Rethinking Oppositional Defiant Disorder—Children Reacting to the System Around Them

Curt and Katie chat about Oppositional Defiant Disorder (ODD), exploring the bias, systemic implications, and treatment considerations for this controversial diagnosis. This continuing education episode reframes ODD as a contextual response to environmental factors—rather than a fixed characterological flaw—helping therapists better assess and intervene with children exhibiting defiant behaviors.

(Show notes provided in collaboration with Otter.ai and ChatGPT.)

In This Continuing Education Podcast Episode: Oppositional Defiant Disorder

ODD is often diagnosed through a biased lens, especially in system-involved or minoritized children. In this episode, Curt and Katie challenge outdated conceptualizations and explore how systemic oppression, trauma, neurodivergence, and misapplication of diagnostic tools contribute to mislabeling kids as “bad.” Therapists will learn to apply a trauma-informed, systemic, and developmentally appropriate lens to assessment and intervention.

Learning Objectives:

After listening to this episode, participants will be able to:

• Apply the diagnostic criteria for Oppositional Defiant Disorder to a client
• Differentiate between at least three similar presenting differential diagnoses
• Initiate treatment interventions in at least three systems affecting a child’s oppositional and defiant behavior

Key Takeaways for Therapists on Diagnosing and Treating ODD in Systemic Context

“This should be looked at more of a diagnosis akin to how we look at adjustment disorders… rather than a characterological flaw.” – Curt Widhalm, LMFT

• The DSM criteria for ODD are low-threshold and can easily be misapplied without full contextual assessment
• Differential diagnosis must include neurodivergence, trauma, mood disorders, and cultural factors
• ODD behaviors are often adaptive responses to coercive environments or attachment wounds
• Systemic bias impacts who receives the ODD label—Black boys are 35% more likely to be diagnosed
• Treatment must include family systems, school environment, parenting practices, and attachment repair
• Effective interventions involve CBT, DBT skills, family therapy, and parent support—not just behavior modification

“It feels like when you meet families with this in place, they are mortal enemies—and that’s not a great place to have a caregiver–child relationship sit.” – Katie Vernoy, LMFT

Receive Continuing Education for this Episode of the Modern Therapist’s Survival Guide

Hey modern therapists, we’re so excited to offer the opportunity for 1 unit of continuing education for this podcast episode – Therapy Reimagined is bringing you the Modern Therapist Learning Community!

Once you’ve listened to this episode, to get CE credit you just need to go to learn.moderntherapistcommunity.com/pages/podcourse, register for your free profile, purchase this course, pass the post-test, and complete the evaluation! Once that’s all completed – you’ll get a CE certificate in your profile or you can download it for your records. For our current list of CE approvals, check out moderntherapistcommunity.com.

You can find this full course (including handouts and resources) here: https://learn.moderntherapistcommunity.com/courses/oppositional-defiant-disorder-children-reacting-to-the-system-around-them

Continuing Education Approvals:

When we are airing this podcast episode, we have the following CE approval. Please check back as we add other approval bodies: Continuing Education Information including grievance and refund policies.

CAMFT CEPA: Therapy Reimagined is approved by the California Association of Marriage and Family Therapists to sponsor continuing education for LMFTs, LPCCs, LCSWs, and LEPs (CAMFT CEPA provider #132270). Therapy Reimagined maintains responsibility for this program and its content. Courses meet the qualifications for the listed hours of continuing education credit for LMFTs, LCSWs, LPCCs, and/or LEPs as required by the California Board of Behavioral Sciences. We are working on additional provider approvals, but solely are able to provide CAMFT CEs at this time. Please check with your licensing body to ensure that they will accept this as an equivalent learning credit.

Resources on Oppositional Defiant Disorder and Systemic Bias

We’ve pulled together resources mentioned in this episode and put together some handy-dandy links. Please note that some of the links below may be affiliate links, so if you purchase after clicking below, we may get a little bit of cash in our pockets. We thank you in advance!

• American Psychiatric Association. (2022). DSM-5-TR
  
• Hawes et al. (2023). Oppositional defiant disorder. Nature Reviews Disease Primers
• Legha, R. K. (2025). There Are No Bad Kids: An Antiracist Approach to ODD. Pediatrics
• Highlander et al. (2025). Helping the Noncompliant Child and Financial Strain. Prevention Science
• Kaur et al. (2022). Evidence-Based Review of Behavioral Treatment Programs. Annals of Clinical Psychiatry
  
• Lin et al. (2022). Systematic Review of Family Factors. IJERPH
• Mars et al. (2025). Oppositional Defiant Disorder. StatPearls
• McCart & Sheidow (2016). Evidence-Based Psychosocial Treatments. Journal of Clinical Child and Adolescent Psychology
• Wolraich et al. (2003). Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS)
• World Health Organization. (2022). ICD-11

Relevant Episodes of the MTSG Podcast:

• Helping Parents Become What They Needed as a Child: An interview with Bryana Kappadakunnel, LMFT
• What’s New in the DSM-5-TR? An Interview with Dr. Michael B. First, MD
• Neurodivergence: An Interview with Joel Schwartz, PsyD
• Why Are So Many Adults Getting Diagnosed with ADHD and Autism?: An interview with Dr. Monica Blied
• Are You Actually Neurodivergent Affirming? An Interview with Sonny Jane Wise
• Going No Contact, Relationship Recovery, and the NY Times: An interview with Patrick Teahan, LICSW
• What is Play Therapy?: An Interview with Ofra Obejas, LCSW
• No Cap: It’s Time to Glow Up Your Teen Therapy Skills
  

