The Angry, Defiant (ODD) Child

Many couples report being surprised, hurt and stressed by the defiant and angry behaviors of the children. These parents often relate, "If I ever treated my parents as he/she treats us, I would have been severely disciplined. I would have never treated them as he/she treats us."

I was surprised in the early years of my practice that the history of these very angry children frequently did not reveal any serious emotional pain or hurts in their lives. Instead, these youngsters were overly indulged emotionally or materially by their parents who acted toward them in a permissive rather than in a responsible manner. The problem was that these children were not given appropriate correction and punishment for their hostile and disrespectful behaviors and were not taught virtues by their parents which can lead to the development of a healthy personality. In other children, however, angry and defiant behaviors are not the result of selfishness, but of serious emotional hurts from selfish, irresponsible or angry parents, siblings or peers or of modeling after angry parents, siblings or peers.

This chapter will attempt to help parents determine whether their child’s anger is the result of selfishness or justifiable hurt. It will describe an empirically proven, effective approach to diminishing excessive anger in children whose behaviors meet the criteria for oppositional defiant disorder. Also, the treatment of the excessive anger in children who have been bullied or adopted, who have been through divorce trauma or who overreact in anger at brother or a sister will be presented.

Oppositional Defiant Disorder

Oppositional defiant disorder (ODD) is one of the most common emotional and behavioral disorders seen in children. Epidemiological data have indicated that by the age of sixteen 23% of children will meet the criteria for a behavior disorder, most frequently oppositional defiant disorder, 11.3% (Costello EJ, et al., 2003.)

As every parent knows, acts and words of defiance in direct or covert ways can begin at an early age. Unfortunately this anger often is not properly identified, understood and addressed by busy parents, family members, educators and mental health professionals. The failure to identify and address this anger has serious consequences for the child, the parents and family, schools and society.

Oppositional behaviors occupy a central position in the development of emotional and mental illnesses.  ODD can lead to the development of a conduct disorder in which children manifest intensely angry and even violent behaviors. This disorder in turn can lead to the development of a sociopathic or criminal personality disorder. Also, there is a substantial overall between ODD and ADHD. 

The wide range of association of ODD with other disorders is also reflected in the finding that it is one of the most common precursors for most psychiatric disorders in adolescence and young adulthood (Kim-Cohen, J. 2003 and Nock, MK, 2007).

Our professional experience indicates that if defiant and angry behaviors are dealt with effectively in young children the emotional and mental health of the child and the family can be protected and strengthened. The serious problems that develop if children do not learn how to control their angry impulses can be prevented.

The American Academy of Child and Adolescent Psychiatry offers excellent resources on ODD at

www.aacap.org/cs/ODD.ResourceCenter.

Research on Children with ODD

In an important paper on ODD published in the leading journal of child psychiatry in 2007 Dr. Whittenger wrote, "It is imperative that clinicians ( and parents) pay specific attention to the presence of childhood ODD behaviors." Her research in England demonstrated the serious negative prognosis of ADHD with associated (co-morbid) conduct disorder (Whittenger, N.S., et al. 2007.) Since, ODD is the major precursor of conduct disorder, we believe that the effective treatment of ODD can prevent the development of conduct disorder and assist in the treatment of ADHD.

Preschool children with ODD are likely to continue to exhibit disorder with increasing association (co-morbidity) with ADHD, anxiety, or mood disorders (Lavigne JV , 2001.)

Identifying angry, defiant behaviors (ODD)

The first step in addressing anger in children is a careful history of the child that is helped by evaluating the degree of active and passive-aggressive anger, the degree of selfishness and the number of ODD behaviors.

Please identify the symptoms of ODD in your child by identifying the behaviors listed in the DSM IV-TR for this diagnosis:

  • Often losing temper
  • Often arguing with adults
  • Often actively defying or refusing to comply with adults’ requests or rules
  • Often deliberately annoying people
  • Often blaming others for his or her mistakes or misbehaviors
  • Being often touchy or easily annoyed by others
  • Being often angry and resentful
  • Being often spiteful or vindictive.

The child must demonstrate at least four of these symptoms for at least 6 months to establish the ODD diagnosis. In our view a number of these behaviors are an indication of selfishness in the child. These include:

  • Often actively defying or refusing to comply with requests or rules from adults
  • Often deliberately annoying people
  • Regularly blaming others for his or her mistakes or misbehaviors
  • Regularly becoming touchy or easily annoyed by others.

In our professional opinion excessive selfishness precedes the development of ODD in many children.

Based on over 30 years of clinical experience I believe that the following symptoms of the covert (sneaky) or passive-aggressive expression of anger should be added to the description of ODD symptoms.

Identifying Covert/Passive-Aggressive Angry Behaviors

  • Failure to respond when addressed
  • Refusal to cooperate with teachers at school
  • Refusal to do home work
  • Deliberate lateness
  • Refusal to keep order in the home or in bedroom/extremely disheveled bedroom
  • Provocation of siblings
  • Unwillingness to be sensitive to others.

Please complete the anger checklist on your child below and identify the number of active and passive aggressive angry behaviors.

Active Anger in Children/Adolescents

Please rate your child choosing the appropriate number on the scale below.

