulty with SELF REGULATION is they can’t control their EMOTIONS very well  – so that when ordinary emotions arise across the course of the day (as they will) the ADHD child can’t manage them as well as another child – they are often VERY impulsive, Quick to show their Emotions – Not moderate their emotions – So you can see the Link between ADHD and ODD – is ADHD is causing it – it is causing the EMOTIONAL aspect of ODD – but it doesn’t take long for those emotions, once they start to occur, to begin to interfere with interactions with parents and then training piece starts to kick in and now you are on your way to clinical ODD 

  • The same is true with the other disorders – whether it is Depression or Manic Depression – those ALSO predispose to the EMOTIONAL component of ODD – BUT once that is operative then the training has a chance to kick in 

ADOPTION & ODD 

We know from studies of adoptive children that 3-5x more likely to develop ODD, ADHD or both of them. Children who have been taken out of the adoption pool carry a much higher risk for psychological problems. WHY would this BE???? it is not the active adoption – that alone does not create these disorders – it has to do with where the child ORIGINATES. If the child is adopted here in the United States or in a Western Developed Country – what is likely is that the child’s ADHD is of the GENETIC type and that means that their biological parents were highly likely to be ADHD and ADHD parents are likely to have their children in their teenage years when they start bearing children. So ADHD is a major risk factor for teenage pregnancy – 40% of ADHD children as they grow up will have a baby before they are 19 years old and more than half of those babies will be put up for adoption because the parents aren’t yet ready to have or raise a child due to their own young age and also the immaturity that ADHD brings with it. So there is a genetic connection here. The child is MORE likely to have ADHD because the parents were likely to have it and the parents were more likely not to be capable of raising their own children – hence they wound up in the adoption pool. 

The Second contributing factor to this high risk for ODD and ADHD in adopted children (again coming back to ORIGIN) – some adopted children originate in undeveloped or lesser developed countries (Eastern Europe, Romania, China or the Koreas or South America like Columbia) these are going to be children that are coming out of situations where there was a high likelihood that there were pregnancy and birth complications- these may be children who were exposed to malnutrition during their pregnancy or parents who smoked and drank more and who had less prenatal care and were more likely to get infections – so these children would have been exposed to INSULTS to their nervous system that might have occurred during their pregnancy and arouse as a result of these various medical risk factors. In addition in certain countries such as Ukraine or Romania – these children may then have been put into orphanages that were understaffed – there would have been continuing malnutrition, lack of caregiver attention (so there was under stimulation)  – So now we have a child who because of the ENVIRONMENT is now at risk of developing ODD and ADHD. ** There is a genetic contribution but also a biological environment contribution that has to do with these EARLY hazards that have to do with pregnancy and/or early childhood. These two can often coexist with each other – that is the Genetics and the parents along with the hazards in the environment. But all of that explains WHY adopted children are more likely to have these disorders. 

DO kids Outgrow these disorders?

If Kids have ODD by itself – especially in EARLY childhood – between 2-4years – and it is the ONLY problem there – then YES about 50% of all children recover every 2 years which means that by the time we get to be about 8-10years of age the vast majority of ODD has dissipated – and the reason is because PARENTS have RE-ADJUSTED their parenting strategies in order to improve the child behavior. And more likely the ODD was of the SOCIAL CONFLICT variety – it didn’t involve the EMOTIONAL component. So if it is the RESULT of parenting then often resolving the parenting resolves the ODD. Nevertheless when the child gets to SCHOOL AGE – the situation is improved markedly. 

IF ODD is developing in the context of ANOTHER disorder (which it often is) then that Emotional  component of ODD is going to be there and adjusting your parenting ALONE isn’t going to necessarily going to be enough to address that second disorder. ADHD is one of the co-existing disorders that goes with ODD and if it is there – then you are going to have to TREAT that ADHD  in order to see REDUCTIONS in the oppositional behavior. ADHD treatments can be quite effective at doing so BUT the longer you let the ADHD go without treatment – the greater is the likelihood that ODD will develop and that treating the ADHD wont be enough to reduce the oppositional behavior and that is because the LEARNING has had a number of years to take place. You can get rid of the ADHD with medications but the LEARNING component of ODD will remain even though the EMOTIONAL component might be resolving with the treatment of the ADHD.