  Meet the Hosts: Curt Widhalm & Katie Vernoy

  Curt Widhalm, LMFT

  Curt Widhalm is in private practice in the Los Angeles area. He is the cofounder of the Therapy Reimagined conference, an Adjunct Professor at Pepperdine University and CSUN, a former Subject Matter Expert for the California Board of Behavioral Sciences, former CFO of the California Association of Marriage and Family Therapists, and a loving husband and father. He is 1/2 great person, 1/2 provocateur, and 1/2 geek, in that order. He dabbles in the dark art of making “dad jokes” and usually has a half-empty cup of coffee somewhere nearby. Learn more at: http://www.curtwidhalm.com

  Katie Vernoy, LMFT

  Katie Vernoy is a Licensed Marriage and Family Therapist, coach, and consultant supporting leaders, visionaries, executives, and helping professionals to create sustainable careers. Katie, with Curt, has developed workshops and a conference, Therapy Reimagined, to support therapists navigating through the modern challenges of this profession. Katie is also a former President of the California Association of Marriage and Family Therapists. In her spare time, Katie is secretly siphoning off Curt’s youthful energy, so that she can take over the world. Learn more at: http://www.katievernoy.com

  A Quick Note:

  Our opinions are our own. We are only speaking for ourselves – except when we speak for each other, or over each other. We’re working on it.

  Our guests are also only speaking for themselves and have their own opinions. We aren’t trying to take their voice, and no one speaks for us either. Mostly because they don’t want to, but hey.

  Join the Modern Therapist Community:

  Linktree

  Patreon | Buy Me A Coffee

  Podcast Homepage | Therapy Reimagined Homepage

  Facebook | Facebook Group | Instagram | YouTube

  Consultation services with Curt Widhalm or Katie Vernoy:

  The Fifty-Minute Hour

  Connect with the Modern Therapist Community:

  Our Facebook Group – The Modern Therapists Group

  Modern Therapist’s Survival Guide Creative Credits:

  Voice Over by DW McCann https://www.facebook.com/McCannDW/

  Music by Crystal Grooms Mangano https://groomsymusic.com/

   

  Transcript for this episode of the Modern Therapist’s Survival Guide podcast (Autogenerated):

  Transcripts do not include advertisements just a reference to the advertising break (as such timing does not account for advertisements).

  … 0:00
  (Opening Advertisement)

  Announcer 0:00
  You’re listening to the Modern Therapist’s Survival Guide, where therapists live, breathe and practice as human beings. To support you as a whole person and a therapist, here are your hosts, Curt Widhalm and Katie Vernoy.

  Curt Widhalm 0:15
  Hey, modern therapists, we’re so excited to offer the opportunity for one unit of continuing education for this podcast episode. Once you’ve listened to this episode, to get CE credit, you just need to go to moderntherapistcommunity.com, register for your free profile, purchase this course, pass the post test and complete the evaluation. Once that’s all completed, you’ll get a CE certificate in your profile, or you can download it for your records. For a current list of our CE approvals, check out moderntherapistcommunity.com

  Katie Vernoy 0:47
  Once again, hop over to moderntherapistcommunity.com for one CE, once you’ve listened.

  Curt Widhalm 0:53
  Welcome back, modern therapists. This is the modern therapist Survival Guide. I’m Curt Widhalm with Katie Vernoy, and this is the podcast for therapists about things that go on in our practices, the clients that we serve, and ways that information about some of the things that we learned long ago has changed over time, and this is another one of our continuing education eligible episodes. So listen at the beginning or the end of the episode on how you might qualify for continuing education. Check our show notes over at mtsgpodcast.com if you don’t listen to that information and retain it, we’ve got it written down somewhere nicely for you to go and find that. The topic of this episode is Oppositional Defiant Disorder. There is been some controversy around this. There’s been some changes in the way that our field looks at it diagnostically. And we are going to get into a lot of this throughout the course of the next hour or so. I think, to kind of start off in talking about this, I tend to see a fair number of kids in my practice who exhibit oppositional behaviors, oppositional approaches to things. Some dare even say defiant. Some of those kids do, in fact, truly have ODD, some are just kind of very stuck in the way that they approach things. And I think that in being able to talk about the ways that this shows up somewhat differently from case to case, it helps to take what is ultimately, when we look at the actual DSM diagnosis to see it’s a really, really easy thing to diagnose people with it, when they don’t, in fact, have it now. Katie, I also know that you have a background of working with youth with oppositional defiant behaviors disorders, even those who have been diagnosed with it. Maybe help frame for people what your experience is with this as well.

  Katie Vernoy 2:57
  Nope, not gonna do it.

  Curt Widhalm 2:58
  That is not what ODD is. I see what you’re trying to do there.

  Katie Vernoy 3:06
  I was waiting to try to get a joke in before you did. I am so excited. So my experience with kids with Oppositional Defiant Disorder or oppositional behaviors, or those types of things are primarily through the work that I did in kind of the greater Los Angeles area, parts in South Los Angeles. And one of my jobs I had was working with honestly, teen boys on probation, so they had a wide array of disruptive and impulse control and conduct disorder kind of diagnoses. I also worked in intensive services and in a lot of DCFS, probation, types of family cases when I was working in the intensive services department. My experience is actually pretty broad. I both worked with the families, as well as supervised hundreds of cases with it. And I also, I think, have a very specific perspective, because it feels like ODD is one of those diagnoses that gets dismissed. This is a bad kid. This is someone who is beyond help. It’s all their fault. And I feel like that perspective is very flawed, and also is indicative of systems of oppression, just very limited in its perspective. And so I’m excited about today’s conversation, because we’re going to talk about all of those things. And when we first talked about this, initially talked about how we learned about ODD, and for me, a million years ago, when I learned about it, it was that ODD was the gateway to Conduct Disorder, which, of course, is part of the kind of prison pipeline. I was hesitant, I guess, a little bit about this topic, because I worry that it is one of the weaponized diagnoses, and so I’m hoping that we can dispel some of those things, sort through and identify and potentially push back against some of the bias, and help folks find a more appropriate way to help kids who find themselves in an oppositional defiant state.

