What Underlies a Teen Oppositional Defiant Disorder Diagnosis

It’s natural for teenagers to defy their parents’ attempts to offer direction and guidance. Rebellion is part of the process of breaking away and forming an independent identity. However, when teens exhibit extremely resistant behavior, such as constant arguing and refusal to follow the rules, they’re sometimes given an Oppositional Defiant Disorder diagnosis (also known as ODD).

Carter Barnhart, Newport Academy’s Chief Experience Officer and former Vice President of Referral Relations, says that an ODD diagnosis can be confusing for parents and detrimental for youth.

“Many parents reach out to us because their teen has been diagnosed with ODD and they want to know what it means and what comes next,” she says. “At Newport Academy, our goal is to move away from unnecessary means, unhelpful labels, and instead focus on the root causes of behavioral disorder diagnoses such as ODD. That addresses the underlying issues.”

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Underlying Causes of Oppositional Defiant Disorder Diagnosis

Defiant, angry behavior in teens is almost always the result of a deeper issue. Opposition tends to mask pain and fear, Carter says. Root causes of defiant behavior include the following:

Trauma: Long-term traumatic stress can impact every area of a teenager’s life. Teens who have experienced a single traumatic event or ongoing trauma, such as abuse or neglect, use most of their energy to cope with the emotional pain and resulting symptoms. Hence, they struggle with daily functioning and relationships. This struggle can manifest as defiant behavior.

Anxiety: An adolescent with an anxiety disorder may become defiant and oppositional in an attempt to escape an anxiety-producing situation. For some teens, social anxiety may prompt a refusal to attend certain events or activities. Teens with Obsessive Compulsive Disorder or phobias may become upset and angry as a result of their fear and discomfort.

Insecure Attachment: When parents are unavailable emotionally or physically, their children may not be able to create a healthy attachment bond. On the other hand, parents who are too involved in their children’s lives can also disrupt attachment. As a result, a child’s self-worth suffers due to the inability to count on their caregiver as a reliable source of love. Hence, they may become resistant and angry.

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Teen Oppositional Behavior and the Concept of Counterwill

Defiant behavior in teens can also be an expression of what’s known as counterwill. Counterwill refers to the instinctive reaction of a child or teen to resist being controlled. Otto Rank, a Viennese psychoanalyst and student of Sigmund Freud’s, first coined the term. Subsequently, Dr. Gordon Neufeld, PhD, further developed the concept.

The counterwill instinct is triggered when a child or adolescent is told what to think, do, or feel—particularly by parents or guardians. Kids don’t decide to resist; rather, the instinctive reaction arises of its own accord. According to the Neufeld Institute, it’s part of the process of developing a unique, independent self.

Dr. Gabor Maté, the renowned author and mental health and addiction expert, wrote on the topics of counterwill and oppositionality in his book Scattered Minds:

“Counterwill is an automatic resistance put up by a human being with an incompletely developed sense of self, a reflexive and unthinking going against the will of the other. It is a natural but immature resistance arising from the fear of being controlled. Counterwill arises in anyone who has not yet developed a mature and conscious will of their own. Although it can remain active throughout life, normally it makes its most dramatic appearance during the toddler phase, and again in adolescence.”

—Dr. Gabor Mate

How Counterwill Manifests in Teens

What parents sometimes see as obstinate or intentionally irritating behavior is typically a teenager’s expression of the counterwill instinct. This resistance can take many forms, including the following:

  • Belligerence and frequent emotional outbursts
  • Procrastination and lack of motivation
  • Passivity
  • Disrespect
  • Negative attitude
  • Resistance to learning
  • Becoming easily annoyed and frustrated by others, particularly adults
  • Consistently questioning rules and refusing to follow rules
  • Arguing with parents and other adults
  • Refusing to do what a parent or other adult requests.

When these reactions become pervasive and intense, and parents find it impossible to shift the behaviors, teens may end up with an ODD diagnosis.

“Oppositionality cannot arise on its own. By definition, it has to develop in response to something. It is not an isolated trait of the child but an aspect of the child’s relationship with the adult world. … Counterwill becomes maladjusted … only when adults do not understand it and try to overcome it by some sort of pressure, be it physical or emotional, be it inducement or threat.”

—Dr. Gabor Mate

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Six Strategies for Shifting Resistance in Teens

Expressions of counterwill are a natural part of the maturation process. However, they can be challenging for parents. Here are six strategies that parents can use with teens who resist what they perceive as control or coercion.

  1. Stay connected. When the relationship between a parent and child is strained, kids have less motivation to follow a parent’s direction or guidance. Therefore, it’s essential to strengthen the relationship through positive connections, such as verbal appreciation or compassionate listening. Strong attachments can deescalate the counterwill reaction in a child, according to the Neufeld Institute.  
  2. Remember to pause in the midst of a difficult interaction. Pausing helps parents move from an emotional reaction toward a more balanced response. That might mean leaving the room after informing a teen that you’ll address the issue again later, after you’ve both given it more thought.
  3. Create routines and structure. Parents and teens can work as a team to map out a consistent daily schedule. When everyone knows what to expect, there are fewer potential areas of conflict. In addition, this schedule can include time for the family to do enjoyable activities together.
  4. Set limits and rules with clear instructions. Moreover, enforce reasonable consequences for breaking these limits. Such rules should be set and discussed at a time when the teen and parents are calm, rather than during a difficult interaction.
  5. Avoid power struggles and authoritarian directions. Focus on minimizing struggle, drama, and conflict, so you can come to a resolution together. Furthermore, avoid statements such as “You have to …,” “You must …,” “You need to do this, or else,” which catalyze the counterwill instinct and increase a teen’s resistance.
  6. Recognize and praise a teenager’s positive behaviors. Moreover, be as specific as possible. For example, “Thank you for getting home on time. I really appreciate how trustworthy you are.”

Therapeutic Modalities That Address Root Causes

When oppositional behavior arises in response to trauma, anxiety, or attachment disorder, clinical treatment can help. Various therapeutic modalities can support teens in addressing these issues and building a strong, independent sense of self:

  • Cognitive-Behavioral Therapy (CBT): CBT shows a teen how to solve problems, communicate better, and navigate intense emotions.
  • Peer Group Therapy: By working within a peer group and being part of a greater community, teenagers develop interpersonal skills and authentic connections.
  • Attachment-Based Family Therapy (ABFT): ABFT focuses on rebuilding trust and establishing communication among parents and teens.
  • Adventure Therapy: Teens build mastery and self-esteem as they confront and overcome challenges within a safe therapeutic context.
  • Expressive Arts Therapy: Self-expression through music and art allows teens and young adults to process their past experiences and difficult emotions.

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Healing Begins with Understanding

In summary, a deeper understanding of teen resistance can help parents support their children through the turmoil of adolescence. And when defiance arises from childhood trauma, uncovering the root causes is the first step in restoring teen mental health and repairing family relationships.

“Residential treatment gives us time to pull back the layers and tap into the ‘why,’” says Carter. “Once we understand the issues that lie beneath a teen’s maladaptive behaviors, we can support them and their families on the journey to true healing.”

Sources:

Scattered Minds, by Gabor Maté

Neufeld Institute 

American Academy of Child and Adolescent Psychiatry