1 - Very Little       2 - Moderately Often      3 - Very  Often

Mild

  • Irritable
  • Often loses temper
  • Impatient
  • Regularly annoyed
  • Blurts out answers before questions have been asked
  • Impertinent; talks back
  • Verbally aggressive
  • Pouts and sulks
  • Uncooperative with teacher
  • Constant teasing
  • Difficulty waiting one’s turn
  • Frequently frustrated
  • Intrudes on others
  • Defiant
  • Argues, quarrels
  • Acts “smart”
  • Negative
  • Disobedient

Moderate

  • Lying
  • Chronic violation of rules at home or school
  • Overly aggressive
  • Initiates fights
  • Cheating
  • Stays out at night
  • Excessive recklessness
  • Tries to dominate others
  • Hostile
  • Excessive swearing
  • Hits others
  • Rude
  • Class clown - disruptive at school
  • Violent threats
  • Spiteful, vindictive
  • Has “bad” companions

Severe

  • Suspension from school
  • Stealing
  • Violent acts against people, animals or property
  • Running away from home
  • Violent acts against oneself
  • Constant truancy
  • Expulsion from school
  • Substance abuse
  • Fire setting
  • Forced sexual activity
  • Carries a weapon
Active Total:

Passive-Aggressive/Covert Anger in Children/Adolescents

Please rate your child choosing the appropriate number on the scale below.

1 - Very Little       2 - Moderately Often      3 - Very  Often

 

Mild

  • Always late/leaves early
  • Deliberately sloppy
  • Uncooperative attitude
  • Forgetful
  • Procrastination - deliberately put things off
  • Twist the truth
  • Refuse to do what is reasonably expected
  • Rehashing the past
  • Deliberate making of mistakes
  • Often loses things necessary for tasks or activities
  • Door banging
  • Withdrawn
  • Deliberately slow
  • Pretend not to hear or see
  • Walk out on people
  • Refuse to listen
  • Always controls the T.V.
  • Manipulative
  • Deliberate inattention

Moderate

  • Refuse to clean the home or oneself
  • Act sick or helpless
  • Withhold love or support
  • School grades markedly below one’s ability
  • Impulsive - failure to plan ahead
  • Deliberately avoid or ignore someone
  • Refusal to function in a responsible manner
  • Divisive
  • Always negative
  • Overly stubborn
  • Silent treatment
  • Absenteeism in school
  • Refuse to be responsible
  • Refuse to study regularly
  • Enjoy seeing people become upset

Severe

  • Refuse to eat
  • Deliberately fail in school
  • Failure to care about anything
  • Deliberately try to be sick
  • False accusations

Passive-Aggressive Total:

If your child denies being overly angry, consider showing him/her how your scoring.

Next please complete the selfishness checklist below on your child.

0 - Never | 1 - Very Little | 2 - Moderately Often | 3 - Very Often

Refuses to help in the home
Never Very Little Moderately Very Often
Lacks of respect for parents
Never Very Little Moderately Very Often
Lack of gratitude
Never Very Little Moderately Very Often
Bad temper
Never Very Little Moderately Very Often
Insensitive to loved ones
Never Very Little Moderately Very Often
Excessively angry when everything doesn't go as one wants
Never Very Little Moderately Very Often
Very sloppy
Never Very Little Moderately Very Often
Curses excessively
Never Very Little Moderately Very Often
Resents giving to others/lack of generosity
Never Very Little Moderately Very Often
Unreasonable expectations of especially favorable treatment
Never Very Little Moderately Very Often
Expects automatic compliance with his or her expectations
Never Very Little Moderately Very Often
Manipulative
Never Very Little Moderately Very Often
Uses others to obtain one's ends
Never Very Little Moderately Very Often
Lacks empathy
Never Very Little Moderately Very Often
Unwilling to identify with the feelings and needs of others
Never Very Little Moderately Very Often
Arrogant, haughty behaviors or attitudes
Never Very Little Moderately Very Often
Acts like a spoiled child
Never Very Little Moderately Very Often
Always demands to have one's own way
Never Very Little Moderately Very Often
Talks about oneself excessively
Never Very Little Moderately Very Often
Fails to attend to the needs of others
Never Very Little Moderately Very Often
Is often envious of others
Never Very Little Moderately Very Often
Refuses to do chores
Never Very Little Moderately Very Often
Tries to control others
Never Very Little Moderately Very Often
Lazy
Never Very Little Moderately Very Often
Fails to care about important matters
Never Very Little Moderately Very Often
Acts helpless to get one'S way
Never Very Little Moderately Very Often
Doesn't enjoy giving
Never Very Little Moderately Very Often
Tries to turn all conversations upon oneself
Never Very Little Moderately Very Often
Avoids responsibility
Never Very Little Moderately Very Often
Refuses to clean up after oneself
Never Very Little Moderately Very Often
Portrays self as the victim
Never Very Little Moderately Very Often
Demonstrates explosive anger
Never Very Little Moderately Very Often
Refuses to study
Never Very Little Moderately Very Often
Won't do chores in the home
Never Very Little Moderately Very Often
When something goes wrong, it's always someone else's fault
Never Very Little Moderately Very Often
Requires excessive admiration
Never Very Little Moderately Very Often
Exaggerates physical and emotional symptoms as a way to control
Never Very Little Moderately Very Often
Lacks of genuine interest in others
Never Very Little Moderately Very Often
Doesn't pay attention to the person he or she is talking to
Never Very Little Moderately Very Often
Refuses to clean up after oneself
Never Very Little Moderately Very Often
False accusations against a parent
Never Very Little Moderately Very Often
Physically abusive of parents
Never Very Little Moderately Very Often
Substance abuse
Never Very Little Moderately Very Often
Taking others possessions
Never Very Little Moderately Very Often
Stealing
Never Very Little Moderately Very Often

Selfishness Total:

A score below 30 indicates a low level selfishness, a score of 30 to 60 a moderate level of selfishness and above 60 a high level of selfishness.

The origins of angry, defiant behaviors in children (ODD)

ODD can be the result of numerous unjust hurts and disappointments with parents, siblings and peers. A child may also acquire ODD from modeling after an angry parent, sibling or peers. In fact, ODD is more common in families where there is serious marital discord (DSM-IV TR) which results in both sadness and anger in children.

