Q My granddaughter, almost 16, is a huge problem. She has been diagnosed with ADHD and ODD. She has been arrested twice for assaulting her mother, and doesn’t seem to care. She tells her mother that she hates her, and always has, and will never love her. She doesn’t eat with the family, and when she is asked to do a chore, she tells her mother to do it herself. She has had some counseling but usually refuses to even get in the car, and if she does go, she just sits there. She refuses to take medication. But she is doing well in school, and we took her to Alaska on a cruise and she was great. My daughter is at her wits' end. What can she do?
This sounds like an overwhelming situation for your daughter, and it’s great that you are reaching out for help.
I would suggest a two-part approach to treatment. Yes, your granddaughter could probably benefit from a full psychological evaluation and therapy that focuses on impulse control and anger management skills. But you can’t force any teenager, especially a defiant one, to engage in therapy. With teenagers, if it’s going to make any meaningful change in their life, they have to want it.
But just because your granddaughter is refusing help, that doesn’t mean that things can’t improve or change at home. What I would recommend is Parent Management Training, or PMT. It’s based on Dr. Alan Kazdin’s work at Yale, and it’s been found to be very effective with teens and children with ODD. A lot of clinicians may say, “I do parent sessions,” but specifically asking for PMT is what I would recommend, and that you do the training with your daughter, since you are very involved.
The other thing I would recommend is a book, based on that work, called Your Defiant Teen, by psychologists Russell Barkley and Arthur Robin.
What you’re going to learn in PMT are some key parenting skills, specifically for teenagers with ODD, especially about how to give positive reinforcement and how to give appropriate consequences.
It’s really important for parents to understand that attention equals reinforcement. Any behavior that results in attention from the mother, even if it’s negative attention for negative behavior, makes it more likely that that behavior is going to be repeated.
So you’ve got to flip the switch: learn how to give attention for positive behaviors. Your granddaughter obviously has the capability to do well, in certain situations. The more attention her mom gives for positive behaviors, such as doing well in school, being great on the cruise, the more likely those behaviors will increase.
I always recommend a three-to-one rule: Three positive comments to one negative, critical comment. The most powerful way to change a person’s behavior is through positive reinforcement, which means giving her praise, a hug or some positive recognition of her good behavior.
The other thing that you’ll learn at PMT is about how to set up a behavioral management program, where you establish your top three priorities for behaviors you want to see, and the teen can earn privileges — extra spending money or going out with friends — by meeting those expectations. It’s important to set up a positive way for your granddaughter to earn privileges first, before you establish consequences and taking away privileges.
Finally I would encourage you and your daughter to keep in mind that your granddaughter’s lashing out, albeit harmful to the family, is something she’s not happy with either. And to recognize that there’s some underlying pain that she’s feeling, and she can’t figure out a better way to deal with it.
It helps if you can hold onto that empathy, knowing that deep down, she doesn’t want to be acting this way and hurting her family, even though it might not seem that way. She probably doesn’t want to be seen as the bad kid.
If you can hold onto moments where she does try, she does have compassion, you can keep in mind that it’s there; it’s just buried deep down inside, and things have to change in order for it to come out more.