1) "Oppositional Defiant Disorder" is a description, it is not really a diagnosis ... it does not tell us much more than that a youngster is "not listening" ... and that he/she is "acting out." It is wrong to give that "diagnosis" to parents and not go beyond that description to develop an understanding of what is the cause of the behavior ... there is always a cause of the behavior and in order to develop effective strategies for change the reasons for the behaviors have to be understood.
2) The goals of therapy for children are really not the same as for adults, they cannot be because the developmental tasks of childhood and adulthood are fundamentally different. '"What do you mean?" you ask. What I mean is that while for adults developing "insight" into one's behaviors is a significant part of the therapeutic process, for children, the developmental push is to be moving forward, not backwards. Children have difficulties when they lag in developing the needed skills to deal with the range of situations they are presented with. For children, a major goal of therapy, whatever the presenting problem, is essentially one of "developmental assistance."
Developmental assistance is the process of helping a youngster develop a wider range of skills so as to be able to move forward in the developmental process.
3) Why "Group Therapy" for children?
In the past few years I have been doing more and more groups with children and have been finding the results quite impressive. It seems to me that this is because, developmentally, peer relationships are so important during childhood. When brought together with other youngsters who are dealing with similar issues, children seem to be able to develop the skills they are lacking within the developmentally appropriate peer context ... it seems to make a very big difference!
4) The UPSET SCALE: A tool to use to help you and your child
begin to gain control when he or she is LOSING IT!
After an an angry, irritable or rageful episode, once things have calmed down, you may find that introducing a simple number scale can help.
The Upset Scale
8 Out Of Control
4 Can Manage
1 No Problem
This scale can allow for an open and calm and nonjudgmental talk about the incident when your child was out of control. It can give you a common language to talk about situations that are happening, including the causes, and can help your child begin to identify his internal triggers. It also helps develop problem solving skills which will help with the development of self-regulation and self-control (all this from a simple number scale!)
If you want to try this scale at home, follow these steps. Make sure you are no longer angry when you introduce this to your child otherwise it will not be successful.
a. Make sure that both you and your child are calm and focused and that you are beyond your own feelings about the recent incident. In an atmosphere of cooperation suggest to your child that you want to try and work together on those times where he/she gets so upset that he seems to be out of control.
Suggest you talk about the most recent incident that occurred, such as when your child lost a game of "SORRY" the day before.
b. Draw the UPSET SCALE and explain to your child that numbers 1, 2 and 3 mean that your child may be upset and this means it's "No Problem," the feeling passes, as all feelings do, and your child is able to move on ... "NO PROBLEM."
The numbers 8, 9 and 10 mean that your child is so upset that there is yelling, screaming, hitting, kicking, throwing things or refusing to move and sulking for hours, whatever it is, it is VERY INTENSE and your child cannot shift out of it.
The numbers 4, 5, 6 and 7 mean that your child has some degree of upset but "can manage" (recognizing that it may take a lot of effort). This mid-range is important to understand, and for your child and for you to identify, because it is the point BEFORE things get out of control, the point midway between going from O to 100! Using the number scale to identify where your child is will help him develop strategies necessary to stay calm.
c. Ask your child to describe the internal upset feeling with a physical description, for example: What were you feeling in your body when you lost the SORRY game and became upset yesterday.
He might say, "I was angry and my jaw was really tight." This gives you both a simple way to identify and describe an experience for which you have few or no words.
d. Have your child then pick a number on the scale to describe that feeling, such as "I was a "5" when I lost the game and my jaw was tight, but then when Robert laughed at me, I went to a "10" and I was screaming and I threw the board." You might then ask what a "10" felt like in his body. He might say, "like dynamite exploding in my head."
e. Try to understand together what happened before, during and after the incident, giving a number stage and then identifying the actual trigger that cause your child to go from "I can manage" to "out of control."
f. Try to identify things that might have helped at each point before getting to the "out of control" range.
g. Make a list of things that help and write them down. When the list is complete you will be able to help your child identify realistic interventions that will help at home and at school.
Sometimes you will still need more help and so will your child, but this intervention can be a useful place to begin.
5) So Wrong To Be Right – Parenting Teens
Are you that perfect parent? Exactly! Nor should you be. Your child learns to do a healthy self-assessment and self-corrrection throughout his life by watching his role models, his parents chief among them.
After all, real life parenting requires a steep learning curve with no resume and only one true feedback loop – one’s child! What a scary proposition if you are a parent who thinks you have only one chance to get it right and that you can’t make any mistakes. You have no choice but to accept a “tweakable” job evaluation from your child. Otherwise, how can you know what kind of impact you are making as a parent?
The truth is that for all of us, parenting is “on the job training” involving sometimes substantial trial and error. A ‘good enough’ parent’s mantra is ‘I’m so sorry!’ preferably in at least two languages! Here in California, “lo siento mucho” just flows so effortlessly. The beloved pediatrician and psychoanalyst, D.W. Winnicott, gave us the phrase “good-enough caregiver.” Notice he did not say ‘perfect parent!’ See Success, Failure, and Life’s Learning Curve.
Parental humility and restraint comes in especially handy during the teen years and even the young twenty-something years when, as a parent, it is clearly ‘so wrong to be right!’ Why? Remember when you were young and you yearned to be taken seriously? No matter how foolish you sounded, you wanted people to listen to you, especially your parents. Your child is trying to develop judgment and you, of course, will want that sensibility to be as honed as it can possibly be before he or she leaves home and casts lots with peers at college or work.
What not to do? Try not to be that expert-parent with advice derived from your years of wisdom! So, we ask, how do we encourage them to develop sound character and how do we keep them safe?! It might be simpler than we imagined. Instead of making statements of authority, we can just reframe our statement in the form of a question: Instead of,” I don’t trust your friend, Billy…he seems like a flake!” …ask, “What do you think of your friend, James? Do you find he is able to think things through before he leaps, or does he have a tough time with that?”
Instead of “Do your homework!”…ask, “When is your best focus time to do homework, before or after dinner, sports activity, etc.?” After all, you are trying to get them to figure out time management skills.
The trick for parents is not to react if their teen disagrees with them; the idea is the parent is planting a seed, not expecting a full grown, perfect response immediately.
Above all, expect rejection and don’t take it personally when it comes – it’s a sure thing!
Diane Pomerantz, Ph.D.