Treatment for ODD: Behavior Modification, or Something Else?
by Dr. James Sutton, Psychologist
Recently I received this email:
I have a nine-year-old son who appears to have mild (or early) symptoms of ODD. Can you refer me to a physician in the (named her city) area … I am particularly interested in behavioral modification without the use of drugs.
Behavior modification is not a new idea; it’s been around for decades. Basically, it is the systematic application of rewards and consequences to behavior as a way of improving it. It certainly has its place as a form of treatment. But its not a panacea, nor is it always the treatment of choice.
Oppositional Defiant Disorder rarely exists in isolation (which is why, I suppose, there is no medication designed specifically for the treatment of ODD). This disorder is more like a fever than a disease, usually symptomatic of something else, or several something elses, that are creating havoc in the psychological and emotional center of the child. This is especially the case when ODD is relatively acute, meaning that there have been clearly identifiable times when the youngster has not been oppositional and defiant. (Note: If the child has always been oppositional and defiant, it is probably a condition in and of itself, a part of the child’s “everyday” personality. B-Mod away!)
An example. I worked with a 13-year-old girl once who had been placed in a children’s home because of her behavior. She gave a whole new meaning to “oppositional and defiant.” She became so difficult to manage at school that she was placed in the in-school suspension program, then in the alternative school. She quit coming to school, violated curfew within her small town, and was picked up for MIP (Minor in Possession of Alcohol).
In glancing through her records I noticed that her recent grades were terrible, but her grades from the previous semester were quite good. Not only that, but there were no discipline referrals in the previous semester. None.
I shared my finding with her, and asked what had happened in her life 3 to 6 months ago that was so devastating. She gave me a “You’ve been reading my mail!” look, then broke into tears.
“My grandmother died,” she sobbed. She then went on to explain that her grandmother had raised her, so she had, all at once, lost her grandmother, her mother and her home.
I didn’t do behavior modification with this girl; I helped her process a deep loss. She recovered, and the early stages of healing were accomplished in days, not weeks or months. (for a story of how another youngster was “cured” of oppositional and defiant behavior in about four hours, check out chapter 7 in If My Kid’s So Nice … Why’s He Driving ME Crazy?)
It is the “something else” then that should always be investigated first. Often it is the focus of treatment and intervention. Granted, it will probably not be as obvious as the situation of the girl I described, but it’s certainly worth a look. If we don’t take a look, we’re apt to start blasting away, spraying our treatment “bullets” without ever seeing a target. And that’s when behaviors can even worsen. It happens, and this is why I would not begin with behavior modification for the nine-year-old of the mother who wrote the email. Since she herself described the boy as having “early” signs (a very favorable finding), I would begin with an in-depth history, focusing especially on the last 3-12 months, and a diagnostic interview with the boy that includes his perception of how things are going with school, family, peers and self. Of course, I wouldn’t know what treatment to use until I knew more about the youngster, his circumstances, and his views, but it might well not be behavior modification.
After all, does this caring mother really want behavior modification, or does she simply want the boy to get better?