Does it ever seem like everything your child does has the sole purpose of making you crazy? Of course it does, you are a parent. Even the most well behaved child can have periods of defiance. When this behavior is consistent for long periods of time and markedly interferes with functioning, it is known as Oppositional Defiant Disorder. ODD is a pattern of disobedient, hostile, and defiant behavior toward authority figures. This disorder is more common in boys than in girls. Some studies have shown that it affects 20% of school-age children. However, most experts believe this figure is high due to changing definitions of normal childhood behavior. It is important to distinguish ODD from defiant behavior that is considered within a range of age-appropriateness when diagnosing a child with ODD. 

Treatment for ODD is usually a combination of individual psychotherapy sessions for the child and parental meetings with a mental health professional in order to work on behavioral techniques. Medication is sometimes helpful to manage other co-occurring disorders such as ADHD or depression. 

One important parenting strategy with children who have ODD (and also just in general), is remembering to "pick your battles." Children will not consistently conform to your ideas of what their behavior should look like. This is perhaps a massive understatement. Many times it seems as though the exact opposite of what you are asking is what children will do. One fun idea is to pretend that perhaps today is Opposite Day. "Don't you dare eat those vegetables!" Children will usually respond to this with some humor. This idea also allows you to keep some humor in a difficult situation. Your attitude and demeanor as a parent is extremely important. Not only to children mimic your behavior and moods, but these things are what you have the most control over. 


A rule of thumb in picking your battles is to ask yourself if safety is a concern in what you are trying to have the child do (or not do). If the answer is yes, you of course have to stick to your guns and ride out any difficult behaviors and objections. If the answer is no, then perhaps you do not need the child to be doing exactly as they are told in that instance. You can certainly ask yourself the follow up question of how important adherence to your demand is to you personally. Every parent has a different set of values in this regard. Just remember that if you identify something as important to you, you have to be able to put in the time and energy of dealing with a potential push back from your child. It is critical to be consistent in your follow through. 


If you have questions around ODD or parenting in general, feel free to contact me. 

Resources:

BOOKS  

Your Defiant Child; 8 steps to Better Behavior, by Russell A. Barkley PhD ABPP ABCN and Christine M. Benton PhD (Hardcover - Oct. 6, 1998)

WEBSITES http://www.aacap.org/cs/root/facts_for_families/children_with_oppositional_defiant_disorder

Photo courtesy of http://adoptive-parenting.adoptionblogs.com 

Selective mutism (SM), is defined as a disorder of childhood characterized by an inability to speak in certain settings (e.g., at school, in public
places) despite speaking in other settings (e.g., at home with family). SM is associated with anxiety and may be an extreme form of social phobia.

The prevalence of SM is perhaps much more than one might expect. 1 in every 143 children are being diagnosed with SM. Usually the difference in speaking is noticed when children are attending kindergarten or first
grade as this is typically their first significant social experience outside of the house. There are often co-morbid (or co-existing) disorders that are commonly seen with SM such as social anxiety disorders or sensory integration disorders. Thus, when providing treatment for SM, a multidisciplinary approach is often very effective. Anti-anxiety medication in combination with therapies has also been shown to help achieve the desired results more quickly.

In working with many children who have a diagnosis of SM, one thing that has really stood out to me is the importance of not placing pressure on the child to speak. It can be difficult for parents and caregivers not to place pressure on the child to speak as it is expected in many situations. It also can be difficult to not "jump in" for the child and speak for them. The advice that I usually give around this is to give the child a few moments to try to respond on their own, and then explain that your child sometimes gets nervous. Most people are used to this to some degree, and will ideally shift their attention away. 

The other common misconception is that the failure to speak in certain settings is a willful defiance or behavioral problem. While some children who have a diagnosis of SM have strong-willed personality types, the most significant reason for their not speaking is a result of a paralyzing anxiety. Research into some of the neurological reasons for SM has suggested that children who have the disorder have an overly active amygdala. The amygdala is a region of the brain that has a primary role in the processing of memory and emotions. When this limbic area of the brain is put on "alert," it sends out a signal to the rest of the body. This can affect breathing, movement, and emotional responses. The so-called "fight or flight" response is enacted. Thus, situations that are to some people essentially non-threatening (being out side the home, coming into contact with unfamiliar people, etc.) are viewed as a threat to one's well-being. 


It is imperative that treatment for SM begin as soon as there is any evidence of its symptoms. Often the recognition happens around the time of the child first school-age experience. As children get older, the symptoms become more ingrained and the disorder is more difficult to treat.


If you have questions around SM, feel free to contact me.



Resources:

BOOKS Helping Your Child With Selective Mutism: Steps to Overcome a Fear of Speaking  By Charles E. Cunningham, Ph. D,  

Melanie K. Vanier Why Dylan Doesn't Talk: A Real-Life Look at Selective Mutism Through the Eyes of a Child. By Carrie Bryson 

WEBSITES http://www.selectivemutism.org/

Photo courtsey of sheknows.com