Another major cause is a weaknesses in the personality or character which are not properly addressed and corrected by parents and important other persons in the child’s life. Selfishness i panrticular can contribute to the regular overreaction in anger. This character weakness leads to a determination to have things/relationships one’s own way, a lack of respect for parents and others, pride, impatience and a desire to control. These conflicts make the child vulnerable to become easily frustrated and uncooperative with resulting overreactions in anger and with an unwillingness to be cooperative with reasonable requests by parents, teachers and other authority figures.

Other causes of excessive anger are jealousy, loneliness, lack of confidence and excessive television viewing.

In a number of studies of ODD, it has been shown that males were overrepresented, as were children of divorced parents and of mothers with low socioeconomic status (Kadesjo C, 2003.)

Single motherhood and angry children

A cause of major concern in regard to the growing anger problem in children is the increased in children being born to single mothers.  In the U.S. almost one third of children are born to single mothers and in many European countries almost 50%of children are born to single mothers. A study cited in the Village Voice found that children brought up in single-mother homes “are five times more likely to commit suicide, nine times more likely to drop out of high school, 10 times more likely to abuse chemical substances, 14 times more likely to commit rape (for the boys), 20 times more likely to end up in prison, and 32 times more likely to run away from home.”

By 1996, 70% of inmates in state juvenile detention centers serving long-term sentences were raised by single mothers.  70% of teenage births, dropouts, suicides, runaways, juvenile delinquents and child murderers involve children raised by single mothers.  Girls raised without fathers are more sexually promiscuous and more likely to end up divorced.

 

Anger and other emotional conflicts

The first diagram below demonstrates the relationship between unjust hurts and the development of sadness, anxiety and weakness in confidence and its relationship to anger.  The second diagram shows how anger can encapsulate in a sense emotional pain and can interfere with its resolution.

 

Unjust hurts and emotional pain

Prisoner of one's past when one doesn't forgive

Selfishness to ODD

It is our opinion that serious conflicts with selfishness often precede the full development of ODD. Most serious cases of ODD we treat are associated with a high level of selfishness. The repeated excessive expression in the home reinforces insensitive and selfish behavior patterns. These behaviors and emotional overreactions then contribute to the weakening of the personality and can lead to the development of strong narcissistic personality traits and later a narcissistic personality disorder (NPD.)

We caution parents that the failure to address selfishness in children can be the most important factor in the child’s failure to learn how to control angry impulses. If selfishness is properly corrected in many children by growth in numerous virtues and by proper parental education and correction, our professional opinion is that ODD may not develop (see selfishness chapter.)

Selfishness and Co-morbidity

The diagram below demonstrates that selfishness can influence the development of numerous other conflicts as the person grows. In this diagram CD refers to conduct disorder, SUD to substance abuse disorder and NPD to a narcissistic personalitly disorder which is diagnosed in young adulthood.  The ongoing sense of entitlement from selfish/narcissistic thinking can contribute to the development of inflated and grandiose thinking which is seen in bipolar disorders. Also, a number of our patients who had ODD and severe selfishness as children later developed bipolar disorder with severe irritabililty as adolescents.

 

Selfishness and Co-morbidity

 

Permissive parenting, selfishness and angry behaviors

In the permissive parenting style the adult overly indulges a child emotionally and/or materially and fails to provide healthy correction of character weaknesses. The parental failure to form character in a healthy manner results in a weakening of a child’s ability to control impulses, a lack of respect for others, an inflated sense of self, a sense of entitlement, an overreaction in anger when the child cannot have his or her way, etc.

Many factors contribute to permissive parenting and these include the desire to have the child as a friend, as well as weak confidence, selfishness, fear of losing the child’s love or a comfort seeking mentality with a dislike for correction. Psychologist Susan Linn, author of Consuming Kids: The Hostile Takeover of Childhood (2004), wrote that the parent-child relationship is being reversed by a trend that sees parents consulting their kids about everything from choosing a movie to the mother’s choosing a new partner. She attributes this change in parenting to the increase in single parent families, incessant marketing that gives children "the trappings of maturity", increased access to information children have because of the internet and Peter Pan parents who think they can stay young and relevant by swapping advice with teenagers.

Dr. William Doherty, professor at the University of Minnesota, in his book, The Intentional Family, 1997, criticized permissive parenting particularly in regard to family meals by stating, "We are talking about a contemporary style of parenting that is overindulgent of children. It treats them as customers who need to be pleased."

The Onset of ODD

ODD is usually diagnosed between the ages of 6 to 10. However, symptoms may appear much earlier. In addition, ODD angry behaviors may not emerge until adolescence. We have even seen these behaviors intensify after high school.

The later development of ODD is often the result of unresolved anger from childhood experiences that can no longer be denied. Another major factor in the later manifestation of ODD is growth in selfishness and in a tendency to want to control parents, siblings and others.

The Serious Consequences of ODD

The manifestations of angry and defiant behaviors can harm the child’s and teenager’s family relationships, academic performance and friendships. ODD has been shown to have extremely detrimental effects in many areas of the lives of children.

One of the major studies of ODD in over 600 children from the Department of Psychiatry at the Harvard Medical School revealed that these teenagers and children had significant impairment in family functioning with parents and siblings and in social adjustment with problems with peers and at school. Also, families of ODD youth were characterized by significantly poor cohesion and high conflict.

In addition this particular study showed that children with ODD had high rates of associated disorders including ADHD, severe major depression, bipolar disorder, pervasive development disorder, multiple anxiety disorders, Tourette’s disorder and language disorders, Greene, RW, (2002). In a national comorbidity survey replication of 3,199 individuals of those with lifetime ODD, 92.4% meet criteria for at least one other lifetime DSM-IV disorder, including: mood (45.8%), anxiety (62.3%), impulse-control (68.2%), and substance use (47.2%) disorders, Nock MK (2007).

ODD is a serious problem in children that impacts everyone in the family. In fact, parents of children with ODD are more likely to utilize child mental health services than parents of children with other disruptive behavior disorders.

