Oppositional/Noncompliant Behavior
Ross W. Greene
I. Description of the problem. Challenging behavior in children and adolescents occurs on a spectrum of severity that can include whining, pouting, crying, sulking, screaming, swearing, spitting, hitting, kicking, biting, lying, and more severe behaviors that are self-injurious or injurious to others. The degree to which one views such behaviors as “severe” is partially subjective (i.e., different adults experience various challenging behaviors to be more or less objectionable or intolerable than others) but is also clearly a function of intensity, frequency, and severity. Psychiatric diagnoses are best understood as groups of concomitant challenging behaviors that occupy points on the severity spectrum. Children meeting diagnostic criteria for oppositional defiant disorder (ODD)—generally the diagnosis of choice for oppositional/noncompliant kids—are those who exhibit “developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures,” manifested in the form of many of the above behaviors.
Yet, such children do not exhibit such behaviors at all times. Rather, these behaviors occur under specific conditions; namely, when the cognitive demands placed upon a child exceed his or her capacity to respond adaptively. Of course, all humans behave maladaptively under exactly the same conditions, although the precise form of maladaptive behavior varies widely. The core feature of ODD—noncompliance—suggests that complying with adult directives requires skills that some kids lack. Thus, it is meaningful that ODD is associated with mood lability and low frustration tolerance and equally meaningful that noncompliance requires, by definition, an adult interaction partner.
A. Epidemiology. Prevalence rates for ODD range from 2%-16%. Research has shown that stubbornness is likely to emerge as a problem at around the age of 3 years; followed by defiance and temper outbursts at around the age of 5 years; arguing, irritability, blaming and annoying others, and anger between the ages of 6-8 years; and swearing at around the age of 9 years. ODD is thought to be somewhat more common in males, although this finding may vary with age.
B. Compliance. Compliance refers to a child’s capacity to defer or delay his or her own goals in response to the imposed goals or standards of an authority figure. As noted above, compliance is best viewed as a skill, and one that is affected by a variety of other cognitive skills. Children who are frequently and/or intensely noncompliant can be viewed as lacking these cognitive skills, and noncompliant behavior can therefore be understood as a form of developmental delay.
C. Contributing factors. If noncompliance and its associated behaviors occur when the demands being placed upon a child exceed his or her capacity to respond adaptively, then lagging skills in the child are only part of the picture: how an adult is going about imposing goals or standards and solving adult-child problems is of equal importance. Traditionally, parents of noncompliant children have been viewed as passive, permissive, inconsistent, noncontingent disciplinarians. According to some theories, it is the tendency of such parents to capitulate to a child’s wishes rather than endure tantrums that gives rise to chronic noncompliance. Thus, it’s not necessarily the case that caregivers of noncompliant/oppositional kids failed to impose their will. It is possible that these caregivers learned firsthand the havoc that can ensue when one imposes will (with or without formal consequences attached) on a child who does not have the skills to handle imposition of adult will adaptively.
This mismatch between environmental demands and lagging skills could occur at any point in development, beginning in infancy (kids lacking skills at this point in development are often referred to as temperamentally difficult), the toddler years (when language development becomes increasingly crucial), and later in childhood (when demands for self-regulation increase, both at home and school). It is curious, therefore, that many popular interventions aimed at improving compliance teach parents to impose their will more firmly, consistently, and contingently. If a child’s noncompliance is unsuccessfully treated and adult-child interactions remain conflictual, then the child is at significant
risk for moving in the wrong direction down the spectrum of severity: almost all youth meeting diagnostic criteria for conduct disorder are diagnosed with ODD first and before that are labeled “oppositional.”
II. Making the diagnosis. In consideration of the above information, one might rightly question whether making a formal diagnosis of oppositionality is a crucial step in the process of improving interactions between the child and his adult caregivers. Diagnoses pathologize the child, suggest that the problem resides within the child, and infer a stable (rather than situational) trait.
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