Eliciting Change in Oppositional and Defiant Children

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Eliciting Change in Oppositional and Defiant
Children

• W. Bradley Goeltz, PsyD
• Marriage Family Health Services, Inc.

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The children now love luxury they have bad
manners, contempt for authority they show
disrespect for elders and love chatter in place
of exercise. Children are now tyrants, not the
servants of their households. They no longer rise
when elders enter the room. They contradict their
parents, chatter before company, gobble up
dainties at the table, cross their legs, and
tyrannize their teachers.
Socrates (469 BC - 399 BC)
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Common Characteristics of Difficult Children

• Defiant behavior is a normal part of healthy
  development, especially between the ages of
  transition such as 2 to 3 and during the early
  teenage years
• Oppositional-defiant behavior is a matter of
  degree and frequency

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Common Characteristics of Difficult Children

• Children with ODD display difficult behavior to
  the extent that it interferes with learning,
  school adjustment, and social relationships.

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Common Characteristics of Difficult Children - ODD

• Pattern of negativistic, hostile, and defiant
  behavior lasting at least 6 months during which 4
  or more of the following are often present
• Loses temper
• Argues with adults
• Actively defies/refuses to comply with adults'
  requests or rules
• Deliberately annoys people
• Blames others for own mistakes or misbehavior
• Touchy or easily annoyed by others
• Angry, resentful, spiteful, vindictive

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Etiological factors for ODD

• Underarousal to stimulation
• Prenatal exposure to toxins, alcohol, poor
  nutrition
• Abnormalities in the prefrontal cortex
• Altered neurotransmitter function in the
  serotonergic, noradrenergic, and dopaminergic
  systems
• Low cortisol and elevated testosterone levels

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Etiological factors for ODD

• Mismatch between temperament of child and parent
• Inconsistent, ineffective parenting
• Family instability, divorce, multiple losses
• Economic stress
• Parental mental illness, substance abuse
• Trauma

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Etiological factors for ODD

• With all of this complexity, then, what can we
  actually do to help?

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Common Characteristics of Difficult Children

• Ross Greene describes ODD kids as
  Inflexible/Explosive in his book, The Explosive
  Child

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Common Characteristics of Difficult Children

• Greene sees things largely in terms of
  temperament, which he sees as the factor that
  predisposes a child inflexibility and
  explosiveness.

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Pathways to Inflexibility and Explosiveness

• Mix high intensity with a poor reaction to new or
  unfamiliar things, add poor adaptability and
  negative persistence, stir in low sensory
  threshold and negative mood. Season with
  hyperactivity (optional). Heat (briefly).
• - Ross Greene, PhD

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Pathways to Inflexibility and Explosiveness

• Executive Function Deficits (EFDs)
• Social skills problems
• Language processing difficulties
• Mood disruption/anxiety
• Non-Verbal Learning Disability (NVLD)
• Sensory Integration Dysfunction (SID)

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Pathways to Inflexibility and Explosiveness -
EFDs

• Executive Function Deficits include problems
  with
• Ability to shift cognitive set
• Organization and planning
• Working memory
• Ability to separate affect

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Pathways to Inflexibility and Explosiveness -
EFDs

• How might these EFDs express themselves?
• Difficulty sustaining attention and effort
• Distractibility
• Lack of attention to detail
• Failure to attend/listen
• Inadequate follow-through and disorganization
• Restlessness, fidgetiness
• Difficulty waiting, tendency to interrupt

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Pathways to Inflexibility and Explosiveness -
EFDs

• This is essentially a description of a child with
  ADHD

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Pathways to Inflexibility and Explosiveness -
EFDs

• Not coincidentally, kids with EFDs (and ADHD)
  also often demonstrate
• Poor frustration tolerance
• Inflexibility
• Temper outbursts
• Instability of mood

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Pathways to Inflexibility and Explosiveness
Social Skills Deficits

• Effective social functioning requires that a
  child is able to
• Demonstrate cognitive flexibility
• Think quickly
• Process complex and sometimes ambiguous input

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Pathways to Inflexibility and Explosiveness -
Language Processing Problems

• Language skills allow a child to
• Reflect
• Self-regulate
• Set goals
• Solve problems
• Plan behavior
• Manage emotions

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Pathways to Inflexibility and Explosiveness -
Language Processing Problems

• Problems can take the form of
• Receptive difficulties
• Expressive difficulties
• Mixed expressive and receptive difficulties
• Difficulty labeling and organizing emotional
  material

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Pathways to Inflexibility and Explosiveness
Mood

• Most mood problems, especially in children, are
  marked by
• Irritability
• Poor frustration tolerance
• Agitation
• Fatigue

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Pathways to Inflexibility and Explosiveness
Anxiety