ODD and Attention Deficit Hyperactivity Disorder

ODD is also often seen in children with ADHD. A number of studies reveal that 40% and more of those with ADHD also have ODD. Our clinical experience is that ODD may contribute to the development of the hyperactive and impulsive types of ADHD. We have found that treatment of the anger in ODD can also diminish the hyperactive and impulsive symptoms in these two types of ADHD.

ODD and Anxiety

ODD has been shown to be directly predictive of future anxiety and depression, and anxiety predicted future depression as well. (Burke, JD, 2005). Anxiety in children with ODD can be the result of a difficulty in trusting from hurts with parents, siblings or peers and of a fear of his/her strong angry impulses.

ODD and Depression and Suicide

A major study in 2007 revealed that risk for youth suicide was strongly associated with current depression and ODD and current depression with anxiety, specifically generalized anxiety disorder. (Foley, D.L., 2006.) Our clinical experience confirms the research of Dr. Bob Enright at the University of Wisconsin, Madison, that diminishing excessive anger by the use of forgiveness also decreases symptoms of depression and anxiety.

ODD to Bipolar Disorder

ODD is strongly associated with bipolar (manic-depressive) disorders in children and in teenagers. In the Harvard study of children with ODD 45% of them met the criteria for bipolar disorder (Green R., 2002.) Another study demonstrated that 43% of children with bipolar I disorder had ODD (Birmaher B, 2006.)

There is a veritable epidemic in U.S. of the diagnosis of bipolar disorder in children with 40 fold increase in this diagnosis between 1994 an 2004 - a jump to 800,000 children from 20,000.  Dr. Roger McIntyre, Mood Disorders Psychopharmacology Unit, Columbia University has stated,“That’s a staggering increase, and it has rightly raised questions about whether there has really been a true increase of that magnitude.”

We have worked with teenagers with bipolar disorders with mania (bipolar I) who were diagnosed years earlier with ODD. It is also important to recognize that severe irritability has been shown to be the most common presentation of mania in the young (Wozniak, J. 2005.)

Also, research has shown that irritability in bipolar disorder is influenced by the severity of the oppositional defiant disorder (Rich BA, 2007.)

Growth in virtues in children and family therapy can help in a marked reduciton of the ODD symptoms in children. We suspect that the successful treatment of ODD may possibly help in the prevention of bipolar I disorders.  Much more research is needed on nature of childhood irritiability and its treatment given the serious possible long term side effects from the use of atypical antipsychotics in children.

Finally, we recommend that the parents of all children with severe irritabililty and rage rate the selfishness in these children because this conflict regularly predisposes children and adults to serious overreactions in anger.

ODD and Substance Abuse

In at least one community research study the number of ODD symptoms in childhood was a significant predictor of later alcohol use. (White, H.R., 2001). The results suggest that drug use prevention programs should target youths with early symptoms of excessive anger. Also, ODD in association with ADHD, is associated with elevated risk of drug use (August, G.J., 2006).

ODD to Conduct Disorder

The International Classification of Diseases 10th Revision (ICD-10) classifies ODD as a mild form of conduct disorder (CD), and it has been estimated that up to 60% of patients with ODD will develop CD. Therefore, ODD should be identified and treated as early and effectively as possible, (Turgay, A. 2009.)

Studies and clinical experience have demonstrated that ODD can precede the onset of conduct disorder (CD), the most serious anger disorder in children and adolescents, by several years. The angry behaviors in ODD can escalate into aggressive behaviors against people and property. CD in children is associated with the most intense expressions of anger and aggression against people and property. A significant percent of these youngsters with CD will go on to become criminals in young adult life and may be diagnosed with an antisocial personality disorder (ASPD).

Again, our clinical belief is that if the anger in ODD is properly uncovered and worked on in family and individual therapy that such an effort can prevent the development of conduct disorder in many youngsters.

Diagnosis of Conduct Disorder

The DSM-IV categorizes conduct disorder behaviors into four main groupings: (a) aggressive conduct that causes or threatens physical harm to other people or animals, (b) non- aggressive conduct that causes property loss or damage, (c) deceitfulness or theft, and (d) serious violations of rules. Conduct Disorder consists of a repetitive and persistent pattern of behaviors in which the basic rights of others or major age-appropriate norms or rules of society are violated. Typically there would have been three or more of the following behaviors in the past 12 months, with at least one in the past 6 months:

Aggression to people and animals

  • often bullies, threatens, or intimidates others
  • often initiates physical fights
  • has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun)
  • has been physically cruel to people
  • has been physically cruel to animals
  • has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery)
  • has forced someone into sexual activity

Destruction of property

  • has deliberately engaged in fire setting with the intention of causing serious damage
  • has deliberately destroyed others' property (other than by fire setting)

Deceitfulness or theft

  • has broken into someone else's house, building, or car
  • often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others)
  • has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery)

Serious violations of rules

  • often stays out at night despite parental prohibitions, beginning before age 13 years
  • has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period)
  • is often truant from school, beginning before age 13 years

ODD and Severe Mood Dysregulation (SMD)

Severe mood dysregulation (SMD) is a newly defined disorder in children in which chronic irritability and hyperarousal were the predominant symptoms without the euphoria of bipolar disorders. Among 1420 children, the lifetime prevalence of SMD in children ages 9-19 was 3.3%.

In this study most (67.7%) SMD youth had an Axis I diagnosis. These were

- attention-deficit/hyperactivity disorder (26.9%),

- oppositional defiant disorder (24.5%)

- conduct disorder (25.9%).

In another study 80% of children with SMD had the combination of ADHD and ODD while only 20% of children with Bipolar disorder had this toxic combination (Carlson, GA. 2007. American Journal of Psychiatry.)

