Psychotherapy for Oppositional- Defiant Kids

Childhood temperament is the elephant in the living room of child psychotherapy. Just as the influence of substance use and abuse on clients' behavior problems was often minimized by psychotherapists before the 1970's, the importance of temperament in children's behavior problems is becoming an increasingly essential part of child and family therapy.

After thirty years of working with children and parents, I am convinced that, barring developmental disorders or a major family tragedy, most children who come to therapy have higher maintenance temperaments (i.e., frequently described as difficult, spirited, or challenging) that frustrate typical parenting approaches.1 Some parents are unable to effectively deal with certain children who try their patience despite having no such difficulty with their other children. Here I will focus on one aspect of childhood temperament, frustration tolerance, its relationship with Oppositional Defiant Disorder (ODD), and how such concerns can be worked on in therapy with children and their parents. I will also examine the important role played by the therapist's inevitable personal reactions in the therapeutic process.

ODD and Children's Frustrations

When I worked with James R. Cameron, Ph.D. at the Preventive Ounce,2 we observed that children with low frustration tolerance are at risk for becoming oppositional. We saw that parents often responded to these kids in ways that exacerbated their problematic behavior. ODD has also been related to the child's temperament and the family's response to that temperament. This model helps therapists work with the child's temperament, the parent's style, and the interaction between the two.

In the same vein, Barkley3 states that "children who are easily prone to emotional responses (high emotionality) are often irritable, have poor habit regulation, are highly active, and/or are more inattentive and impulsive and appear more likely to demonstrate defiant and coercive behavior than are children not having such negative temperamental characteristics." He also notes that "immature, inexperienced, impulsive, inattentive, depressed, hostile, rejecting, or otherwise negatively temperamental parents are more likely to have defiant and aggressive children."

Children with low frustration tolerance are adamant in wanting to end the cause of their frustration as quickly as possible. When they are having a hard time with a task (e.g., homework, some tasks they don't immediately understand, or a toy or game that they can't make work the way they want), they find that the best way to eliminate their frustration is to stop trying and do something else instead. If they want to do something and their parent (or another adult) won't let them do it, the best way to eliminate their frustration is to act in ways that might get the adult to change their mind and leave them to their own desires and interests.

It is worth noting that except for being spiteful and vindictive, ODD traits and behaviors listed in the DSM represent how many children usually act when they don't want to do what they are told to do. The children that meet DSM criteria are diagnosed with ODD, but they could also likely be children with low frustration tolerance who are acting oppositionally in an effort to eliminate their frustration. The behavior that a parent or adult calls oppositional may also, in fact, be a child's age-appropriate response to a developmentally inappropriate limit set by the parent or environment.

1Chess, S., & Thomas, A. (1989) Know your child: An authoritative guide for today's parents. (New York: Basic Books)

2Cameron, J.R. & Rice, D. (2000). The Preventive Ounce Web Site. www.preventiveoz.org. (Oakland, CA: The Preventive Ounce)

3Barkley, R. A. (1997). Defiant Children, Second Edition: A Clinician's Manual for Assessment and Parent Training. New York: The Guilford Press

4American Psychiatric Association, (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. (Washington, D.C.: American Psychiatric Association)

5Stern, D. (1985) The Interpersonal World of the Infant. (New York: Basic Books)

6Hughes, D. (1998) Building the Bonds of Attachment. (Northvale, NJ: Jason Aronson)

7Schore, A. (2003). Affect Dysregulation and Disorders of the Self. (New York: W.W. Norton)