• Anxiety vs. nervousness
• Anxiety interferes with Executive Functioning
• Can lead to exhaustion
• Obsessive thoughts and compulsive behaviors can
  be the result of ongoing anxiety and problems
  with thinking rationally

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Pathways to Inflexibility and Explosiveness NVLD

• Non-Verbal Learning Disability
• Poorer nonverbal than verbal skills
• Poor math skills
• Difficult with reading comprehension despite good
  word recognition
• Difficulty with tasks that demand flexibility,
  problem solving, social judgment, and social
  interaction skills

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Pathways to Inflexibility and Explosiveness NVLD

• Non-Verbal Learning Disability
• Tend to be good at rote learning
• Often are rigid, concrete, and literal
• Can be difficult to distinguish from Aspergers
  Syndrome and High Functioning Autism

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Pathways to Inflexibility and Explosiveness - SID

• Sensory Integration Dysfunction problems
  processing sensory input (hyper- and/or
  hypo-sensitivity to)
• Touch
• Movement and coordination
• Body position and awareness
• Sight
• Sound

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Pathways to Inflexibility and Explosiveness - SID

• Can impact
• Motor planning
• Academic functioning
• Self-care
• Frequently overlaps with EFDs

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Pathways to Inflexibility and Explosiveness -
Miscellanea

• Other factors that lead to problems
• Problematic home environment
• Learning disabilities
• Bullying
• Drug/alcohol use
• Social isolation
• Trauma

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The Truth About Consequences

• The Standard Behavior Management (SBM) Approach
  presumes that
• The child learned that tantrums, explosiveness,
  noncompliance, and so on worked to get needs
  met
• Poor teaching/parenting is a major factor
• The behavior is planned, intentional, purposeful,
  and under the childs control
• Better teaching/parenting is the answer

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The Truth About Consequences

• The SBM unlearning process includes
• Lots of positive attention
• Issuing fewer and clearer commands
• Teaching that compliance is expected and enforced
  on all commands
• Consequences (rewards and punishment) are
  contingent on the childs behavior
• Teaching the child that tantrums wont result in
  authority figures giving in

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The Truth About Consequences

• The Standard Behavior Management Approach works
  very well as long as its presumptions are
  accurate, but . . .
• If the problems are fundamentally developmental
  in nature, then the SBM approach only makes
  things worse.

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The Truth About Consequences

• Consequences work very well if the child has the
  cognitive and emotional tools necessary to
  appreciate their meaning, or as Greene puts it .
  . .

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The Truth About Consequences

• The consequence you administered on the back end
  last time (must be) accessible and meaningful to
  the child on the front end the next time he (or
  she) becomes frustrated.

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The Truth About Consequences

• Remember, many if not most difficult and
  explosive children have problems with
• Shifting cognitive set
• Organizing and planning
• Working memory
• Separating affect from thought

These difficulties negatively impact the childs
ability to learn from consequences.
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Reducing Explosivity and Inflexibility Creating
a User-Friendly Environment

• Appreciation of antecedents of problem behaviors
  is vital for working with explosive children.
• This allows one to establish a setting that helps
  compensate for the childs deficits in
  flexibility and frustration tolerance

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Creating a User-Friendly Environment

• A user-friendly environment is one in which all
  the adults who interact with the child have a
  clear understanding of his or her unique
  difficulties

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Creating a User-Friendly Environment

• Allows authority figures to
• Eliminate or modify unimportant or unnecessary
  frustrations for the child
• Think more clearly when the child is melting down
• Be more prepared to anticipate and cope with
  situations that are likely to lead to
  explosiveness

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Creating a User-Friendly Environment

• Allows authority figures to
• Become less adversarial while maintaining
  authority
• Avoid perceiving the childs explosive and
  defiant behaviors as a personal affront or as a
  reflection on ones parenting, teaching, or
  therapeutic abilities

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Creating a User-Friendly Environment

• User friendly environments are characterized by
• Reduction of overall demands for flexibility and
  frustration tolerance
• Identification in advance of situations that will
  lead to explosiveness

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Creating a User-Friendly Environment

• User friendly environments are characterized by
• Quicker and more accurate perception of warning
  signs
• Appreciation for how one may be exacerbating
  inflexibility and explosiveness
• Adoption of a more effective language approach

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Reducing Explosivity and Inflexibility

• There are three general approaches to choose from
  when working with children
• Option 1 Imposition of adult will
• Option 2 Reducing or removing expectations
  relative to childrens limitations
• Option 3 Involving the child in a collaborative
  problem solving to address whatever is
  interfering with meeting expectations

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Reducing Explosivity and Inflexibility The
Options

• Option 1
• Imposition of Adult Will
• This essentially means that, when expectations
  are not met, we insist more emphatically

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Option 1 Imposition of Adult Will

• It presumes that the child either didnt
  understand the importance of the demand or failed
  to appreciate how strongly we desire the demand
  to be met

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Option 1 Imposition of Adult Will

• Problematically, Option 1 tends to increase the
  likelihood of an
• explosive outburst
• (think back to the EFDs)

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Option 2 Lowering Expectations

• Option 2
• Reducing or removing expectations relative to
  childrens limitations
• (both those that are developmentally appropriate
  and those that reflect individual differences)

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Option 2 Lowering Expectations

• The goal is to reduce the global level of
  frustration, because frustration exacerbates
• Problems with EFDs
• Mood/anxiety problems
• Any difficulties with language

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Option 2 Lowering Expectations

• It is not the same thing as giving in.