Severe mood dysregulation is relatively common in childhood and predicts risk for early adulthood depressive disorders, but not bipolar disorders (Brotman M A, et al. 2006.)  Also, research has shown that irritability in severe mood dysregulation is influenced by the severity of the oppositional defiant disorder in these children (Rich BA, et al., 2007.)   In addition, in our clinicial experience strong narcisissistic (selfish) personality traits influence the irritability in these children.  Therefore, we regularly recommend that parents also complete selfishness checklists on these children.

The role of forgiveness in diminishing ODD

The psychotherapeutic use of forgiveness can play an important role in decreasing or resolving the hostile feelings, thoughts and behaviors seen in ODD. The acquisition of this virtue is most important and helpful for children to develop in order to control and resolve their anger.

The following case study on the treatment of a defiant child which is taken from our textbook, Helping Clients Forgive: An Empirical Guide for Resolving Anger and Restoring Hope, demonstrates the effective use of forgiveness in the treatment of ODD.

Sean, a seven-year-old, became increasingly angry and rebellious with his mother after his father left the family. He regularly lost his temper, refused to listen to his mother, and provoked his sisters. He also became much more defiant and narcissistic and demanded that his mother buy him new toys several times weekly.

In the sessions with his mother and sisters, Sean admitted, "I’m really mad at Dad. He doesn’t care about us. All he ever did was watch TV anyway." Sean’s mother told him that his anger was hurting her and his sisters and that it reminded her of his father’s selfish temper tantrums. Sean became tearful and remorseful during the session and stated that he did not want to hurt anyone. He agreed to try to let go of his anger with his father on a daily basis and thus attempt to avoid repeating his dad’s self-centered behaviors. This intervention seemed to motivate Sean and when he slipped back into oppositional defiant behavior, his mother would remind him to continue to forgive his father. Over the course of several months, the work of daily thinking that he wanted to understand and try to forgive his father helped Sean to gain more control over his angry feelings and behaviors. However, there were times when, after spending a weekend with his selfish father, it would take several days to gain control over his sad and angry feelings. Unfortunately, the attempt to engage his father was unsuccessful.

While employing forgiveness therapy in the treatment of the defiant anger in children, the major obstacles that therapists encounter include: the sense of control their anger gives clients over others, modeling after their parents, and a sense of strength and self-esteem derived from the expression of anger. It is not uncommon, either, for the process of forgiveness to be blocked by parents who excuse all angry behaviors in their children, claiming that their behavior is solely the result of biological factors over which their children have no control. Such parents may have serious problems with excessive resentment themselves and therefore they attempt to undermine efforts made to teach their children to be responsible for their anger and to resolve their hostile feelings. Subsequently, therapy often focuses on encouraging parents to identify their own anger and to work on forgiving those who have hurt them. However, the fathers, in particular of those whose children have excessive anger, are often highly resistant to participate in treatment and often have no desire to control their excessive anger. By modeling forgiveness, the majority of parents can bring about a marked improvement in the level of resentment and acting-out behaviors in their children.

Defiance from the Gift of Strength

Children who are very strong often have great difficulty in being obedient to parents. They can overreact in anger when asked to be responsible. An effective parental response to these strong children can be that it is good to be strong, but harmful to be controlling. These children can also be encouraged to grow in the virtue of gentleness that can balance their strength. Also, Children with faith can be encouraged to consider that God is in control -- not them.

Parental Response to the Angry, Defiant Child

Parents benefit by understanding the nature of excessive anger and methods of being able to master this powerful emotion. Such knowledge is essential for their role in the development of healthy personalities in children. We recommend reading the nature of anger in the major child chapter on this site and then communicating to children that they have 3 options for dealing with their anger. These are denial, expression and forgiveness and they are described in detail in the child chapter on this site.

Parents play an important role in helping their children with defiant anger. In our clinical experience ODD is prevented in many children and resolved in others by their parents helping them to grow in early childhood in the virtues of forgiveness, obedience, orderliness, respect, generosity, gentleness and humility.

The following parental actions, some of which employ a faith component when appropriate, can be helpful

  • work diligently to develop strong virtues in children and adolescence
  • work to be a responsible parent and try not to be a permissive one
  • work on having a healthy marital relationship
  • relate to aggressive males that hitting younger and smaller males or females is not manly
  • try to avoid the expression of anger in the marriage by working on understanding and forgiving one’s spouse
  • work to resolve marital conflicts and do not separate or divorce unless severe abuse is present (most marriages can be healed)
  • teach children the virtues that can decrease anger and selfishness
  • correct appropriate selfishness and lack of respect in children regularly
  • provide appropriate punishment for repeated acts of defiance and selfishness
  • give praise when appropriate/ do not give praise excessively if it is not warranted
  • try to overcome selfishness and anger in one’s life and share with children how one tries to work against this vice
  • consider corporal punishment for strong acts of defiance
  • present role models of saints who worked to overcome their bad tempers, such as St. Peter and St. Francis De Sales.
  • encourage teachers at school to teach virtues to children, particularly, forgiveness, generosity and patience.
  • protect children from angry and selfish peers
  • warn about the dangers of using others
  • discuss with the children the desire to stop the expression of anger in the home because it harms everyone
  • remind the children that God is in control, then their parents and finally them
  • suggesting that the kids ask others for forgiveness
  • At bedtime prayer ask the Lord for forgiveness for the way they may have hurt others especially brothers and sisters
  • When the kids can't forgive, suggest that they give their anger to God.

The parental confidence is most important in correcting children with oppositional defiant disorder. Pope Benedict's writing on Colloboration Between Men and Women from 2004 can help to strengthen this confidence.

He wrote that the "Genius of Women" include:
 

  • special capacity to show love
  • delicate sensitivity to the needs of other
  • understanding of inner conflicts in others
  • special capacity for the other.


The "Genius of Men" include:

  • Greater distance from process of gestation and birth enables him to act more calmly on behalf of life.
  • He acts to protect life and guarantee its future. 
  • He is a father in a physical and spiritual sense.
  • He is called to be strong, firm, reliable and trustworthy.
    Joseph Cardinal Ratzinger, 2004, The Collaboration of Men and Women in the Church and in the World.

