The challenges of adolescence have always loomed large for young people and for families -- for as long as adolescence has been a recognized stage in human development. A constellation of skills is needed by young people to bridge the transition from childhood dependency to adult independency (Smith, Cowie, & Blades, 1998). For some young people, the transition is especially difficult and skill development does not progress smoothly or without incidence. One of the areas in which adolescents may particularly experience difficulties is that of originating, developing, and directing purposeful goal-directed action (Zimmerman & Cleary, 2006). The umbrella term that covers these behaviors is personal agency (Zimmerman & Cleary, 2006). When these behaviors result in positive outcomes in line with an individual's intention, the behavior is deemed effective (Zimmerman & Cleary, 2006). Having confidence in one's ability to achieve according to one's desires and abilities is referred to as self-efficacy (Zimmerman & Cleary, 2006).
As with most belief systems, self-efficacy is not static -- belief in one's self-efficacy can swing wildly depending on life circumstances, available resources, and how broadly a person can extend their sphere of control (Zimmerman & Cleary, 2006). A belief in the ability to influence the world external to the self holds within it a belief in the ability to influence how one interacts with the external world (Zimmerman & Cleary, 2006). For everyone, not just adolescents, these beliefs in oneself are nested, one within the other (Zimmerman & Cleary, 2006). For most adults, however, there exists some history of personal efficacious behavior from which to draw when faced with challenges and doubts (Zimmerman & Cleary, 2006). Adolescents generally do not have this springboard from which they can propel themselves forward with a reasonable level of confidence that they will figure things out (Zimmerman & Cleary, 2006). Further, adolescents are not afforded the same options as adults regarding choices of life activities (Zimmerman & Cleary, 2006). Most adolescents have to attend schools -- a milieu that imposes a swath of social and intellectual challenges that can be as punishing as they are rewarding (Zimmerman & Cleary, 2006).
For young people who behave in a manner that indicates the presences of some disordering of the natural responses to the challenges of adolescence, a decidedly discouraging and self-fulfilling downward spiral can occur. The behaviors that are associated with oppositional defiant behavior -- and its frequently co-morbid condition conduct disorder -- are not tolerated well by social systems, and particularly not by schools. Counselors who provide therapeutic support for these adolescents draw on a number of theoretical bases. This paper will examine the occurrence of oppositional defiance disorder in the adolescent experience, and consider and discuss therapeutic approaches to the adolescents who exhibit behaviors associated with this disorder.
The first section of the paper presents a brief discussion of oppositional defiant disorder and its relation to co-morbid conditions. A discussion follows of self-efficacy as the bridge to behaviors and actions that tend to increase the probability of positive outcomes for adolescents. The second section explores the relation between self-efficacy and the self-regulatory behaviors of self-directed learners. This discussion considers explores the linkages between self-efficacy beliefs, self-regulatory behaviors, and the expression of empowerment and capability that drives further increases in self-efficacy. The relation of oppositional defiant disorder to perceived self-efficacy is discussed in this section and connects with the counseling and therapeutic approaches. In the final section, the strategies and approaches available to counselors and therapists who treat adolescents with oppositional defiant disorder are explored.
Oppositional Defiant Disorder
Oppositional Defiant Disorder, as described in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and as reported in several large community-based studies, occurs in approximately three percent of children in the population (Hamilton & Armando, 2008; ). However, considerable variance exists across the studies with regard to age at diagnosis, the number of informants interviewed, the exact criteria applied in assessment, such that, the prevalence estimates range from one percent to 16% (Hamilton & Armando, 2008).
The disorder is more common in girls than in boys, but there is some inconsistency in reported data, particularly since rates of incidence appear to even out in adolescence (Hamilton & Armando, 2008). Behavioral differences are apparent and there is some consideration in the field about using different criteria for assessing girls over boys (Hamilton & Armando, 2008). Aggression in girls is evidenced differently and exhibited more covertly than in boys (Hamilton & Armando, 2008). Verbal attacks, exclusion of others, and spreading rumor about other children are all more common expressions of aggression in girls and appear to typically supplant the physical aggression that is typical of boys with this disorder (Hamilton & Armando, 2008). Interestingly, the prevalence of oppositional defiant disorder is greater among children from low socio-economic backgrounds (Hamilton & Armando, 2008). Although symptoms typically appear two to three years prior to diagnosis, formal diagnosis of the disorder most often occurs in the later years of preschool or in the early years of elementary school (Hamilton & Armando, 2008). As children age, according to cross-sectional epidemiologic research studies, the prevalence of oppositional defiant disorder gradually increases (Hamilton & Armando, 2008).