  Curt Widhalm 5:25
  So we are going to start with the DSM, not only the diagnostic criteria, but also the part that I think that many people gloss over, which is the actual text that goes along with some of these diagnoses, and even beyond the text about this particular one, about the entirety of the chapter in the DSM-5-TR called Disruptive Impulse Control and Conduct Disorders. At least kind of in my mental shorthand, when I’m looking through DSM, I also look at what are the neighboring disorders that go along with this and Katie had mentioned Conduct Disorder, but this also includes discussions around Intermittent Explosive Disorder, Antisocial Personality Disorder, Pyromania, Kleptomania, other unspecified disruptive or impulse control disorders.

  Katie Vernoy 6:17
  Well, there’s also in this text, there’s also some differential diagnoses around ADHD, Mood Disorders, Anxiety Disorders, and so there’s so much complexity here, I think we should just frame that we aren’t going to be able to talk about all of it in great depth. And I think assessment is hugely important, especially given some of the additional pieces that we’re going to talk about right now.

  Curt Widhalm 6:40
  And that is going to be the exact theme of this episode over and over again, is assessment. Rather than having such wonderful podcast content of me reading the entirety of the DSM to people, I am just going to take some sections out of this and not read everything to everybody, but this does come from the preamble part of the DSM-5-TR for this chapter on disruptive impulse control and conduct disorders. Quote, “There is a developmental relationship between Oppositional Defiant Disorder and Conduct Disorder, in that most cases of Conduct F 91.3 Disorder previously would have had symptoms that met criteria for Oppositional Defiant Disorder, at least in those cases in which Conduct Disorder emerges prior to adolescence. However, most children with Oppositional Defiant Disorder do not eventually develop Conduct Disorder. Furthermore, children with Oppositional Defiant Disorder are at risk for eventually developing other problems besides Conduct Disorder, including Anxiety and Depressive Disorders. Many of the symptoms that define the disruptive impulse control and conduct disorders are behaviors that can occur to some degree in typically developing persons. Thus, it is critical that the frequency, persistence, pervasiveness across situations and impairments associated with the behaviors indicative of the diagnosis be considered relative to what is normative for a person’s age, gender and culture when determining if they are symptomatic of a disorder. The Disruptive Impulse Control and Conduct Disorders have been linked to common externalizing spectrum associated with the personality dimensions, disinhibition and negative emotionality, and inversely with constraint and agreeableness. These shared personality dimensions could account for the high level of comorbidity among these disorders.” Now there are several things in that paragraph that I chose to emphasize, because when we talk about this as a diagnosis, and I think that there are many people in our field who feel that this is a flawed diagnosis, and we’re going to give our perspectives on that throughout this episode, because to a certain degree, I agree that there are problems with the way that we approach ODD, but I don’t think it’s necessarily a bad diagnosis in and of itself. And you get to spend the next rest of the episode with us to hear our perspectives on how that plays out. But Katie as I’m bringing up kind of this preamble of what is happening in this chapter, what are the things that stand out to you so far?

  Katie Vernoy 9:29
  The one that I really resonated with is that there is a piece of this that aligns with normative development, and that kiddos, who are individuating or who are grumpy, or whatever it is, can have phases of oppositionality, that, if it gets diagnosed as ODD, is really not appropriate. When we’re talking about something that is on a spectrum with normative behavior, it feels even more challenging to parse through. And as we’ll go into, there’s so many environmental factors. You know, there’s so many elements of this that, in my experience, have come from trauma or social pressure, or just social impacts, framing it as a disorder that is going to lead to conduct. I’m really glad they separated that out. There have been potentially a lot of kiddos who were in an oppositional phase, who were treated as though they were on the pipeline to Conduct Disorder and developed it because their environment supported that direction. And that makes me sad.

  Curt Widhalm 10:53
  And I think that there needs to be acknowledged here that there is a generational gap of clinicians, those who were raised and educated on the DSM-4, DSM-4-TR, in my case, or earlier, versus a pretty significant change that happened with DSM-5. And we’ll get into some of the diagnostic criteria here in just a moment. But there has been kind of an evolution around where some of these diagnostic criteria end up fitting, and why I think that the DSM-5 and 5-TR have pointed out that this is not just a pathway from one diagnosis to the other, is because those of us who were raised on DSM-4 or earlier were taught it’s pretty much this. The difference between ODD and Conduct Disorder is whether or not somebody is violating the rights or properties of others. And I’m glad to see that there is some of this splitting out things, but it also has affected the way that the research ends up overall looking at this. Because one of the things that got removed in moving to the DSM-5 was that if somebody has Conduct Disorder, they can’t have ODD, and when we look at the prevalence of what that means for ODD is when the DSM-5 came out, a lot more people were eligible for an ODD diagnosis because they had been previously ruled out by having Conduct Disorder. Even with that, as part of it for the DSM-5 generation of diagnostics, to be able to say, even with this increased elevation with people with Conduct Disorder being diagnosed, it’s still not a direct causation from one into the next. People who have Oppositional Defiance aren’t necessarily still going to go into Conduct Disorder. They can, but the majority of them don’t.

  Katie Vernoy 12:52
  Well, and then there’s also this element of they’re not necessarily mutually exclusive either.