Virtues for ODD

Parents can help their children learn how to grow in healthy personalities and avoid giving into angry and defiant behaviors by teaching them daily the following virtues:

  • Obedience
  • Forgiveness
  • Respect
  • Patience
  • Generosity
  • Humility
  • Gratitude
  • Patience
  • Self-giving/self-sacrificing
  • Gentleness (to balance strength)
  • Faith.

Children can also fight against the tendency to be selfish and angry by regular visits the sick and the elderly and by giving to the poor. 

Also, John Paul II has offered excellent advice for parents in The Role of the Christian Family in the Modern World (FC, n.37): "Children must grow up with a correct attitude of freedom with regard to material goods, by adopting a simple and austere life style and being fully convinced that ‘man is more precious for what he is than for what he has (Gaudium et Spes, n.35.)’”

Faith and Anger

In year four of a 12 year study of excessive anger in children in Belfast and in Milwaukee Dr. Robert Enright, U. W., Madison) reported that more robust research findings are found for forgiveness use in angry children when the option of spiritual forgiveness is offered, (Enright, R., et al. (2007) Reducing anger through forgiveness education: Teacher-led curricula for primary grade children in impoverished and violent communities. J. Research in Education, Fall, pp. 63-78.)

We have found that in Catholic families the regular reception of the sacrament of reconciliation is very effective in diminishing intense irritiability.

Medication

Medication has been helpful in decreasing ODD while uncovering the causes of anger and working on growth in virtues. A 1999 study reported that stimulant medication produced significant improvement both in ADHD-related and oppositional behaviors (MTA Cooperative Group, 1999.) Other research has provided evidence for the effectiveness of mood-enhancing medication (SSRIs) in children whose oppositional behavior is associated with obsessiveness and irritability (Garland EJ, 1996.)  Atypical anti-psychotics have also been useful in some highly disruptive children with ODD.  Patients with ODD and CD with severe aggression may respond well to risperidone, with or without psychostimulants, (Turgay, A. 2009.)

A major concern in regard to medication in children is that from 1992 to 2002, the prescription of atypical antipsychotics for the treatment of aggressive and disruptive behaviors in children increased seven fold, (Correll, CU, et al. 2006 and Olfson, M, et al. 2006,)  This research clearly demonstrates both the growing problem of excessive anger in our children and the need for alternative approaches for addressing this serious difficulty other than through medication.

Alternative Placement

Some parents find that if numerous attempts to resolve their child’s disruptive angry behaviors fail that it is necessary to consider removing their child with ODD from the home. This is particularly the case when the angry behaviors begin to have a negative effect upon the physical and emotional health of a parent or other siblings.

Successful alternative placements have been with other relatives, friends and boarding schools. A guiding principle in these cases is to protect the marriage and family from the harmful effects of a child’s excessively angry and defiant behaviors. Too often parents err by not taking stronger steps to protect their family from the harmful effects of ODD anger.

Anger in Children of Divorce

Conflicts with excessive anger and mistrust in children from divorce families have been reported in many studies (The Unexpected Legacy of Divorce, Wallerstein, 1991.) Also, some stepchildren harbor serious resentment toward their biological parents which is often hard to control. They may deny the anger, but this powerful emotion can emerge in times of stress. Stepparents can also have difficulties with their anger as a result of a number of factors including residual resentment from their previous marriage.

Parents who are considering divorce should also consider reading Between two worlds; The inner lives of children of divorce by E. Marquadt, 2006 and The effects of divorce on America, The Backgrounder, Executive Summary by P. Fagan and R. Recto, 2000, the Hertiage Foundation.

Case Study

Rachel was a thirty-five year old married woman who, in addition to her own two children, had two stepchildren in her home. The step-children had been deeply hurt by their alcoholic mother and her abusive boyfriend before they had come to live with Rachel. The children's anger that was meant for the adults with whom they had formerly lived was frequently misdirected toward Rachel and the other children. Their angry behaviors created enormous tension in the home. Rachel became so exhausted and overwhelmed that she even considered separating from her husband, Aaron. She began therapy and quickly after the first session took steps to become assertive with her stepchildren. She identified the origin of their anger and encouraged them to try to let go of their resentment by forgiving their mother and her boyfriend rather than by misdirecting their anger.

It was particularly difficult for Rachel's stepson, Brad, to let go of his anger with his mothers physically abusive boyfriend. Brad viewed that this man as being emotionally sick and his opinion was validated by the therapist. The treatment of his anger was facilitated by punching a pillow and then by thinking he wanted to let go of his impulses to strike back.

This work of forgiveness was a lengthy and difficult process for the children and, at times, they continued to overreact in anger toward Rachel. When that would happen, she would remind them that she did not deserve their anger and would encourage them to try to let go of their resentment with their mother by forgiving her. They were helped in the process by trying to recall that much of their mothers behavior was the result of her illness of alcoholism. Finally, Rachel modeled forgiveness in the home by asking for forgiveness for any ways in which she may have disappointed the children and by granting it to others who hurt her, including their father.

Some children from divorced families harbor rage and some have violent impulses against a parent. Often these young people are unable to use the word forgiveness because they sincerely believe that the parent, stepparent or parents friend should not be forgiven. In lieu of using the word forgiveness, when these children choose the spiritual form of forgiveness, they are asked to think that they are powerless over their anger and want to turn it over to God.

It is important for such strong anger to be addressed because the failure to do so can result in hostile impulses becoming misdirected internally or outwardly toward the family, school, or community. Also, the failure to face and resolve the anger predisposes these children to depressive episodes and difficulties in trusting.

Finally, in merged families a stepparent should have the freedom and the spousal support to correct the anger, mistrust or selfishness in a stepchild by encouraging growth in forgiveness, trust, generosity and other pertintent virtues.