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Option 2 Lowering Expectations

• This is not necessarily a bad idea in some
  circumstances
• Cognitive limitations
• Autistic Spectrum Diagnoses
• Psychotic symptoms
• Extraordinary environmental stress
• Extraordinary psychological stress

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Reducing Explosivity and Inflexibility The
Options

• Option 1
• Pursues adult expectations but often at the
  expense of an explosive episode
• Option 2
• Reduces explosiveness but often results in the
  elimination or reduction of expectations

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Reducing Explosivity and Inflexibility Option 3

• Option 3
• Involving the child in collaborative
  problem-solving to address whatever is
  interfering with meeting expectations

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Option 3 Collaborative Problem Solving

• In short, this means that one teaches the
  cognitive skills that the child lacks.

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Option 3 Collaborative Problem Solving

• Remember, the goal is to
• pursue adult expectations
• while reducing the
• frequency, intensity, duration
• of explosions.

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Option 3 Collaborative Problem Solving

• Essentially the adult acts as the Surrogate
  Frontal Lobe (remember the EFDs) by
• Walking the child through a frustrating situation
  
• Solving problems that routinely precipitate
  explosions
• Over-teaching the thinking skills that the
  child lacks (with the goal of supplanting the
  need for an adult to act like a surrogate frontal
  lobe)

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Option 3 Collaborative Problem Solving

• Basically, Option 3 has three steps.

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Option 3 Collaborative Problem Solving

• Step One Empathize
• Identify the problem and the childs emotional
  reaction to it, without judgment

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Option 3 Collaborative Problem Solving

• Step Two Define the problem
• Introduce the adult perspective
• (the adult concerns)

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Option 3 Collaborative Problem Solving

• Step 3 Collaboration
• Invite the child to brainstorm ideas for solving
  the problem in a manner that is mutually
  satisfying

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Option 3 Collaborative Problem Solving

• How to make sure that Collaborative Problem
  Solving works
• Relationship, relationship, relationship
• Remain neutral (focus on clarification)
• Keep things on track (dont get distracted)
• Constantly emphasize the expectation of mutual
  respect

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Making the Most of Your Options

• At the outset, ask yourself what the behavior
  looks like.

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Making the Most of Your Options

• If you are in a situation that is necessarily
  non-negotiable (e.g., a safety issue), then you
  go with
• Option 1 - Exertion of Adult Will
• and be willing to accept a meltdown.

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Making the Most of Your Options

• If you are in a situation wherein the child does
  not possess the capacity to meet expectations,
  then you go with
• Option 2 Lowering Expectations
• and stop working for compliance
• (for now).

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Making the Most of Your Options

• If you find yourself with a temperamentally
  difficult explosive child, then you go with
• Option 3 Collaborative Problem Solving
• and look for a mutually acceptable solution.

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Making the Most of Your Options

• Focus on finding a good balance
• Early-on, you may have to do a lot of lowering of
  expectations (Option 2), while strict enforcement
  of adult expectations (Option 1) may be less
  frequent
• Over-using Option 2 is a common mistake as the
  process proceeds and the childs abilities
  develop
• Picking your battles (fluctuating between
  Options 1 and 2) isnt enough

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Some Points in Review

• Flexibility and frustration tolerance are skills
• Standard parenting/discipline approaches are not
  the best approach for all kids, especially those
  with certain areas of deficit
• Your perception and understanding of the childs
  inflexibility and explosiveness determines how
  effectively you will respond
• Meltdowns dont teach anyone anything

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Some Points in Review

• An adult is more likely to be able to respond
  differently to a childs inflexibility than a
  child is likely to radically improve his capacity
  to be flexible, at least initially
• Creation of a user-friendly environment and a
  focus on antecedents should lead to improvement
• Such improvement tends to lead to momentum,
  creating the context for the child to learn the
  skills related to flexibility and frustration
  tolerance

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• W. Bradley Goeltz, PsyD
• Marriage and Family Health Services, Ltd.
• 2925 Mondovi Road ? Eau Claire, WI 54701
• 715-832-0238 ? Fax [phone]
• dr.goeltz_at_sbcglobal.net