  Curt Widhalm 12:57
  Right. Let’s actually look at the part of the DSM that most people do, which is the checklist looking things that we call diagnostic criteria. And for Oppositional Defiant Disorder, you need four of the following eight things broken down into angry, irritable moods, and these are things that need to have lasted for at least six months, at least four of these symptoms and exhibited with at least one individual who is not a sibling, mostly because kids can with their siblings have very disruptive sorts of things. So this needs to be done with at least somebody else. But these eight things: number one often loses their temper, two is often touchy or easily annoyed, three is often angry and resentful. Under the category of Argumentative Defiant Behavior: often argues with authority figures, or for children and adolescents, with adults. Five often actively defies or refuses to comply with requests from authority figures or with rules. Six often deliberately annoys others. Seven often blames others for his or her mistakes or misbehavior. And then, under the category of Vindictiveness, has been spiteful or vindictive at least twice within the past six months. Now, if we look just at these checklist kinds of things and picking out just a handful of them, if somebody is often touchy or easily annoyed, is often angry or resentful, often deliberately annoys others or actively refuses to comply with requests from authority figures. I think most of us would qualify for this diagnosis.

  Katie Vernoy 14:52
  I might qualify for it right now.

  Curt Widhalm 14:56
  And especially when you and I hold into all of the political protesting that might be going on out in the world that this is kind of my point around this is a very, very low threshold diagnosis for somebody to qualify for. And why I keep emphasizing that there is a rest of the DSM to read, it’s to go beyond just this checklist of things, because it can be really just lazy diagnostics to describe a difficult child as, here’s somebody who’s angry, here’s somebody who’s resentful and argues a lot. Let’s saddle them with this diagnosis that many people consider that’s a tough diagnosis.

  Katie Vernoy 15:43
  Well, and as you’re describing it, I just think through all of the differentials. Trauma can lead to that so dramatically, grief, especially in kids, right? There’s Depression, Anxiety, there’s ADHD and Pervasive Demand Avoidance, like there’s so many different things that can be characterized in the same way. And to your point there is, there’s a lot of text which I will not read in the different differential diagnosis section that help to sort through that. But if we’re looking at bias, a quote, unquote bad kid for whatever reasons would get ODD versus PTSD potentially, right? I mean, I think there’s, there’s some real problems here with how easy it is to diagnose a kiddo with this diagnosis.

  Curt Widhalm 16:41
  So under some of the notes in the diagnostic criteria, it does specify that for children younger than five years the behavior should occur on most days for a period of at least six months, unless otherwise noted. And for individuals five years or older, the behavior should occur at least once per week for at least six months, and again, I’m having a little bit of a difficult time, or a side eye as far as what that actually means. And I think common sense in being able to do a good clinical evaluation before arriving at this as a diagnosis. The frequency criteria provides a guidance on a minimal level of frequency to find the symptoms, and where I come back to the DSM-5 actually addressing things well, other factors should also be considered.

  Katie Vernoy 17:31
  Yeah.

  Curt Widhalm 17:32
  And I think that this does speak to some of the things that you’re talking about, such as grief and trauma. And Criterion C on this is that doesn’t occur exclusively during the course of a psychotic substance use, Depressive or Bipolar Disorder. And this is one of my things, where in any of the frequently diagnosed in childhood things, how many five year olds are really exhibiting that substance use disorder alongside this?

  Katie Vernoy 17:58
  I hope not many.

  … 18:02
  (Advertisement Break)

  Katie Vernoy 18:03
  It’s just very, very interesting, because I think when we look at utility, what does this diagnosis help with? How do we use this information in a helpful way? I think oftentimes it gets slapped on as a label, potentially put in an educational cum file, and teachers then treat the kid as a problem to solve, as a problem child. And I think that’s my real hesitation with giving this diagnosis, is that it it seems descriptive of a pattern of behaviors that are present in so many different potential diagnoses and normative behavior. I don’t know, I don’t know the threshold of where it becomes an actual useful diagnostic to be able to make a treatment plan around.

  Curt Widhalm 19:04
  This gets into what some of the diagnostic features are that the DSM does further get into and again, not reading everything, but still going to read a significant amount here. “The symptoms of Oppositional Defiant Disorder may be confined to only one setting, most frequently, the home. Individuals who show enough symptoms to meet the diagnostic threshold, even if it is only at home, may be significantly impaired in their social functioning. However, in more severe cases, the symptoms of the disorder are present in multiple settings, given that the pervasiveness of the symptoms is an indicator of the severity of the disorder, it is critical that the individual’s behavior be assessed across multiple settings and relationships. Because these behaviors are common among siblings, they must be observed during interactions with behaviors other than siblings. Also, because symptoms of the disorder are typically more evident in interactions with adults or peers whom the individual knows well they may not be apparent during a clinical examination.” I will put my own talking points at this point here, but simple rudeness or unwillingness to participate in an examination with a therapist does not necessarily mean that a client has ODD. It might be any number of other things that you have to consider, and that sitting down for one session with a client and assessing their interaction with you before jumping to this as a diagnosis is not taking into account the global presentations of where a child may be exhibiting this and the severity of it across that six plus months that would be necessary. So don’t just take a snapshot of where a child is behaving one time with you as a clinician, but actually look and assess: how does this show up across multiple different environments?

  Katie Vernoy 21:00
  I think this is the biggest problem with clinicians that have the I’ll know it when I see it, kind of mindset, because behavior is so fluid and dynamic, and relationships can be so different across the board, I would hate to be a clinician who diagnosed this in the first session without a lot of additional context. It just kids can be annoying, and they might not want to be in therapy, and the family might not have a positive frame of therapy, and so they’re not even supported in coming to you in a in a space that’s going to be warm and effective and they’re responsive to your joining effort. So I just, ah, yeah, this is just a really hard one for me, because I feel like so much context is needed, and I don’t think that you’re going to get that in the first session, and maybe not even in the second.