 ** The fact is that these other disorders DO contribute to ODD and they will need treatment in their own right. 

What Kinds of Parenting Strategies Seem to Lead to this inadvertently Training 

  • It is hard to not have negative feelings towards a child after they have drug you through the coals. It is hard to not develop a NEGATIVE attitude towards a child and also start avoiding interaction with a child that you know is going to fight you every step of the way. So it certainly understandable how parents slip into this. 
  • What can Parents do on their own or in conjunction with seeking therapy
  • Great Book To buy “Your Defiant Child” 8 steps to better behavior 
  • VERY IMPORTANT POINT: If you suspect your child has ANY of these disorders: ODD, ADHD, Depression, Bi-polar disorder… the Parent needs to ACT very QUCKLY and that is because RISK FACTORS are starting to occur if you leave these disorders untreated and the LONGER you let them go the more likely other risks start to occur – and some of those are IRREPARABLE risks – like risks of accidental injury – risk of Losing friends within the neighborhood & community and being labeled as a “PROBLEM CHILD” and so on – ** It is HARD to DUMP that label! 
  • The American Academy of Pediatrics – last November 2011 – issued a recommendation to ALL PEDIATRICIANS with regard to EARLY diagnosis & treatment of ADHD & ODD – but particularly ADHD because of its risk factors – they are now asking that pediatricians identify and treat these children from as young as 3-4 years of age rather than waiting until the child is 7, 8 or 9 years of age and has entered school and has 3-4 years of failure under their belt which is VERY difficult to reverse if you LET IT GO – FOCUS needs to be on EARLY identification & treatment in ALL of these cases. This is VERY different from what they used to say: “Give them some time, maybe it is immaturity…” – “We certainly don’t want to start them on drugs.” THAT HAS ALL CHANGED NOW as of November 2011 – The RISK FACTORS – the amount of RESEARCH on ADHD that has been done showing that it is an EARLY onset disorder and the EARLIER you treat it – the more likely you are to eliminate these ongoing RISKS – including the risk for ODD – So EARLY INTERVENTION is something that the American Pediatric Academy is pushing – Rather than the OLD CONSERVATIVE approach of: “Just Leave them alone – lets see if they outgrow it and if they don’t then we’ll intervene.” BUT that is TOO LITTLE TOO LATE 

SOCIAL COMPONENT of ODD – which is LEARNED through FAMILY INTERACTIONS with other people in the family – particularly with parents – WHAT IS GOING ON THERE????

  • What is going on there is that we see a pattern that we call – DISRUPTED PARENTING – ABNORMAL PARENTING – it is characterized by the following features: 
  1. HIGHLY inconsistent reactions to the child – some days the child acts up and defies and you are ALL OVER THEM – You React EQUALLY as NEGATIVELY HARSHLY: Yelling, Screaming, Threats and so on. OTHER DAYS your child defies and you LET IT GO – you are tiered of dealing with them – you don’t want to confront them anymore so you let that episode SLIP by. So what is seen is a VERY INCONSISTENT PATTERN of Vacillating between CONFRONTING the child IGNORING or NOT CONFRONTING the child’s defiance. 

*** Defiant Behavior is very much like GAMBLING behavior  – it doesn’t have to be rewarded every time in order for the gambler or addict to keep playing the slot machine – in fact it only needs to succeed about 1 in 10 times and the child will try to DEFIANT behavior every time – even if it doesn’t work and that is because they are on what is called a GAMBLERS REWARD SCHEDULE – Their behavior succeeds periodically and that is all it has to do to maintain it CONTINUOUSLY – just like the person playing the SLOT machine only need to succeed 1 out of every 5 or 6 handle pulls in order to keep putting their money in the slot machine every time – So this INCONSISTENT PATTERN contributes to this PERIODIC success of the child at b being OPPOSITIONAL 

2. The second thing that we see is that the parents are also VERY emotional themselves – we see a high rate of EXPRESSED emotions: ANGER, YELLING, SCREAMING, ARGUING  – The parent sometimes looks to be almost as oppositional as the child is in their Emotionality 

