When working with children who exhibit defiant behaviors, it can be hard to sustain an environment conducive for learning. Some children exhibit defiance to seek attention and express frustration towards the level of work that is expected of them, while others may be experiencing a behavioral disorder.

The first step in managing negative behaviors in therapy may be to shift gears. Many behaviors demonstrated by children (i.e., self-stimulatory, attention-seeking, aggression) are triggered by stimuli in their surrounding environment.

The treating SLP must consider the framework of each session and the goals being targeted. Some children with oppositional traits benefit from a patient-centered approach, in which the patient guides the structure of the session (maintaining a sense of control) while goals are integrated into productive, yet achievable tasks.

Other children may exhibit success with visual schedules, positive reinforcement (verbal/tangible), and work-to-earn systems. It is important to tailor incentive to each individual in order to yield the most success.

Tips for Dealing with Defiance in Therapy:

• Respond without anger.
• Speak calmly and matter-of-factly to a defiant child. Defiant children will not respond well to sarcasm, lectures, or complex directions.
• Avoid open-ended questions (unless you are willing to accept any answer).
• Avoid a power struggle; children with defiance often seek power and control. Offering limited choices let’s the child feel in control and allows them to hold onto their sense of significance and dignity but teaches them expectations.
• Avoid negotiating in the moment; decide on a consequence and remain firm in this decision. Negotiation gives the child more control and gives them the message that they can avoid redirection by resisting.
• Be strong in your follow through; defiant children will work to “wear adults down and win.”
• Do not take a child’s behavior personally.
• Be as neutral and objective as possible (in both verbal and non verbal expression).
• Keep setting limits with children and follow through by giving them consequences/holding them accountable for their actions.
• Defiant children need to feel that despite difficulties, you will still care about them, recognize their successes, and actively include them in the learning environment.
• All children, including those who frustrate you, have positive attributes. Make a point to learn about their interests and channel their talents in ways that foster their sense of significance.
• All children, especially those who struggle with defiance, need to hear when they are doing well and where they are improving.
• Make a point of noticing a child’s successes, such as following directions, transitioning smoothly, or doing anything ordinary that might invite resistance.
• Avoid suggesting that pleasing you is what’s most important; steer clear of phrases such as “I like..”, “I want…”, or “I appreciate” when reinforcing positive behavior.

A child who is sensitive to being told what to do may feel manipulated by “I” statements.

• Teach defiant children how to disagree respectfully; when teaching children appropriate ways to disagree make it clear that in the moment they still need to follow directions and rules. Let them know that later they can discuss what they feel was unfair and what should be changed. Teaching phrases such as “I feel that…”, and “I suggest…” can go a long way.
• When a child is being defiant make sure they are (1) safe and (2) give them time to cool down.
• Avoid doing things that may heighten a child’s level of stress and trigger more resistance.
• Do not try to reason or make en emotional appeal to “win” the child over.
• Slow down; waiting a few seconds before you say/do anything lets the child regain their ability to cooperate and also lets you assess the situation calmly and objectively.
• After an episode of defiance, reflect on what preceded it. Eventually you will begin to recognize the situations that set off the child’s defiance, such as unexpected schedule changes or tasks that are too challenging.
• Look for signs of frustration and discomfort such as opening and closing fists, body tension, and avoiding eye contact. Often times we may overlook red flags and consequently push children further into a defiant episode.
• Intervene early; respond as soon as you can with respectful reminders or redirections. Following redirection do not expect immediate compliance. Children often need space literally and emotionally. Taking a step back will lessen the sense that you are controlling them.
• A reward system can give children incentive to be compliant. Behavior contracts may also allow children to earn privileges through compliance (i.e., 15 extra minutes of iPad at home when session goes well).
• Consistent discipline across settings is essential in reducing defiance.

Ward off attention-seeking negative behavior by giving children a daily dose of positive attention. A few minutes of positive attention can be enough for defiant children to feel satisfied.

Sometimes after cycling through teaching techniques and therapy approaches, children still exhibit reluctance to participate in sessions. This may be indicative of a clinical behavioral disorder.

What is Oppositional Defiance Disorder (ODD)?

Oppositional Defiance Disorder (ODD) is a childhood behavioral problem characterized by constant disobedience and hostility. The characteristics of ODD usually appear in school-aged children and include:

• Child is easily annoyed or angered
• Child has frequent temper tantrums
• Child argues frequently with adults, particularly their parents
• Child refuses to obey rules
• Child appears to deliberately annoy or aggravate others
• Child has low self-esteem
• Child has a low frustration threshold
• Child seeks to blame others for any misconduct

Some children with traits of ODD may experience:

• Poor social interactions
• Difficulties complying with rules and expectations
• Anger/Frustration
• Difficulty taking responsibility for their own actions

Management Strategies for School and Home:

• Parent counseling by a licensed psychologist helps parents to better manage and interact with their child. This may include learning behavioral techniques that reinforce good behavior and discourage bad behavior.
• Functional family therapy teaches family members how to problem solve and communicate more effectively with one another to decrease defiance and hostility in the home.
• Consistency of care is essential. For effectiveness of intervention, all people involved in the care of the child need to be consistent in the way they behave and manage the child. This includes teachers, grandparents, parents, siblings, babysitters, etc.

Speech-Language Therapy to Support the Child with ODD:

• A thorough speech and language assessment may help families understand how a child is processing, understanding, learning, and using language and communication.
• Communication strategies may provide families with strategies and techniques to increase and enhance communication with their child.
• Daily activities can be targeted to help children with ODD understand the environment, routines, and importance of language.
• Developing language can help younger children to understand and use language more spontaneously and appropriately.
• Working on conversation and pragmatic language skills can help children with social communication (i.e., turn-taking, appropriate use of language across settings). An SLP can help children learn when and how to use language.
• Concept skills can enhance a child’s ability to develop abstract concepts, such as time (this can decrease frustration and confusion in regards to change and consistency in routine).
• Visuals can be used to help children express their needs, wants, and thoughts, as well as organize and plan a routine for the day.
• Speech goals may enhance verbal and non-verbal communication, including gestures/signs, speech, and written language.
• Communicating with educators and family members to discuss the nature of the difficulties and ways to help the child will help ensure a cohesive plan for generalization of skills.

What does a diagnosis of Oppositional Defiance Disorder (ODD) really mean for a child?

A diagnosis can help to identify:

• Other co-morbid disorders
• Medication that might be appropriate
• Therapies that might help the child
• Course of intervention/projected outcome

According to the DSM-V, diagnoses are used to label a set of symptoms that are being experienced by a child. A licensed psychologist can provide a comprehensive evaluation to determine the nature and severity of a child’s deficits, as well as the presence of a behavioral disorder.

Ashley DiGregorio M.A. CF-SLP, TSSLD