  Curt Widhalm 22:01
  Going back to the DSM-5 here, and hopefully to help further your question around: where is that threshold?

  Katie Vernoy 22:09
  Yeah.

  Curt Widhalm 22:10
  “There are several key considerations for determining if the behaviors are symptomatic of ODD. First, the diagnostic threshold before more symptoms within the preceding six months should be met. Second, the persistence and frequency of the symptoms should exceed what is normative for the individual’s, age, gender and culture.” Again, emphasizing that there are several fluid dynamics here that one must take into account when evaluating this as a diagnosis. “For example, temper outbursts for a preschool child would be considered a symptom of Oppositional Defiant Disorder only if they occurred on most days for the preceding six months, and if they occurred with at least three of the other symptoms of the disorder, and if the temper outbursts contributed to The significant impairment associated with the disorder; example, leading to destruction of property during outbursts, resulting in the child being asked to leave the preschool. It should be noted that temper loss needs not always involve tantrum behavior, and can be displayed by angry facial expressions, verbal expressions of anger and subjective feelings of anger that would not typically be considered a tantrum.” So a little bit of going in both directions here, that is, this needs to rise up, you know, if we’re only looking at a child’s going into preschool for the first week or so, and they’re having tantrums, that’s not ODD, that’s a child who’s learning what the transition process into preschool is. This needs to be for at least six months, and it needs to also include more than just kind of crying and tantruming type behavior.

  Katie Vernoy 23:55
  I’m just also picturing neurodivergent kids being called oppositional because of their sensory challenges and the difficulties with transitions. Like this is something where I can see going to one extreme, boys will be boys, and their behaviors that are pretty intense are normative for their gender, so to speak. But I can also see the other extreme, which is, well, these behaviors are bad, and I don’t like them and they’ve been going on for six months, must be ODD. Versus, let me go through all of the other assessments that I need to differentiate between developmental disorders or neurodivergence or whatever. So it still feels a little squishy, Curt.

  Curt Widhalm 24:40
  One last snapshot from the DSM before we move on with this a little bit. “The symptoms of the disorder often are part of a pattern of problematic interactions with others. Furthermore, individuals with this disorder typically do not regard themselves as angry, oppositional or defiant. Instead, they often justify their behaviors as a response to unreasonable demands or circumstances. Thus, it can be difficult to disentangle the relative contribution of the individual with the disorder to the problematic interactions they experience. For example, children with ODD may have experienced a history of hostile parenting, it is often impossible to determine if the child’s behavior caused the parents to act in a more hostile manner towards the child, if the parents hostility led to the child’s problematic behavior, or if there was some combination of both. Whether or not the clinician can separate the relative contributions of potential causal factors should not influence whether the diagnosis is made. In the event that the child may be living in particularly poor conditions where neglect or mistreatment may occur, such as in institutional settings, clinical attention to reducing the contributions of the environment may be helpful.” In other words, look for all of the potential causes and seeing if those things are what is contributing to this before arriving at this diagnosis.

  Katie Vernoy 26:10
  And even if it’s 100% parenting, which it says that it’s hard to discern that. The kid still gets the diagnosis and the parents do not. I mean, it’s, it’s, yeah, I still, I still have concerns about it, but I do, I do, think we’ve understood better what might qualify as a diagnosis is there. Do we want to have a further conversation about differential?

  Curt Widhalm 26:37
  I think we do, and there’s a couple that you have specifically brought up. And I’m going to transfer over to the ICD-11 for this, because I like how they specifically talk about several of these. There’s a couple that we’re going to highlight here, but there’s a fuller list here. I’m going to talk first and foremost about the one that you seem to be bringing up Autistic Spectrum Disorder. From ICD-11, non compliant and other disruptive behaviors characteristic of Oppositional Defiant Disorder should be distinguished from behavior problems that are common among individuals with ASD. The key difference is that in ASD, disruptive behaviors are often associated with specific environmental factors, such as a sudden change in routine, aversive sensory stimulation, etc, or the non compliance as a consequence of the core symptoms of that disorder, such as social communication deficits, restrictive, repetitive, inflexible patterns of behavior, sensory sensitivities, rather than reflecting in an intention to be provocative or spiteful. Individuals with ODD do not typically exhibit the social communication deficits and restrictive, repetitive and inflexible patterns of behavior, interests or activities that are characteristic of Autism Spectrum Disorder.

  Katie Vernoy 27:57
  I think I understand the difference. The challenge I see is that these diagnostic bullet points seem to be in the eye of the beholder. Is this kid intentionally trying to piss me off? Is this strategic? Do they have some sort of problem going on? I mean, a lot of stimulus and those types of things neurotypical folks don’t notice, and they wouldn’t understand why there was such a huge response to the environment transitions that other kids don’t have a problem with can seem like just a kid not wanting to do something, and so I feel like there, there is a real need to go deep into an analysis of what is actually happening, because I think a lot of adults are not patient enough to discern what is neurodivergent activity, you know, I don’t know a better way to say that. And what is a kid you know, with Oppositional.

  Curt Widhalm 29:09
  Katie, you’re almost making the point that people, clinicians should not diagnose disorders that they’re not familiar with.

  Katie Vernoy 29:21
  Potentially.