Adopted children and excessive anger

Adopted children and adolescents can have difficulty with excessive anger. In our experience, this anger originates from a number of sources, including traumatic memories with their birth parents or other caregivers, shame, a profound difficulty in trusting, or other experiences of rejection. These youngsters can exhibit angry behavior and usually lack an understanding of the origin of their resentment. Their anger can diminish by discussing the early-life, unconscious betrayal anger that may develop after separation from a biological parent. The youngster should be encouraged to consider making a decision to work at forgiveness rather than venting anger in an excessive manner. In some cases forgiveness exercises are given to them in which the young people are asked to think of forgiving one or both biological parents for abandoning them.

The hostile feelings in such children are a defense against their feelings of vulnerability and fear of further betrayal. These youngsters often will only work at changing hostile behavior after their trust in the adopted parents has grown significantly.

Case Study

Amber was an intelligent nine-year-old girl who was adopted from Russia at the age of five with her two-year-old brother. After being taken away from her drug-addicted mother who was a prostitute, Amber was placed in a strict orphanage and later related being treated in a harsh manner there. Her adjustment to her family and community was quite difficult. She distanced her adoptive parents, children in the neighborhood, and anyone who tried to befriend her. She became increasingly angry and later engaged in violent behavior toward her mother.

The therapist told Amber, You have every reason to feel very angry about what happened to you in Russia with your mother and in the orphanage. However, that anger has never left you and now you are misdirecting at your mother and others. Why not try to think that you want to forgive your birth mother rather than take that resentment out on your mother? I have seen forgiveness diminish the anger in other adopted children. Amber denied this anger for months.

At home her mother was told to tell her that she didn't deserve her hostile aggressive treatment and that if she could forgive her birth mother her anger would diminish and they might have even have a good relationship.

Amber slowly acknowledged that she had felt a great deal of resentment toward her birth mother for her addictive behavior and for failing to protect both her and her brother. She also expressed anger toward the caretakers of the orphanage in Russia. Painful memories emerged in which she recalled hitting her birth mother in Russia when she was drunk. It was suggested to Amber that at the present time she was misdirecting intense hostile feelings that she had for her birth mother toward her adoptive mother and was using her anger as a defense to keep everyone at a distance.

Amber was given handwritten forgiveness notes to take home and work on between sessions. These notes stated, (1). I want to stop misdirecting my anger at those who don't deserve it. (2). I want to try to understand that my birth mother was sick with a drug addiction and I want to try to forgive her. (3.) I want to let go of the anger from Russia so that I can be free and not controlled by the past. She was challenged to trust people more than her mother had ever been able to trust. It was stated that unless she took these steps, she might be as lonely, unhappy, and fearful as her birth mother.

As she worked on trust and forgiveness of past hurts, Amber became aware that some good could come from her pain. She expressed the desire to become a health professional and someday go back to Russia to help children who had suffered in the same manner as she. As her resentment diminished and her trust grew, she became much less defensive and hostile toward her mother and toward her peers.

Amber's mother was Catholic and had a great devotion to Our Lady. She encouraged her daughter to think of Mary protecting her now and as her other loving, healthy mother when she was in Russia. She also asked her to reflect that Our Lady could help her to feel safer in relationships and that this would diminish her fears of being abandoned.

Some adopted children have such severe anxiety, mistrust with associated irritability as a result early betrayal experiences that they benefit from a low dose of an SSRI antidepressant such as Paxil. This medication has resulted in a significant decrease in levels of anxiety and then anger in children making them much more cooperative and trusting in the family. Often they are then more cooperative in working on trying to trust and to forgive.

In an important study published in 2005 of 1,484 young adult inter country adoptees in the Netherlands the adopted young adults were 1.52 times as likely to meet the criteria for an anxiety disorder as the non adopted young adults. The adoptees were 2.05 times as likely to meet the criteria for substance abuse or dependence. The adopted men were 3.76 times as likely to have a mood disorder as non-adopted men. Surprisingly, the adoptees with high parental socioeconomic status were 2.17 times as likely to meet the criteria for a disorder as non-adoptees with high parental socioeconomic status (Tieman,, 2005).

Anger due to bullying: Major Peer Disorder

We have seen large numbers of patients over the past 32 years whose emotional pain was primarily the result of peer rejection, insensitivity and ridicule in their childhood and adolescence. A major reason for insensitive peer treatment today is narcissism. While the diagnosis in these children and teenagers is often adjustment disorder with anxiety, we suggest to these children and their parents that their diagnosis should really be a major peer disorder. In fact, these children are frequently very gifted boys and girls.

Several studies cite that 21% of children in middle school (Bouton, 1992) and 22% in elementary school (Austin, 1996) report that they have been bullied. Children who are bullied by their peers often develop a number of psychological difficulties including social isolation and loneliness (Boulton, 1992), psychosomatic symptoms and hyperactivity (Kumpulainen, 1998), anxiety, social phobia (Gilmartin, 1987), depression and suicidal ideation (Rigby, 1999), fear of going to school and low self-esteem. Also, their peers regularly side with the bullies against them, do not support them and even develop strong anger toward them (Rigby, 1991.) As a result of harsh treatment by their peers these children and teenagers develop regularly intense anger and at times violent impulses for revenge against their tormentors.

These impulses can become obsessive even though usually they are not acted upon. The anger in these children that is really meant for their peers can be misdirected often into the home toward younger siblings or the mother. Embarrassment concerning the abusive treatment by peers often keeps the child from relating their feelings to their parents. Subsequently, parents are often unaware of the causes of their children’s excessive anger.

Victims of bullying may:

  • be harassed because of his/her clothing or appearance
  • not be good in sports/lack of eye hand coordination
  • be intellectually gifted
  • have strong creative and artistic gifts
  • have strong moral code
  • may not go along with the crowd
  • may not be narcissistic and have a healthy personality
  • be small in stature, overweight, thin, etc.
  • be from a wealthier family
  • be confident.

