When dealing with Oppositional Defiant Disorder (ODD), the caregiver should
consider the age of the person in 4 categories: A.  Per-school age.  B.  
Elementary school age. C. High school age and D.  Adult
All four categories pose two sets of problems for the caregiver:  1-Physical
aggression and 2-Persistent pattern of defiance toward authority figures.  
Individuals with ODD over time hone their manipulative skills and can be very
difficult to deal with by the time they reach teen or adult age.  A common
description by caregivers is, "he is miserable and wants everyone else to be
miserable with him."  The caregiver may never notice the characteristics of "joy"
in the person and compliance may only occur when the individual has gotten his
way.  In children look for frequent tantrums and hitting.  Elementary children
may display verbal and physical aggression toward their peers, teachers and
parents.  By this age they have improved their manipulative skills enough to
combine physical aggression (toward people and property), verbal abuse and
lying to challenge any caregiver's patience and sanity.  By their late teens,
persons with ODD may well have had experiences law enforcement
interventions and developed other mental illnesses.  An ODD person, more often
than not lives a lonely life as an adult because as the saying goes, "he has a
temper of rattlesnake in mid summer" and  has a tendency to destroy his
relationship with others if he don't get his way.  One of the common and life
threatening (to the person) secondary illness associated with ODD is depression.
Suicide rate is slightly higher in this population.  
ODD person will use everyone of his tricks to get a reaction from the people
around him including destroying and/or stealing others property.  He will also do
his best to destroy other's relationships. Caregivers must be aware of this
especially if the ODD person lives in their household or a group setting.  Slightest
disagreement among the caregivers or signs of strained relationships will invite
the ODD person to sabotage.  As it relate to aggression, caregiver should
understand that a mild to moderate ODD person does not necessarily engage in
aggression to harm but rather to annoy.  
Some of the other behaviors associated with this illness are:  Running away,
emotional outbursts, impulsive behavior, refusal to follow rules and cues from
adults.
Communication amongst all involved is key to containing an ODD person.  
Caregivers, parents, teachers, consolers, workshop staff need to maintain a close
contact with each other and never relay on the information ODD person provides
them.  
In dealing with an ODD individual consider writing down the behavior problems
and prioritising them and target the first two or three worst behaviors.  Ignoring
and redirection of the minor behaviors may be all the caregiver can do to deal
with the situation.  For example, the individual at the dinner table will say, "this
mashed potatoes smell like poop".  The caregiver responds by asking the person,
"do you have any math lesson to work on tonight?"  Another helpful strategy is
to remove the person from his immediate surroundings; in case the environment
is an issue.
It should be noted that depending on the level of functioning, the person will
eventually realize caregiver's attempt to redirect him and will adjust accordingly.
Another concern is that the ODD person can easily be manipulated by her peers
and others.  Since she may have few or no friends, the ODD individual may do
anything for a "friend" that allows the individual to perceive she is getting her
way.  These types of negative influences may lead to the ODD individual to be
manipulated to engage in criminal activities such as prostitution, theft and drug
use.  
In dealing with this type of persons one must separate the illness (behavior) from
the individual and I must admit, it is a lot easier said than done.  Especially when
the ODD person may demonstrate an exemplary behaviors in a different setting.  
However, in order to be proactive in helping the ODD person, anger,
punishment, inattention, absence of love, caring and support will contribute to
the problem, not help it.  The caregiver must realize and know that the behaviors
displayed by the individual is not caused by the caregiver responses.  If the
caregiver can detach herself from the problem, she is more likely to be proactive
in her responses.
Caregivers should understand that an ODD teenager or adult may have endured
numerous spankings as a child and experienced  unreasonable restrictions, verbal
abuse, anger, peer manipulation, rejection and resentment from family, peers and
caregivers which may have contributed to the person's current mental and
emotional being. Determining whether the person's life experiences may have
cause additional mental health issues the person is suffering from is very helpful.
In doing so, the caregiver can focus on the person, not the behaviors.  Here are a
few tools that can help caregivers respond appropriately to the ODD person:
A.  Understand that the ODD person goal in an argument for example is to "win"
and any rational dispute resolution will be rejected.
B.  The ODD person actions may be compulsive and he may not know why he
did what he did.  Thus an "I don't  know" answer maybe the best he can give.
C.  A poster set of rules (with pictures for those who can not read) can define the
"house rules" and the consequences of breaking those rules.  It also divert anger
from the caregiver to the poster so, make sure you have more than one of them.  
The "house rules" poster should encompass the expectations relevant the
environment and should apply to all persons, not just the individual with ODD.  
For example, a home environment "house rules" may include: making bed,
brushing teeth, bathing, vacuuming room weekly, etc. When the ODD individual
breaks one of these rules, the caregiver approaches her and explains the positive
consequences of complying with the rules.  For example, "Jenny, you forgot to
make your bed before breakfast; if you go ahead and do it, your room will be
neat and pretty when you come home".  The care giver then state the negative
consequence: "But if you don't make your bed, the rules says you will lose your
T.V. Privileges for 1 hour when you get home; and I hate for you to lose that
privilege."  You may get three possible respond from this request:
1-  I don't care.  Which is a response looking for reaction.  Stay calm and be
respectful of the choice she has made.  It is imperative to allow the ODD person
or anyone with disability to make as much of their life decisions as possible.  This
will enhance the person's self worth and it offer them the opportunity to make
responsible decisions.
2-  "I hate these stupid rules."  Somewhat of the similar response as #1;
provoking but more emotionally intense and semi-irrational.  While describing to
Jenny the consequences of not making her bed,  should the care giver had said,
"if you don't make your bed, you can't watch T.V. for an hour when you get
home",  Jenny's response may have been, "I hate you".  If at all possible the
caregiver should avoid any situation that allows the ODD person or others from
having an excuse to justify to severe her relationship with the caregiver.  It is
much better for Jenny to hate the poster than caregiver.  In many occasions I've
observed the individual running to the poster and tearing it into pieces; a torn
poster has a much better outcome than a torn face.
3- She may comply.  Verbal praise such as "great job" is appropriate.
D.  Be sure to provide plenty of intermittent positive reinforcements through
praises, unexpected gifts, activities and so on.  
E.  Avoid too many consequences that removes personal belonging or the
individual will be walking around naked and accusing you of neglect.
F.  It is OK to hate the behavior.  Love, nurture and care for the person.
G.  Understand that this is a disability that requires coping skills and there are no
cures.  
This information can be used to tailor a behavior object unique for the individual
served.  For example:
1-A.  Jenny will improve her social/behavirol skills by in a group setting
describing the house rules when staff points to each picture.
Method: Staff will.  When Jenny describes the rules, ask "why is it a good idea to
follow this rule?"  "What happens when we all follow this rule?"
1-B.  Jenny will follow the house rules by taking a shower daily.
Method:  Staff will.  Provide options and choices as to when Jenny wish to take a
shower by saying, "Jenny, what time do you feel like taking your shower today?  
Do you rather take shower or bath?.  If Jenny refuse, state consequences of
following house rules beginning with the positive consequence first.  
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