  Curt Widhalm 29:23
  One of the other associated disorders that often has some comorbidity with this and still staying within our neurodivergent umbrella here is Attention Deficit Hyperactivity Disorder, and again, to the ICD-11 individuals with ADHD often have difficulty following directions, complying with rules and getting along with others. When these disruptive behaviors are better accounted for by inattention or hyperactivity, impulsivity. Examples, failure to follow long and complicated directions, difficulty remaining seated or staying on task, when asked, Oppositional Defiant Disorder should not be diagnosed. Oppositional Defiant Disorder, the pattern of non compliance is characterized by disobedience beyond problems with attention and behavioral inhibition. However, ADHD and ODD commonly co-occur, and both diagnoses may be given if the full diagnostic requirements are met for both disorders. So again, speaking to your musing, there does seem to be a level of intentionality behind this.

  Katie Vernoy 30:34
  Yeah, and it’s still in the eye of the beholder. I mean, I think when someone says I’ve told you 20 times you know exactly what I want you to do. Why are you not doing it? You’re, you’re Oppositional. ADHD can show up that way.

  Curt Widhalm 30:50
  ADHD can show up that way. What might push it into further evaluation for ODD is after that harsh or hostile parenting, however, that is brought up, not as gentle as you’re describing it here, but how that can show up is if the child in that situation starts to over argue back as a matter of revenge, not as a matter of trying to escape the situation. And this is where some of the features to evaluate further. And I’m saying that very intentionally, because this is not a shorthand text box to something that is a very impactful diagnosis. But some of the features that you would need to evaluate further is, is the kid doing this just to avoid the task, or are they doing this to avoid the responsibility? And it sounds very different, such as in the blaming category, it’s well, I didn’t do this because it’s somebody else’s fault. It’s the teacher’s fault that I didn’t write down in my homework because in my homework agenda, because that is something that the teacher is supposed to do, to make up things for me. That has a blame component to it, as opposed to, oh yes, I’m I forgot. I forgot. I’ll get to it at some point. And that seems to have more of that ADHD flavor to it, which is it’s Executive Functioning Deficits that go with putting things into longer term memory to be able to follow through on tasks. So it’s really in that it’s blaming somebody else, rather than taking ownership of a component that would necessitate evaluating further for ODD.

  Katie Vernoy 32:50
  In listening to that, I really hear a pathway from ADHD to ODD, because I think a lot of kids who are either undiagnosed or who are not provided sufficient accommodations or support, get to a place where it’s a defensive structure saying, Well, this is what was supposed to happen, and they can become very defensive. And so it’s almost like ADHD can turn into ODD. And ODD is really just traumatized ADHD, where their protective structures come into play. I mean, this is maybe going down a rabbit hole, which is fun, because we’re talking about ADHD. But I think that there’s this, this element where the complexity here, I keep saying is very high, that this is not easy. Just like, well, if it’s a if it’s a remorseful person, they have ADHD, if it’s a defensive person, they have ODD and ADHD.

  Curt Widhalm 33:52
  And we are getting to a place where we’re going to do something with this and and I agree with you, and this is where there’s no single snapshot to take from this so far. So if at the end of the episode, if you need to go back and listen to this repeatedly, both us and our sponsors, thank you for that.

  Katie Vernoy 34:11
  And listen from different IP addresses, it really helps us out.

  Curt Widhalm 34:16
  But we are getting somewhere. But to your point around looking at this and the comorbidity with ADHD, some of the assessment tools for ADHD actually have a subsection that evaluates for ODD alongside of it. I’m thinking about the Vanderbilt assessment for Attention Deficit Hyperactivity, that does have several questions for both parents and teachers to be able to give perspectives on are there Oppositional Defiant features actually associated with this? We are going to get to your point and our point because we’ve done a lot of background talk in preparation for this episode, that where some of this complexity ends up. But I’m going to just tick off the other categories that the ICD-11 here mentions. I’m not going to get into these. It also looks at boundary with conduct to Social Disorder, boundary with Mood Disorders, boundaries with Anxiety or Fear related Disorders and boundaries with Intermittent Explosive Disorders. So these are all things that are suggested to look at in your differential diagnoses. And just for time in our episode, we’re not going to get into all of the differential diagnoses, because we want to transition into: What do we actually do with this? What are we, how do we take some of these complexities together? And here is my hot take on this. This is something where, in the larger discourse within the therapist community about whether or not this diagnosis should exist, I’m on the side of yes it should, but not in the way that lazy diagnostics have allowed for this to play out in the system. I think that there is a functional use for this diagnosis, but if anything, this is one where there is a identified patient who is showing a response to a system around them that leads to these kinds of behaviors and is more of a description of some of the behaviors that a child has developed in order to be able to interact with their environment in a maladaptive way.

  Katie Vernoy 36:39
  I’ll go ahead and go on the record as well. I’m not sure how helpful this diagnosis is. I’m still sitting in kind of this place of maybe it’s helpful at times. Maybe it’s not. I feel like there’s so much context and so much bias in this actual diagnosis. When you were, when we were talking, before we hit record, something that you looked at suggested that black boys are diagnosed 35% more than non black boys. There is there are a lot of different numbers around how often this is diagnosed. And in the work that I did in South Los Angeles, there were a lot of kids in gangs and in deep poverty and really troubled family systems with very few resources that oftentimes were given an ODD diagnosis where, you know, kind of a rich kid in a suburban neighborhood might have gotten a little bit of help and no official diagnosis. And so to me, I feel like this diagnosis is helpful to the point that it’s helpful and it’s not helpful if it is a gatekeep for them getting the help they need. It’s not helpful if it’s something that’s going to label them and put them in a space where they’re not gonna be able to get jobs in the future. I think there’s, there’s a huge problem with how we use this diagnosis currently, and as when we start talking about treatment and that kind of stuff, if we actually treat the system and we do it what we’re talking about, I think it can be helpful as a framing, but the actual labeling of a kid with this diagnosis still feels really awful to me.