Substantially impaired relationships with peers, parents, and teachers are the primary indicator for oppositional defiant disorder (Green, et al., 2002; Hamilton & Armando, 2008). In comparisons with same-age, same-sex peers, children and adolescents with oppositional defiant disorder score more than two standard deviations below the mean when assessed using scales for social adjustment (Green, et al., 2002; Hamilton & Armando, 2008). Their social impairment is considered to be greater than it is for children who have bipolar disorder, various anxiety disorders, and major depression (Green, et al. 2002; Hamilton & Armando, 2008). Conduct disorder and pervasive developmental disorder show a similar degree of difference -- though it is not statistically significant -- in social adjustment in comparison with oppositional defiant disorder (Green, et al., 2002; Hamilton & Armando, 2008).
Etiology. There does not appear to be a single greatest risk factor or a single cause for oppositional defiant disorder (Hamilton & Armando, 2008). The predominant theory is presented within the context of a biopsychological model (Hamilton & Armando, 2008). According to this theory, biology and environment combine to influence the likelihood that the disorder will develop (Hamilton & Armando, 2008). A child with oppositional defiant disorder will have certain biological protective factors and biological vulnerabilities that interact in complex ways with the protective aspects and the harmful aspects of the child's environment (Hamilton & Armando, 2008).
Contemporary theories point to deficits in discrete sets of skills that result in behavior that is seen as defiant or oppositional (Hamilton & Armando, 2008). Immature cognitive or emotional development may result in immature responses from children with oppositional defiant disorder (Hamilton & Armando, 2008). For instance, self-regulation skills such as affective modulation, may not be well developed such that a child with oppositional defiant disorder generally overreacts emotionally and physically, temporarily shutting off their capacity (child-like and immature to begin with) to reason or be reasoned with (Hamilton & Armando, 2008). Other theories point to deficits in executive cognitive functioning, such as the ability to shift focus and change tasks, to organize for problem solving, or to effectively tap working memory (Hamilton & Armando, 2008). In fact, some of these deficits have been demonstrated in children with pervasive developmental disorder and autism (Hamilton & Armando, 2008). Deficits of this order can undermine a child's effort to comply with the demands of adults and the challenges of interacting with peers (Hamilton & Armando, 2008). These skill deficits are central to the transactional theories of oppositional defiant disorder that examines the context of the problem behaviors and the interactions between the parents and the children (Hamilton & Armando, 2008). This transactional conceptualization of oppositional defiant disorder highlights the predictability of behavioral meltdowns by the child according to certain contexts, such as transitions to dinnertime, bath time, and bedtime (Hamilton & Armando, 2008). Functional behavioral assessments show that characteristic transactions between parents and children occur at these transitional times that tend to exacerbate problem behavior and increase the probability that it will occur (Hamilton & Armando, 2008).
Conditions co-morbid with oppositional defiant disorder. Various neurobiological theories have been put forward regarding the aggression that occurs in children with oppositional defiant disorder (Hamilton & Armando, 2008). No single neurotransmitter or neurological pathway has been found to be the root cause of oppositional defiant disorder (Hamilton & Armando, 2008). There is a clear familial relation but the role of genetics is not yet clear and studies have produced inconsistent results (Hamilton & Armando, 2008). The natural history of oppositional defiant disorder is not well understood, however, the majority of people who are diagnosed with the disorder as children will exhibit the disorder along with a co-existing condition (Hamilton & Armando, 2008). Typically, disorders co-morbid with oppositional defiant disorder in adults include an affective disorder and attention deficit hyperactivity disorder (ADHD) (Hamilton & Armando,…