3. The third thing that is seen is that the parents often drift towards EXTREME forms of discipline with the child – and that’s because they are FED UP – they are TIERED – they are BURNED OUT and they OVER REACT from time to time and then there are other times when they completely IGNORE the child because they are FATIGUED or in a state of what is called LEARNED HELPLESSNESS = nothing seems to be working so they just don’t even bother dealing with the child (they usually just try to avoid the child) and you will see them spending LESS SOCIAL time, recreational and leisure time with the child and that gives the child a lot more opportunities for their DEFIANCE and RULE BREAKING to succeed 

*** So this pattern of disrupted parenting is  VERY important for people to understand because what is leads to from the child’s perspective is that the child can be periodically successful at getting the parent to BACK OFF – to NOT enforce their RULES & INSTRUCTIONS & COMMANDS and so on AND the child LEARNS that the quicker they get ANGRY and the HIGHER the ESCALATION (that is the more they escalate to more extreme forms of anger which may include even violence or self injury in some children) The child is learning that QUICK ANGER – ESCALATING ANGER usually gets the other person to BACK DOWN and LEAVE the interaction and then the child can go off and do whatever it is that they were doing before (watching TV, playing wth friends, doing whatever they wanted to do) 

  • So – it is often during these times – RULES, DEMANDS, CHORES that the child becomes DEFIANT and if that defiance succeeds at getting the parent to withdraw – even if it is only ONE out of TEN times – it is going to be used every time with the parent. 
  • The truth is that these kids are SO HARD to parent – so without putting any judgement on the parents  – it is CERTAINLY HELPFUL for parents to LOOK at themselves  — Really in ANY relationship, anytime you have a problem in ANY relationship – the FIRST place you ought to LOOK is at YOURSELF and not in a blaming sort of way but also because the only one you have a whole lot of control over is YOUR OWN REACTION in that relationship. It is not a moral failure and there are many reasons WHY the parent may be engaging in these behavior patterns BUT the first thing is to RECOGNIZE what they are. Just acknowledging: “What a minute – I have a role to play in this and the role I am currently playing is not working it is contributing to the problem – not helping.” 
  • WHY is the PARENTING DISRUPTED? Where is that coming from?? ONE Source: is that the child is VERY difficult  – you have a negative, difficult, strong willed – maybe even a child with ADHD or mood disorder – so that is posing difficulty  – these are VERY HARD CHILDREN TO RAISE even for NORMAL parents but what has also been discovered is that some of the disruptive parenting is coming from the fact that the parent has a psychological disorder as well – For EXAMPLE: ADHD runs in families – If a child has it – there is a 30-50% chance that one of those parents is ADHD as well. NOW one can see where the disrupted parenting is coming from because the PARENT is ALSO IMPULSIVE, INATTENTIVE, DISTRACTED, EMOTIONAL and in general has more DIFFICULTIES with SELF CONTROL themselves and now you have TWO people with the same disorder trying to interact with each other and it is making things WORSE. 
  • OR another disorder that is often seen linked to disruptive parenting is DEPRESSION (particularly in the mother) and where there is depression – a parent is going to be more IRRITABLE, more HOSTILE, less TOLERANT, less PATIENT – they are going to be OVERLY sensitive to even normal child gambits of child defiance and that is going to start in with this parental training of the child in this oppositional behavior 
  • OR if it is not depression – another link is that the father has a drug abuse problem or also is depressed, has ADHD or may is even ANTI SOCIAL and the FATHERS behavior can start to engender the same kind of interaction problem – the same kind of disruptive parenting – 
  • So before we start blaming the parenting for the child’s ODD – we need to first step back and ask WHY is the Parenting Disrupted?? And often – not always but often – the parent may have a psychological disorder as well 

Disrupted Parenting is CONTRIBUTING to the PROBLEM 

  1. Get your child diagnosed – see if there are any co-morbid disorders like ADHD or Depression which can be treated – The Emotional Component Can be treated 
  2. We know there is a PARENTAL component most of the time in this disorder  – caused by disrupted parenting 

What should a Parent DO????? Parent may be thinking “I am just worn out and I just want to avoid the child acting out and that is what I do…” Understandable – HOWEVER it is NOT working! So what should a Parent DO??? 

