Oppositional defiant disorder

We spend a good amount of time processing with our patients and helping to put their emotions into context. I try to partner with my patients by letting them vent about what's troubling them at home or school, finding those areas where they really feel unheard or unwanted, and trying to get their buy-in on focusing there. I continue to hone my approach and can be flip-floppy depending on how the interaction goes. Often times, my patient feels their behaviors are due solely to factors outside of their control, e.g., "My mom is crazy, not me! Get her a$$ in the hospital!" or "My foster dad doesn't know what I've been through and he's not even trying to learn - he just gives me rules that don't make sense." In those cases, I go with something like, "You know what? I hear you. Sometimes we end up here because of the challenges we have with other people. If there's nothing you feel like you need to change, maybe we need to focus on something that's gonna actually be useful for you, like "how to deal with difficult people." You'd be surprised how often this can spark an alliance (however fleeting), even with hardcore kids. I also tell them that they can probably be really helpful to the younger kids in the milieu during group discussions, because they've got a story to tell. I also let them know that they can always look for me or ask for me if they start feeling "some type of way" during my shift. Sorry if that all sounds really simple or hokey. I'm still working on it, but it's what I've got for now.

Also, finding alternate activities can be helpful. For kids that just cannot bear sitting in the dayroom all day long, and really aren't about the life of crayon-coloring mandalas in the hallway either, I enlist their help. Sometimes their interests can surprise you. And we all like feeling useful. I try to find some work around the unit that can be safely done, and let them know I could really use their help with it. Even if it requires keeping an eye on them while you work, it beats de-escalating and chasing them in and out of the quiet room all day and night. I've had teenagers help me by folding unit sweatshirts (even if I then take the folded sweatshirts into the back, ball them up, and present them as a new batch to be worked on). I've had some inspect the unit, clean the baseboards with purple wipes (really!), sort print-outs and books, make lists of stuff like topics we could use for groups, get shower supplies prepared, etc.

Don't get me wrong. Some -- maybe even most -- kids with ODD aren't gonna buy what you're selling, no matter what. They will present one long behavioral management task for the duration of their stay. But I make it a personal challenge to crack them somehow. If not, nothing lost in trying.

Hope this helps somewhat. Best!