Parenting Is Crux of the Cure in Defiant Disorder

By Damian, McNamara | Clinical Psychiatry News, May 2008 | Go to article overview

Parenting Is Crux of the Cure in Defiant Disorder


Damian, McNamara, Clinical Psychiatry News


MIAMI BEACH -- It is important to confront parents about their parenting style when conveying a diagnosis of oppositional defiant disorder, a developmental pediatrics specialist advises.

It is difficult to address a parenting issue, particularly in a 15-minute visit and when you want to keep a relationship with the family, Dr. David O. Childers, chief of the developmental pediatrics section at the University of Florida, Jacksonville, told the annual Masters of Pediatrics conference. Instead, ask them to return for a more comprehensive discussion, perhaps as the last appointment on a day in the near future. "When I make the diagnosis, I don't just throw them out the door. I spend 45 minutes to an hour to speak with parents about options and things they could do better," Dr. Childers said.

Parenting class is an important strategy regarding oppositional defiant disorder (ODD), one that Dr. Childers knows from personal experience. "A parenting class is essential. In the world of behavioral medicine, good parenting style is very important. When I walked out of my parenting class, I said, 'Man, I didn't know what I was doing.' My wife and I were not good parents when our son was 5 years old," he said.

Dr. Childers typically tells parents three things about ODD. "No. 1-my son got diagnosed with ODD at age 5 and it was a good, valid diagnosis. No. 2-you're going to hate my third thing. And No. 3-it's a mismatch between the parents and the child ... when the parenting abilities suck."

Discipline and consistency are critical to improve life for a family affected by ODD, Dr. Childers said at the conference sponsored by the University of Miami.

Discipline is also important for parents, he said. They "have to be consistent over time. Kids are screaming for boundaries and rules. They don't know this is what they want, but they do. Kids get irritable when the boundaries are shifting all the time."

A short period of negative reinforcement helps parents gain control over the inappropriate behavior so they can implement positive changes over time. Dr. Childers said, "I tell parents it's going to be 1 or 2 months of miserable existence to buy the next 10 or 15 years of happiness."

"For most children who are coming to my level of care," he added, "it takes a few weeks to a month or two for the child to realize the parents is not going to break."

Sending a child to the corner for a "time out" is a component of the negative reinforcement. "The 'corner' is available everywhere you go. You can take them out of a restaurant and put their nose to the side of the building, or if you are driving you can pull into the next parking lot," Dr. Childers said. This strategy will alter future behavior for a majority of children.

In some rare cases, he added, medications to reduce the child's irritability are warranted to give parents a better opportunity to address the bad behaviors. …

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