Working with the Oppositional Teen

by Andrew Patch, edited by Paul Rohling

 

 

We’ve seen it so often that it’s almost cliché: I am teen, therefore I argue.  We see it represented in our television shows, our movies, in the community sections of our newspapers: the eternal struggle between youth and authority.  For most, this is a developmentally appropriate, coming-of-age period in which we individuate from our parents, begin to define our own identities, and stretch the boundaries of our world.  For some, however, this so-called teenage defiance is something much more significant, and much more difficult.  For these youth, defiance is not an issue of normal development, but of compromised mental health.

 

What is Oppositional-Defiant Disorder?

 

Oppositional-Defiant Disorder (ODD) is a diagnostic term referring to an individual who experiences an ongoing pattern of hostility, defiance and general uncooperativeness that seriously impacts their life in at least two major areas (commonly school and home).  Often this includes frequent temper tantrums, near-constant arguing with adults—especially authority figures, refusal to follow rules, unwillingness or inability to accept responsibility for behavior, frequent anger and resentment, themes of revenge, low frustration tolerance, and active defiance.  Between 5 and 15% of school-aged children experience this disorder, and its genesis is believed to be both biological and environmental.  Roughly 65% of youth diagnosed with Attention-Deficit Disorder will later develop ODD, and both are much more commonly diagnosed in boys than girls.

 

How can I tell when I’m working with someone with ODD?

 

We have all worked with a teen who was oppositional at one time or another—likely, we’ve even been an oppositional teen (or adult) ourselves at some point.  But how can we tell between a student who is simply frustrated and angry versus one who fits the ODD diagnosis?

 

First, ODD is a long-term disorder—this isn’t a cold that will go away in a week or two.  With an ODD teen, you will see a long-term pattern of disruptive and defiant behavior that will likely have resulted in detention, suspension, frequent groundings at home, and even legal action.  For most ODD youth, symptoms begin to appear by preschool age.  Learning the youth’s history (through contact with parents, past teachers, records) can be a helpful tool. 

 

Second, examine the purposefulness of the youth’s behavior.  The typically defiant teen will usually have a clear goal in mind—getting out of an assignment, “messing with” someone, etc.  The ODD teen, on the other hand, will often argue without rhyme or reason.  Even on discussion after they’ve calmed, they will likely be unable to tell you why they became so angry in the first place.  A “revenge” theme to the ODD youth’s hostility is common; this population tends to be highly egocentric, interpreting even the most benign behavior by others as personal slights and attacks.

 

Finally, look at how they argue.  The ODD youth will frequently argue and defy without basis, flying in the face of reason and logic.  They will have great difficulty de-escalating once they are upset, which typically takes very little to achieve.  Usually, their arguing style will lack sophistication, as they will be reacting in anger at a more primal and emotive state than a logical one.

 

So I’ve determined I’m working with a youth with ODD—What can I do bout it?

 

Though it can be very difficult, especially in the school setting, it is highly recommended that you attempt to avoid power struggles when possible.  This can be accomplished in several ways.  First, provide clear, concise instructions, using few words.  Keep in mind that each sentence you add provides more room for misinterpretation, reinterpretation and argument.  Second, don’t be drawn into arguments with the student.  Set firm, enforceable limits from the outset, and choose your battles; there may be times when the best response is simply none at all.  Create immediate rewards and consequences focusing on behavior rather than attitude.  Finally, maintain a sense of humor, if for no other reason than to maintain your own sanity.  A smile is infectious, even to an angry teen (though this doesn’t mean that you should pick on them!).

 

When in conflict with the youth, focus on problem-solving, and on attacking the situation and not the teen.  Remember, your student does not want to act this way, and would prefer not to be arguing with you and embarrassing themselves in the middle of the classroom.  Be empathic, when possible.  Avoid becoming overly worked up yourself, as your level of arousal will elevate theirs.  Where possible, actively ignore attitudinal problems that are clearly designed to engage you in an argument.

 

When not in conflict with the youth, make a focus of accentuating the positive with them.  Note specifically what they are doing well, and why this is helpful.  Very often, an ODD teen will have a poor concept of themselves as a student and an individual; providing them with positive feedback will allow them a new way of looking at themselves, and allow you to see them in a more positive light, as well.  Attempt to connect with the teen, and encourage use of stress management skills like deep breathing, imagery, and “time outs.”

 

Attempt to engage the youth’s parents.  Continuity and consistency with this population is extremely important, and if the individual sees that his behavior in school has consequences in the home milieu, he will be more likely to comply with you.  Bear in mind that many parents coping with children with ODD have had their parenting skills pushed to the limit and often are very frustrated themselves.  Presenting your concerns and ideas with an attitude of openness, cooperation and empathy will yield much more positive results.

 

My student is frequently sullen and angry, but is it possible he’s depressed?

 

Absolutely.  Depression and Bipolar Disorder (commonly referred to as Manic Depression) can look very similar to ODD, especially in teens and especially in males.  Ours is a culture that does not value emotional expression, particularly among men; hence, youth often do not have a language to discuss or express more complex emotions such as sorrow and despair.  Instead, they are manifested through anger and defiance.  It can be quite difficult to differentiate between a youth who is ODD and one who is depressed; it is very common in fact for both ODD and depression to appear at the same time (comorbidity).

 

A key difference you will see between a teen who is depressed versus a teen who is ODD is the direction of their anger.  The depressed teen will tend to turn his anger inward, focusing on self-blame and criticism.  They will often shoulder responsibility for situations they have little or nothing to do with.  The ODD teen, on the other hand, will refuse all responsibility and blame others.  In fact, the suggestion that they take responsibility for an action will often result in a fresh bout of conflict.

 

Regardless the source of the teen’s anger and negative behavior, their situation is likely negatively impacting their life, and is not likely to improve without some form of treatment.

 

When should I refer my student to a counselor, and to whom should I refer?

 

Comorbidity of ODD with other diagnoses including Attention-Deficit Disorder, Depression, Bipolar Disorder, learning disabilities and drug and alcohol abuse is quite common.  Often, the symptoms (or their consequences) of one diagnosis will exacerbate the other.  Furthermore, the ODD youth is at increased risk for violent conflicts with others, involvement in drugs and alcohol, and criminal activity.  As such, it is highly recommended, if you suspect a youth you work with to be suffering from Oppositional-Defiant Disorder, that you refer them for an evaluation with a mental health professional. 

 

At Therapy House, we have experienced providers ready to work with such youth and their families.  Further, unlike many area counseling or psychiatric centers, we have both therapists and psychiatrists on staff and are thus able to offer counseling and medication management in house, with strong continuity of care.  If you are working with a youth whom you suspect could benefit from counseling or psychiatric care or have any questions about ODD or other psychiatric disorders of childhood or adolescence, please contact us for more information.

 

 

 

 

 

Information adapted from:

 

            Facts for Families:  Children with Oppositional Defiant Disorder.  (Dec. 1999)  Pamphlet

provided by the American Academy of Child & Adolescent Psychiatry (72).

 

Diagnostic and Statistical Manual of Mental Disorders, Fourth Ed.  (1994).  American

Psychiatric Association.