Oppositional Defiant Disorder
The Learning Disability of Oppositional Defiant Disorder
Common explanations for explosive and noncompliant behavior in children tend to focus on a child’s lack of motivation to behave appropriately and on parental incompetence. For example, recent letters to the editor in Time magazine in response to an article describing an Ohio school strategy for handling behaviorally challenging kindergarten students (the strategy was to teach kindergarten teachers how to use physical restraint procedures). The letter writers blamed the parents of the behaviorally-challenging kindergartners.
Recent research into the childhood diagnosis ”Oppositional Defiant Disorder" (ODD) found the presence of cognitive skill deficits amongst these children who are behaviorally challenging (Greene et al, 2002a). Such deficits were found most notably in areas of executive functioning skills, emotion regulation skills, language processing skills, and social information processing skills. For example, approximately 55% of children with language processing difficulties also met the diagnostic criteria for ODD, suggesting that, if a child does not possess the linguistic skills necessary to label and categorize emotions or communicate needs to others, the stage may be set for concurrent difficulties with frustration tolerance and problem solving (Greene and Ablon, 2003).
These cognitive skill deficits suggest that it may be productive to understand explosive/noncompliant behavior as the byproduct of a development delay or learning disability. Unlike other well-recognized learning disabilities that manifest themselves purely in the academic domain (i.e., dyslexia), the learning disability of a child diagnosed with ODD appear in specific arenas in which frustration tolerance and flexibility are required.
If those working and living with such children view ODD as a developmental delay, rather than as a reflection of poor motivation or inept parenting, there is much to be learned from methods successful in addressing other learning disabilities. For example, in the case of reading disabilities, the curriculum is modified ensure that the child is not being required to read at a level that exceeds his or her capabilities, with instruction aimed at helping the child make incremental progress in reading skills. When this model of remediating learning disabilities is applied to a child with a behavioral challenges, parents and teachers reduce the demands on the child for flexibility and frustration tolerance while simultaneously trying to teach the child cognitive skills (Greene et al, 2002b, Greene et al, 2003). Years ago, people used to view dyslexia and other learning-disabled children as simply lazy and unmotivated (Levine, 2002). Thankfully, it would seem barbaric and unethical today to attempt only to motivate a child to overcome dyslexia without supporting the child and teaching the child the decoding skills that s/he lacks. However, this is precisely the standard of care for behaviorally challenging children in a variety of education and mental health settings.
The analogy of ODD as a learning disability points us in the right direction as it relates to our understanding and treatment of children with ODD. Sending a dyslexic child out of the class or giving him/her a detention because he/she was not reading? Unimaginable. Putting that same child in time-out when he/she was not able to read a bedtime story at home? Unfathomable. Hopefully the same reactions will be applicable to ODD in the coming years.
J. Stuart Ablon, Ph.D., Ross W. Greene, Ph.D. CPS Institute, Department of Psychiatry, Massachusetts General Hospital.
Greene, R.W., Biederman, J., Zerwas, S., et al., Am Journal of Psychiatry 2002a; 159, 1214-1224
Greene, R.W., Ablon, S.A., & Goring, J.C., Journal of Psychosomatic Research 2002b; 1, 1-9
Greene RW and Ablon JS (2003). Disruptive behavior disorders. In Breen MJ, Fiedler CR (Editors). Behavioral Approach to Assessment of Youth with Emotional/Behavioral Disorders (2nd ed.). Austin, TX: Pro-Ed.
Greene, R.W., Ablon, S.A., Goring, J.C., et al., 2003. Treatment of oppositional defiant disorder in children and adolescents. In P. Barrett & T.H. Ollendick (Eds.), Handbook of Interventions that Work with Children and Adolescents: Prevention and Treatment. West Sussex, England: John Wiley & Sons.Levine, M. (2002). The Myth of Laziness, Simon and Schuster, NY.
Content provided with Permission from Ross W. Green.
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This content was last modified on: 09/05/2008