  Curt Widhalm 38:23
  I agree that a lot of the problems with the way that this diagnosis is problematic is the way in which it’s handled. And my hot take on this is this is more of a snapshot in time. Diagnosis a reaction to a system, rather than a character logical flaw. I think that we should look at this more of a diagnosis akin to how we look at Adjustment Disorders, which is this is somebody responding to an event or a system around them, as opposed to here is a thing that this person will carry with them for the entirety of their lives. And the reason that I say that is because the way that the diagnostic criteria that we talked about in the first half of this episode are laid out so simply and the threshold is so low that we can’t help but look at this in a responsible way, to look at the actual causal factors of the behaviors, as opposed to this being a characterological flaw.

  Katie Vernoy 39:30
  100% Totally agree.

  Curt Widhalm 39:34
  And if you’re not doing that, I don’t think that you’re appreciating the intent that is in the rest of the descriptions, even within the DSM. I have a lot of problems with the DSM, but this is one where I really have a lot more problems with the way that clinicians use this diagnosis.

  Katie Vernoy 39:57
  Yeah.

  Curt Widhalm 39:58
  And I think that the functionality that comes with this is if we actually stop and look at: why is this kid behaving this way? What are the symptoms that are causing this? How is this a survival skill that is being taught? What are the factors such as poverty, such as the systems of support that are either available or not available to a child, to their parents, to their parents own mental health sorts of issues.

  Katie Vernoy 40:28
  Racism, systems of oppression.

  Curt Widhalm 40:30
  Yes, all of these kinds of things that if we’re not doing that, then we’re in a situation where all we’re trying to do is behaviorally manage a child or a teenager, which, surprise, doesn’t work. At least it doesn’t work on its own. And therefore, we actually have to do an analysis, a good functional analysis, of where do these survival behaviors come from, so that way we can treat the causes rather than the symptoms.

  Katie Vernoy 41:29
  Yeah, yeah.

  … 41:38
  (Advertisement Break)

  Katie Vernoy 41:09
  In some ways, I think this conversation is going to be eye opening for folks. I think in other ways, it’s just do good therapy. Actually understand what’s happening in the full system, actually understand what’s behind the motivations, what what’s happening with this kid, and address those things versus seeing this kid, I’ll say it again, seeing this kid as a problem child, a problem to solve, and not a human with feelings and potentially harmful coping strategies.

  Curt Widhalm 41:44
  Since you have brought it up in citing our sources in being responsible in this episode, the article that you had mentioned about the approach that this does impact racially minoritized children, comes from an article called ‘There Are No Bad Kids: An Antiracist Approach to Oppositional Defiant Disorder.’ This is in the Journal of Pediatrics, 2025 by Dr. Legha. In this article, she goes on to describe that odd is 35% more prevalent in black people than in white people, and an even higher disparity in between institutionalized settings such as group homes, the juvenile justice system, etc, etc, where black children are overly represented anyway. And a lot of what she goes on in describing in this article, as far as good evaluation and intervention is shockingly some of the same things that we’re talking about, which is actually look at the impact of the systems that go along with how children in these situations, these institutions, these socio economic classes, how this can end up contributing to the ways that they learn how to relate and address them as human beings, rather than as argumentative, oppositional people who are just destined for the classroom to the prison system.

  Katie Vernoy 43:15
  Yes, thank you.

  Curt Widhalm 43:17
  A really wonderful article that I came across, and I think ends up describing things even more in depth than I was expecting, is a 2023 article called Oppositional Defiant Disorder, and…

  Katie Vernoy 43:36
  That’s the whole title?

  Curt Widhalm 43:39
  Yes, this is in Nature Reviews, and is by Hawes et al, and this does get into a lot of very in depth aspects, as far as some of the background, some of the things that we’ve talked about already. This is where I got the information about the shift from the DSM-4 criteria to the DSM-5 and the impacts on the research. The epidemiology ends up citing some studies from across different cultures that looks at the prevalence rates. While primarily, a lot of the research does take place in North America and Europe, it does also cite studies in Iran and China that show that there is kind of a global diagnostic rate of somewhere between 3.1 to 4.4% of all of the meta analyses on these. It does also repeatedly suggest that most of the research is done on people under the age of 18, so the impacts into adulthood are not really understood and studied very well, but in looking historically at people who may have qualified for the diagnoses, up to 10% of all of humanity could have qualified for this diagnosis at some point or another. And I think that this furthers my hypothesis that this should be looked at more as a period of responding to something, as opposed to a lifetime sort of diagnosis, because this may very much be something where looking at the time and context and the systems around somebody as being reflective of why somebody might be behaving in that way, rather than a lifelong saddled with you’re always going to be this way.

  Katie Vernoy 45:33
  Yeah, I then wonder why people don’t just diagnose it as an adjustment disorder, but that is a whole other conversation.

  Curt Widhalm 45:42
  I’m not going to get into a lot of the genetic influences or some of the neurobiology that goes along in this, because I don’t think that that is something that we want to particularly use our limited time here on. But this article does go into that a lot more. But one of the things that I think this article emphasizes is that showing it as a response to a coercive cycle is really where a lot of the formations of this starts to develop, and what it goes on to describe is that there are cycles that happen between children with ODD and parents that get reinforced. And again, I’ll point back to the DSM-5-TR, which says that we don’t really have a causal factor as far as which direction of influence, if it’s harsh parenting that creates ODD, or if it’s ODD that creates harsh parenting, it’s more of one of those: let’s describe it as that’s what exists and we need to fix it either way.

  Katie Vernoy 46:52
  Yeah.

