Therapeutic Interventions

1. Provide developmental 1.

history and a description of current problems presented by the oppositional child. (1)

2. Seek information from 2.

professionals and mental health organizations and by reading literature describing the diagnosis and treatment of oppositional/defiant behavior in children. (2, 3, 4)

Gather a developmental history and review the parents' concerns about behavior, academic, and social-emotional problems presented by the child with ODD and the effects on the family.

Assist the parents in arranging for a comprehensive psychosocial, medical, and educational evaluation of their child completed by a mental health practitioner in cooperation with the child's school.

Investigate the possibility of comorbid conditions that may be affecting the defiant child. (5, 6)

Child and parents participate in ongoing counseling sessions focusing on the multifaceted problems of parenting an oppositional child. (7, 8)

3. Assign the parents to read literature that describes ODD in children (e.g., The Explosive Child by Greene, Parenting the Strong-Willed Child by Forehand and Long).

4. Instruct the parents how to access ODD diagnosis, treatment, and behavior management information (e.g., American Academy of Child and Adolescent Psychiatry (202) 966-7300 or, Family Self-Help Group for Parents of Children and Adolescents (800) 950-6264 or

5. Advise the parents that ODD often exists with other neuropsychiatric conditions and review the child's psychiatric and psychological evaluations with the parents to identify any other co-existing conditions (e.g., ADHD, depression, anxiety, learning disabilities).

6. Assign the parents to consult with the child's medical doctor to explore the possibility of medication to treat the symptoms of ODD and other existing co-morbid conditions.

7. Discuss with the parents the emotionally draining nature of parenting a defiant child and encourage them to participate in regularly scheduled family counseling sessions to help them deal with the critical issues they may face.

8. Advise the parents to arrange for ongoing individual counseling for the oppositional child at school or with a private therapist.

9. Advise the parents to consult the school regarding special education or Section 504 accommodations to help the child participate successfully in the academic environment (e.g., smaller classroom, assistance from an instructional or behavioral paraprofessional, special classes).

10. Advise the parents to recommend that the school establish a time out area or Student Responsibility Center for students who are disruptive or a Learning Center area in the classroom for students to catch up on academic work.

6. Meet with the child's teacher 11. Assign the parents to meet with and other involved teachers to evaluate the child's educational staff regularly to academic potential and deter-

coordinate strategies for mine a mutually agreed upon responding to the child's level of academic performance academic and behavior that must be maintained to earn problems. (11, 12) privileges at home or school.

12. Facilitate a meeting between the parents and the educational staff to determine appropriate academic accommodations for the child that encourage successful academic performance (e.g., close supervision during times of transition; seat near teacher's desk, in an area of low distractions or near a good role model; involve the child in lesson discussions; give simple, clear instructions; arrange for remedial tutoring).

5. Cooperate with the school to insure that the child's oppositional/defiant behavior is not interfering with school achievement and socialization. (9, 10)

Enroll the oppositional child in anger management and social skills classes provided by the school or a community mental health agency. (13, 14)

Implement strategies to enhance communication, reduce stress, and support one another's parenting efforts. (15, 16)

Participate in programs designed to promote a healthy lifestyle and enhance physical and mental fitness. (17, 18)

Attend parenting classes and initiate a system of positive discipline in the family. (19, 20)

13. Instruct the parents to consult with the school counselor or school social worker regarding programs that may assist the oppositional child in developing responsible behavior.

14. Assist the parents in locating and enrolling the defiant child in an anger management or a social skills program offered by the school or a local community mental health agency.

15. Instruct the parents to plan a social evening every week to escape from the pressures of parenting and the demands of their children.

16. Advise the parents to be aware of attempts at triangulation and manipulation by the oppositional child and to stand together and support one another with all of their parenting strategies.

17. Urge the parents to adopt daily habits that will prepare them for the immensely challenging job of parenting a defiant child (e.g., get enough sleep, exercise regularly).

18. Encourage the parents to participate in programs designed to reduce stress and enhance emotional balance (e.g., reduce workload, keep a journal, build a support network).

19. Refer the parents to a parenting class (e.g., Becoming a Love and Logic Parent by Fay, Cline, and Fay, or The Parent Talk System by Moorman and Knapp) to acquire techniques of positive discipline.

11. Adopt a parenting approach that is compassionate, yet very firm and highly structured, and takes emotion out of the discipline. (21, 22)

12. Create a behavior management plan that targets the problem behaviors, and provides structured and straightforward parental actions and consequences. (23, 24)

20. Encourage the parents to initiate weekly family meetings to discuss concerns, reflect upon positive events, coordinate activities, review values, answer questions, and plan for positive interaction.

21. Emphasize to the parents the crucial difference between firmness (holding to a disciplinary intervention and focusing on the child's inappropriate behavior) and harshness (attacking the child's personality and demeaning the self-esteem) and instruct them to use empathy and compassion instead of anger and disgust when disciplining their children.

22. Instruct the parents to create a plan for using the time-out technique with the oppositional child when the behavior becomes defiant; explain this process as an opportunity for the child to calm down, regroup, and regain appropriate behavior.

23. Assist the parents in prioritizing a few critical inappropriate behaviors for modification (e.g., hitting, swearing) and defining an alternate expected, appropriate behavior for the child (e.g., use words to describe your feelings, use only "family friendly" vocabulary).

24. Instruct the parents to plan ahead and prepare their responses to the chronic negative behavior and to remain calm and extremely firm when implementing a predetermined

13. Use privileges to shape cooperation, compliance, and positive behavior. (25, 26)

14. Limit and monitor the child's exposure to television, movies, computer, and video games. (27)

15. Arrange counseling and/or other support services for the siblings. (28, 29)

intervention (or assign the "Planning for Disruptive Behavior" activity from the Parenting Skills Homework Planner by Knapp).

25. Assist the parents in creating a list of privileges (e.g., use of family computer, listening to music, limited use of television) that can be used as contingent rewards when the child behaves appropriately or denied access when the child does not adhere to the behavior plan.

26. Assign the parents to complete the "Using Privileges as Contingencies and Consequences" activity from the Parenting Skills Homework Planner (Knapp) to encourage the defiant child to engage in more appropriate and compliant behavior.

27. Assign the parents to monitor their child's use of media including the computer and Internet, and to watch television and videos with their children (or assign the "Family Approved Media List" activity from the Parenting Skills Homework Planner by Knapp).

28. Advise the parents to enroll the siblings in counseling sessions at school or with a private therapist or agency to deal with the emotional stresses of living with a brother or sister with oppositional behavior.

29. Assign the parents to actively listen to the feelings and concerns of the siblings and

16. Educate friends, day-care providers, and family members about ODD by having them attend informational sessions or read literature describing the condition. (30, 31)

schedule quality time with them on a regular basis to help them feel valued and affirmed.

30. Advise the parents to meet regularly with all caregivers of the defiant child to coordinate behavior plans, address problem situations, and clarify the current level of adjustment.

31. Assign the parents to invite family members and day-care providers to attend counseling sessions, parenting classes or informational meetings to become more familiar with the recommended strategies for managing an oppositional child.

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