  • If the parent thinks they have a psychological disorder such as adult ADHD or Depression or Drug Use problems or the Parent happens to be a Single Parent that has been abandoned by their partner  or in a Divorce situation  – the parent needs to get professional HELP for themselves and for these issues or these stressors BEFORE they are going to be successful at dealing with their child  – So it is like a “HEAL THY SELF” recommendation – BOTH child and parent need to be evaluated and make sure that the parent is getting help for any issue that be contributing to the disruptive parenting 
  • REFERRAL – EVALUATION & TREATMENT 
  • Parents need to TAKE A STEP BACK and REDUCE the number of commands they are giving  the child because it is NOT working – the child is defying them. The more commands you give the more that the child defies you – the more TRAINING that is going to take place. 
  • So one thing that parents are told to do is to PULL BACK for 1 or 2 weeks  from the number of commands and instructions they are giving a child and begin to look at WHAT is ESSENTIAL and what ISN’T – in other words “Don’t Fight Battles You Don’t Have to Fight.” 
  • A lot of the instructions we give to children are NOT necessarily important for their DEVELOPMENT – they are the usual routine things like – picking up toys or putting away clothes or emptying dishwashers or feeding pets – those kinds of things – SOME of those such as – “cleaning up your bedroom” can be SET ASIDE for a week or two – it is NOT going to be a DISASTER if we let those go AND that is because you want to FOCUS on REDUCING some of the things that produce CONFLICT  – now coupled with that Parents are Encouraged to Develop a more POSITIVE relationship with the child and that comes through using your ATTENTION, APPROVAL, PRAISE, RECOGNITION with that child – Whenever the child does something appropriate  – even if it is NOT following a command – even if it is just playing quietly or getting along with another child in the family  – Parents need to go LOOKING for these ‘momentary’ periods of GOOD behavior  – where the child is behaving WELL and Parents need to COME IN with as much ATTENTION, APPROVAL, even AFFECTION around those times – NOTICE that this is ASKING parents to do something COUNTER INTUITIVE  – RATHER than doing what the PARENT WANTS – which is “How can I get this child to listen when they defy me”  – Parents are asked to STEP back for now and IGNORE that for now  – Lets even CUT BACK  on the rules and instructions and Lets START TO FOCUS on the POSITIVE episodes of behavior. 
  • All children have some positive behavior  – it may not seem that way BUT kids are not oppositional ALL DAY LONG and so YOU want to INCREASE the ATTENTION that is being PAID to this kind of QUEIT behavior, Getting along behavior (with other children or with parents) and even the times when the child follows an instruction or a command  – the Parent needs to make sure that they come in with A LOT more APPROVAL, PRAISE and even AFFECTION  – The point is to try to STRENGTHEN that good behavior FIRST. 
  • Make a GAME for a day – See How many times you can catch your kid being GOOD – often you will find that you FOCUS on the bad because it is what is driving you NUTS – but if you START looking for the good – all of the sudden you start noticing more often that your child isn’t ALWAYS defiant. 
  • Also what is often found is that parents are NOT noticing the good behavior because when the good behavior is happening parents are using that time to get other work done! If the child is quiet the parent is not using that time to go and reward the child – the parent is using that child to go and load the dishwasher, or attend to a younger sibling, or run a load of clothing, or get some extra work done, or answer their email, or reply to phone calls – but notice that the parent is kinda letting SLEEPING DOGS LIE – ‘ I got a chance here to get some other things done!!’  ——-> What that SHOWS the child is that the ONLY attention they are going to GET is when they are DISRUPTED because when they are well behaved – they are pretty much IGNORED. It is understandable WHY parents are doing it – but Parents are their own WORST enemies in this case. And parents really need to REVERSE the situation – And whenever they catch their child playing well, playing quietly, getting along with another child/someone, and ESPECIALLY if the child is following some type of instruction  – They need to come down on that child with as much APPROVAL and ATTENTION and AFFECTION as they can  – Parents will find that, that INCREASES that behavior – It is hard to believe BUT it does! 

