Complex Oppositional Defiant Disorder

                                                                                                              What is it and How to Help

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Normal ODD:

We all come into this world with the ability to regulate moods and it is a developed skill, not will power.  Most ODD children present behaviors of defiance, stubborn, resisting to do most anything such as chores.  Most parents use parenting skills with boundaries and structure that can handle most conflict situations. 

Complex ODD:

Parents are really concerned about their behaviors of anger, defiance, temper.  There are other problems to be concerned with:

Executive skills problem:  ADHD, impulsive, inattentive, don’t look beyond present, and lacks the ability to learn from the past.

Mood disregulation:  Can’t turn on and off, can go for days with explosive emotions and behaviors.

Parents often blame themselves or get blamed by others for being bad parents.  They could have other children who behave normally but all the interventions used with them doesn’t work on a complex ODD child.  Parents often admit they have no control over child for some time.  Most of the situations, something has been going on for some time.

5 Core Cognitive Deficits:

1. Affect regulation/mood regulation.  Child gets frustrated easily and their tolerance goes from 1 to a 10 very easily.  They get their moods provoked and it is not related to any context.
2. Cognitive inflexible.  Sees things in back and white, can make mountains out of mole hills.  Most are around transitions, not events, such as getting up, going to bed, going to school, etc.  They may be behaving very well while watching TV and when asked to go somewhere, it triggers the outbursts.
3. Lack of problem-solving skills.  These kids have a hard time knowing what is bothering them.  They are unable to label or know to explain it.  They have poor foresite, have a hard time choosing options, doesn’t learn from the past.  Cognitive problems—they go into react mode, often anger, cannot slow down to think things through.  It is as if they are in a traumatic state, their brain goes into a fight or flight mode.  That is how their brain is wired.
4. Language.  They are unable to link how they feel and label it.  Cannot problem solve unless you can label it.  If you cannot label it, you cannot be empathetic so they don’t know why parents are feeling about their actions.
5. Solving.

Brain

The brain can be influenced by social influences.  There are three parts of the brain.  

Interventions for ODD

Strategies:

Trying to build the quality of relationship.

3 Areas of Main Focus:

1. We explain to the parents, bringing then education.  Have to do something different.  May say to the parent, “I can understand what you mean, but has anything worked?”
2. 50% reduction in explosive situations!  We want to help the brain grow and have compliance interaction within the family.  5 Goals for each intervention:

• Concerns taken seriously—empathy.  Child and parents concerns separately.
• Reduce Meltdowns—Kids often say, “I want to die, I hate you, I wish I had different parents, etc.”
• Stop brain disintegration.  The more the brain gets breakdowns, the more the brain damage.
• Work on cognitive skills.
• Improve secure base.

3. 3 Pathways for Interventions:

Force the concern.  You may have a child that gets up and the parent notices the trash has not been taken out the night before and it is raining.  You can force the child to do this but if you have a Complex ODD child, there will be a meltdown.  Ask, Is the kids concerns taken

A Plan             serious?--No  Is the parents concerns being taken serious?--Yes  Have

                        we done anything to prevent a meltdown?—No  Is the brain stopping

                        disintegration?—No  Have we worked on cognitive skills?—No  Have

                        we done anything to have a secure base—No.

Is a better choice.  Temporarily dropping the concern (about taking

out the trash).  This is not a good time, etc.  Is this good for the kid?

C Plan            —Yes  Is this good for the parent?—Probably not  Is this preventing a

                       meltdown?—Yes  Is this stopping the brain to disintegrate?—Yes  Is

                       this doing anything to provide a secure base—Yes.

Ultimately wanting parent to get to this point.  Use the EARIC method.  E stands for Empathy.  “Why do you believe you don’t want

B Plan             to take out the trash?”  It is basically telling them, “I got you” and

                        they are telling you why (labeling it).  Use 5 goals method on each

                       part.  A stands for assertion.  “You are a part of this family and

                      everyone has a part in this family.  We have to work together and

                      everyone doing their part.  R stands for respect.  Parents often

                      disrespectful to their children because they view them as being

                      disrespectful.  No matter what, show respect.  Most kids don’t listen to

                      what we say but the tone and actions of what we do.  Refuse to talk

          negatively to your kid and thinking things such as, “you are selfish,

          stupid, spoiled, lazy, etc.”.  Words can be very damaging and we loose

          the secure base that complex ODD kids need.  I stands for Invite

          Problem Solving.  Ask them to help with the problem, “how are we

          going to take out the trash?”  They may say, “I will take it out later

          tonight”, you can respond “I’ve heard that before, what is another

          option?”  The kid may say, “You take out the trash”.  You can state,

          “Nice try but this is your job, not mine.  Would you like switching one

           of my jobs?”  The parent may ask, “Aren’t you going out later today?”

           If the kid says, “Yes”, then say, “Good, you can take it out then, I’ll go

           ahead and pull the trash bag out and sit it by the door, Okay?”  This is

           C—Collaboration.  This is the ultimate goal that will get these kids

           who have difficulty in being able to label, problem solve, and slow

           down to plan anything because of emotions and lack of security.

Try this and see if this will help you with your out of control child. One thing to remember is that we cannot help others before we help ourselves.  If we cannot control our emotions and outbursts, how can we expect other to do the same.  Kids follow by example.

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