Case Study

Miguel, a ten-year-old boy, told his parents whenever other children made him a scapegoat at school or at sports. Although he was the smartest student in his class and a good athlete, he became increasingly anxious and angry as a result of the constant ridicule by peers. The apparent reason for the abuse was his protruding front teeth. They called him Bucky the Beaver at every opportunity. To his credit, even when he was outnumbered, he was emotionally strong and had no difficulty responding in an assertive way to his tormentors. However, he developed symptoms of anxiety as a result of peer ridicule.

The anger with his peers regularly spilled over into his relationships with others in the family. Miguel knew he was misdirecting anger and was motivated to try to resolve his resentment with his peers. He was asked daily to try to view his peers as being jealous of his intelligence and athletic abilities and then to think of forgiving them. He was helped in this process with his fathers encouragement. Miguel’s dad told his son that he had been subjected to similar treatment as a boy. Miguel actually came to feel compassion for his peers and viewed them as being weak males who could not face him individually, but needed to hide in a group.

Our clinical experience from treating bully-victims for over two decades is that bullying has increased significantly in our schools and communities. Teachers, regardless of length of service, report not being confident in their ability to deal with bullying and 87 per cent want more training (Boulton 1997). New programs for teachers and students need to be developed to protect children in our schools, to help victims learn how to resolve their strong anger with impulses for revenge, to encourage peers to understand bullies and to support victims, and to provide treatment protocols for the hostility in bullies.

When parents complain to the school about the bullying of a child, a common response from school administrators is to hold the victim equally responsible for the conflict(s). In our clinical experience this often is not the case. Then, parents can present a written list of the bullying episodes with the name(s) of the bully and insist that bullies participate in an empirically proven anger management program. They may also request that teachers receive more training on dealing with anger in the classroom and with bullying.

The experience of being bullied can lead to a major depression and loneliness, explosive anger and impulses for revenge, anxiety and mistrust, low confidence, obsessive-compulsive symptoms, social isolation and even paranoid ideation. In addition to trying to resolve anger with the bullies by a process of forgiveness, many of these youngsters benefit from working on building their confidence and their ability to trust; that is, their ability to feel safe with their peers.

Growth in confidence in the victims can occur in a number of ways particularly by working on same sex friendships and by strengthening the relationship with the same sex parent. Confidence can also grow by being thankful regularly for one's special God-given gifts and body.

When appropriate, the role of faith can be beneficial in the healing process. Growth in trust can occur in some children by suggesting that they meditate several times daily, "Lord help me to feel safe with friends whom I can trust." Also, participation in parish youth groups lead to a new ability to feel safe with peers. Many youngsters have been hurt so deeply by bullies that they are unable to forgive them. discover that they cannot forgive those who have bullied them. Catholic youngsters can be helped by giving their anger to God, reflecting that revenge belongs to God or taking their deep resentment into the Sacrament of Reconciliation. The process of resolving anger with bullies is challenging and requires a great deal of strength and grace.

Some males also discover within themselves an anger with God for allowing them to be hurt regularly by their peers. They can experience a relief by expressing aloud, "God, why did you let this happen to me?" Also, uniting one's rejection pain with that of Christ who was also ridiculed and abandoned can help individuals find meaning and strength in their suffering.

When the school is unable to protect children from the pain of ongoing harassment or insensitive treatment, other options can be considered including enrollment in another school, in a charter school or in home schooling.

Sibling Anger

Sibling conflicts are a major source of stress in many families. This disruptive anger arises from many factors including jealousy, selfishness, misdirected anger meant for a parent or for peers, excessive competitiveness, insecurity, poor body image, loneliness, materialism, a tendency to control, a failure to forgive and modeling after angry peers or an angry parent(s).

Parental conflicts are often uncovered which contribute to this anger. They include inappropriate anger, marital quarrelling and irresponsible parenting with either emotional neglect or excessive permissiveness or indulgence.

Parents can protect their children from the trauma of peer hostility by helping them grow in a number of virtues that can diminish these conflicts. These virtues include:

  • generosity and self-denial for selfishness
  • gentleness & kindness for excessive competitiveness
  • gratitude and charity for jealousy
  • forgiveness and respect for anger
  • detachment and faith for materialism
  • friendship for loneliness
  • hope for sadness
  • thankfulness for one’s gifts for insecurity.

Forgiveness education in the classroom

Excessive anger and defiant behaviors are an increasingly serious problems in the classroom. One student refuses to do her/his work. Another lashes out at a teacher who tries to help. A third student deliberately disrupts the classroom making it impossible for the teacher to perform her job.

Research by Dr. Robert Enright and his associates at the University of Wisconsin, Madison, has shown that forgiveness education programs in schools can have a positive impact on the mental health of children by diminishing levels of anger in students (Enright, et. al., 2007.) We have described in an article, Learning to Forgive, in The American School Board Journal, www.catholiceducation.org, how educators employ the virtue of forgiveness in their classroom for angry students and how they can teach this virtue.

Reasons for Hope

Fortunately, some ODD behaviors resolve in children as they grow in maturity. Also, although ODD can have extremely detrimental effects upon many areas of a child’s and family’s life, both clinical experience and the research findings on angry children by my colleague, Dr. Bob Enright at the University of Wisconsin – Madison demonstrate the remarkable benefits of teaching children how to control, master and resolve their excessive anger and subsequent defiant behaviors through growth in the use of the virtue of forgiveness and in other virtues such as generosity, patience and self-denial.   Also, we hope that in the future research studies will done in irritable and defiant children which compare the use of medication with the psychotherapeutic use of forgiveness.

Finally, the treatment of excessive anger in children with ADHD and conduct disorder is described in the child chapter on this website.