*** We do need to understand – Some ODD children – particularly those with ADHD or mood disorders – Praise alone is just not enough to turn the tide back to a POSITIVE relationship – BUT parents should START with that – BECAUSE if that is NOT there (positive relationship) then the REST is NOT going to work. 

*** Some children are just not as responsive or sensitive to PRAISE – it just doesn’t seem to sustain their good behavior as well. —-> 

Systematic Rewards System or a Token Reward System – Parents Call it the ‘Chip Program’ 

  • The parent organizes the child’s rewards & privileges on a chart and then also a chart of the child’s Rules that they have to follow, instructions, chores and just good behavior is created. 
  • Parents create this poker chip program  – where the parents give chips or points to the child for doing what they are supposed to do: Chores, instructions and so on and the child is allowed to spend those for their privileges, other rewards and even for saving up some of those chips longer term (more expensive privileges – like being able to get a new video game, or being able to go to a friends house or going to a movie or doing these other things kids like to do) BUT they are also going to need these points or chips for getting their EVERY DAY privileges such as: using the internet or watching television and staying up a little bit later past bedtime and so on. 
  • In The book “The Defiant Child” It explains just how to set up one of these Chip Programs so that it works well. – It is kind of technical! 
  • It has been found that by linking the child’s GOOD behavior to their privileges and rewards through this kind of accounting system  – this provides that additional reinforcement beyond just the PRAISE alone and Token Systems work VERY very well with Oppositional Children IF they are set up CORRECTLY. 
  • 2. The second component to treatment besides INCREASING PARENTAL ATTENTION is beginning to LINK up good behaviors with REWARDS and privileges with appropriate behavior. And then of course teaching parents how to REMOVE those chips when the child misbehaves – this introduces sort of a FINING element – it is like getting a ‘speeding ticket’ -the child is going to be ‘fined’ within the token system for NOT following rules, NOT doing chores, or for inappropriate behavior. 
  • The CHIP program becomes kinda of a TWO sided COIN – it becomes a means of increasing rewards and privileges for when the child is doing well BUT it also becomes a means of LOW LEVEL discipline or mild punishment to the child when they misbehave – they will be fined within the token system. 
  • Taking a CHIP away from the child gives the parent a method of discipline when they are frustrated. And Parents of children with ODD tend to go towards the EXTREME levels of punishment so introducing this Chip System allows parents a REASONABLE method of punishing so that the parent feels like they are DOING something BUT they do NOT have to go to the extreme. 
  • IMPORTANT POINT: TIMING IS EVERYTHING WHEN DEALING WITH A CHILD’S MISBEHAVIOR – that is if you delay, stall, natter, nag, remind, threaten, yell, scream and then 30 minutes AFTER the misbehavior has started is when you FINALLY decide to do something  (such as put your child in time out) IT IS TOO LATE. 30 MINUTES is FAR TOO LONG. Research shows that if you WANT to control a CHILD’s behavior Your reaction MUST occur within 5 to 10 SECONDS and if you are DELAYING that reaction – if the consequences are being POST-PONED then that is where your problem is coming in. 
  • YELLING is NOT a consequence – THREATENING is NOT a consequence – it is HOT AIR 
  • Parents NEED to understand that yelling and screaming and arguing are NOT consequences for children – Parents have to STEP in and either remove these points or privileges OR institute time out – BUT it HAS to be done within 5 to 10 SECONDS – THE LONGER YOU DELAY THE LESS CONTROL YOU HAVE 
  • Parents delay because they want to be REASONABLE, they want to give THIRD & FOurtH CHANCES, they don’t necessarily want to discipline their child  – there are MANY REASONS for STALLING – BUT the STALLING is HURTING YOU (Parents) – it is your own worse enemy 
  • Just Remember – Timing is EVERYTHING – and the quicker you react – With a Consequence  – the better the CONTROL you are going to have over the child’s behavior 
  • Often times Parents are BURNT out but that is because they have LET IT GO ON for TOO LONG and then they have LOST CONTROL OF THE INTERACTION
  • With the Chip System – it gives parents something SPECIFIC to do – “You did not take the dishes to the sink – that is part of the rule – I have one of your tokens.” This way parents don’t have to go into the screaming and yelling  – Parents have been able “to do something” 

There are TWO other Consequences that need to be mentioned. Although the TOKEN system works VERY well for most children – it is NOT enough to REDUCE ALL THIS BEHAVIOR  —> Some misbehavior is WELL ENTRENCHED and that is when you get into TARGETED TIME OUT and the reason it is called TARGETED is because it is ONLY going to be used for ONE or TWO rule violations during the FIRST week it is introduced – Parents DON’t get to use time out for everything that they may have been doing previously  – Parents ONLY identify ONE or TWO problems and USE time out ONLY for those things  – THIS IS IMPORTANT – because if parents use time out excessively they RUIN it! 

The second thing that has be emphasized with TIME OUTS is that it is QUICK  – “SWIFT JUSTICE” – If you are going to TIME a child out – it is going to have to be done in 5 to 10 seconds of the FIRST infraction  – DON’T let it go on and on and on  – because THAT is why a time out may NOT be working  – some parents say “oh I tried time out and it doesn’t work for me” — it is because that parent waited 15 minutes before they finally timed their child out and of course now it is not going to work. 

What makes punishment work – like time out – ARE TWO things to keep in mind:

  1. THE SPEED WITH WHICH YOU DO IT “SWIFT JUSTICE” works – It is NOT how painful the punishment is  – it’s how quickly you do it AND here is the second piece —>
  2. HOW MUCH reinforcement or reward is available in that family for doing the right thing  – In families where the rewards have been PUSHED up – The approval, the praise, the affection, the token system, the points, the privileges –  When there is a sufficient level of those around  – to reward a child for doing WELL and doing the right thing – THEN PUNISHMENT works – BUT if there is VERY LITTLE reinforcement in the family for what the child is doing well – then you could punish this child FOREVER and it is NOT going to change their behavior 

*** So the Trick to punishment is make sure there is an adequate amount of reward, attention and affection when good things are done and then when you have to time out do it VERY QUICKLY – DO NOT LET IT ESCALATE and then it will work 

*** But often times TIME OUT becomes another area for DEFIANCE – the child will say “Nope not going to the time out chair” and they won’t do it – what do parents do then?? 

Answer: Well often times the child may have to be physically escorted to the time out location – whether its taking them by the shoulder or grabbing hold of their shirt collar or their belt loops in the back (not talking about grabbing an ear or pulling hair!!!) – you may have to physically escort the child to the time out area and if that is what you have to do then that is what you have to do. 

*** Sometimes the child may go to time out but there is a lot of yelling and screaming and whining  – Parents need to IGNORE that as long as the child STAYS in time out  – all the rest is just window dressing – forget about it – DON’T take the BAIT  – don’t ENGAGE the child – as long as the child is staying there in time out – that is okay 

What do Parents do if the child LEAVES the time out location? Before the child has served their penalty? This is when parents should Back Out time out with ISOLATION to the bedroom  – in other words go to the child’s bedroom – make sure there is VERY little toys in there – SANITIZE the bedroom of privileges before you do this and then if the child has trouble staying in time out then they are going to have to go into their bedroom and if necessary the parents will close and HOLD the door shut in order to ENFORCE the time out ** This is the BACK UP when all else fails and the child will NOT remain in TIME OUT – then we use this ISOLATION to the bedroom  – it is called BARRIER RESTRAINT  – that is you are using the DOOR as a barrier to restrain the child from leaving time out  – DON’T try to hold the child in time out, in a time out chair – DON’T try to physically restrain them  – most parents are VERY POOR at doing so  – instead use the bedroom and the closed door as the barrier and then that imposes the restraint on the child  – Often times you do not need to go to this level BUT with more SEVERELY oppositional children YOU DO (more details about this in the book “The Defiant Child”)

Author:

Mother, Pediatric Nurse and a Trail Blazer for Positive Change.

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