  Curt Widhalm 46:53
  But the cycle that this describes is that a parent or a caregiver will give a directive, there’s non compliance, which may be age and context appropriate, the parent escalates, and that creates a counter attack by the child. The parent withdraws from that counter attack, which reinforces to the child that that counter attack works. If the parent withdraws, then the child suspends the attack, the parent will come back, resume their directive, the non compliance responds again, and then there’s a sharp escalation in the parent or caregiver, which results in compliance, and that reinforces to the parent that the parent needs to escalate sharply.

  Katie Vernoy 47:38
  Yeah.

  Curt Widhalm 47:39
  Now for those familiar with chain analysis and systems of reinforcement, parents eventually learn: I have to come in super hot and super sharp to begin with in order to get my child to do things

  Katie Vernoy 47:52
  That is a very, very tough cycle to break.

  Curt Widhalm 47:57
  And this is where a lot of the treatment stuff comes into when this is a diagnosis that exists at this point in time for a child: that we don’t just treat the child. This is some of those you know, therapist’s musings around, hey, come fix my child that we want to as mental health providers or people who work with children, I’ll also include educators in this, requires more of a global approach than just working with a child. I’m a big encourager of, I’m inventing words, but I’m a big encourager of family therapy as being at least one component of the overall treatment of a child, and that may also include individual skill building with a child. It may include some social skills building with children, and it may include parenting skills separate from the family work that the parents need to do in conjunction with that. Because ultimately, what happens in these very harsh directive aspects is that there are also the potential to develop attachment wounds.

  Katie Vernoy 49:11
  Oh, sure. It feels like when you meet families with this in place, they are mortal enemies, and that’s not a great place to have a caregiver, child relationship sit.

  Curt Widhalm 49:26
  And so when we are talking about some of the ways that this shows up, and at least the way that I approach this is a treatment aspect In my practice, is there is an acknowledgement that this is a cycle that is happening. Now, if we go back to the diagnostic criteria, there is going to be some sort of blame that is assigned by the identified patient in this situation, as I wouldn’t do this. It’s all my parents fault who end up doing this, or it’s all my caregivers fault. It’s all the group home runner, you know, faults. It’s somebody else’s fault. This is why I’m responding this way. And in being able to deal with kind of the environmental context as a clinician that gives a great response, to be able to say, yeah, and let’s all do something about this, so that way we can all be able to get to our goals of not being in constant arguments or constant fighting, and to be able to address this on a more global system. Good family therapy will also potentially, at that point, be helping the parents tone down their response of, I wouldn’t do this, if my child does this. It’s more breaking that cycle in the therapy room, even as that’s happening, to be able to say, let’s not get into the arguments of this. Let’s actually work on healthier communication patterns.

  Katie Vernoy 50:49
  So the part that I think I’ve done a lot with, or the most with, is the parent support there. Because I think depending on the parent’s orientation to therapy, do they like therapy? Do they think it’s effective? Do they think they belong in the room when you’re fixing the kid? I think there can be this element of maybe a lack of self assessment, or self awareness, self insight, and so being able to do some of that parent coaching that you were talking about, or parent training, parent therapy or caregiver therapy can be very helpful here, because I think sometimes, depending on how long this dynamic has been in place, there’s a lack of trust that if they do something different, that something will change. And there’s some parents who are so entrenched in my kid is, you know, on my last nerve, it’s too hard to manage. I have to get stronger and stronger and bigger and bigger. There’s a real fear of vulnerability, and so being able to talk through their process and how they can regulate their own emotions, how they can understand their child’s behavior differently. Those types of things can be very helpful.I think, when that’s not as available, when it when there’s not insight and awareness from the parents, I also talk about I only see the kid this amount of time, or when I used to see kids, I only see the kid this amount of time. And so it’s really important that you help reinforce these skills that we’re working on with the kid and use it as a skills building, like, don’t build the skills for yourself, teach your kid how to do it, and that can sometimes also help with that. But it’s really something where you have to address all of the pieces of the system pretty, like, symmetrically, synchronistically, I don’t know what the right word is, all at once. You have to, like, go in and start addressing all the levels of the system as concurrently as you can, because any reinforcement of that previous dynamic can be really lead to a lot of hopelessness, lead to getting re entrenched into this dynamic. And so it’s something where getting to a place of willingness and being able to really work on the whole system getting better, it feels really tenuous and very challenging in a lot of cases.

  Curt Widhalm 53:22
  And I think that that’s something that is the responsible treatment for this. And I think that without looking at it in more of that global way, a lot of clinicians find themselves in trying to fix only one part of the system, and oftentimes that’s the child who’s brought into therapy. And for dealing with some things, and especially working with a child alone in this who might not have other ways of being able to impact the system around them, leads to a lot of frustration on the clinicians part in working with this, because there isn’t more of that global approach to it, working with it in kind of a comprehensive sort of way.

  Katie Vernoy 54:06
  I can see it as it can be the clinician creates their own power struggle and power dynamic with the kid, or they create a space that’s so warm and welcoming their relationship with the kid is different than any other relationship, and they are flummoxed. Why can’t you do this with other people in your life?

  Curt Widhalm 54:23
  Exactly. And when there is the sense that this is going on, one of the best ways that you as a clinician can position yourself is to say, from the outset of therapy, I am going to work with all of the systems in place so that way we can make sure that we’re helping this child in all environments imaginable. And it does take a village to be able to raise a child in this situation, because if we’re not doing this, all we’re doing is signing up for more. Going back to the Hawes et all article, it does suggest that the individual work with children in this does focus on CBT. My experience in working with the individual aspects, I take more of a DBT skills building approach with kids in these situations, that does help to slow down some of the automatic responses in a way that I find for my particular style and practice to be able to work, but it acknowledges that there is systems that are going to react harshly to you, and taking the individual skills that I’m working with with kids in those situations to also the family sessions, and this is the part where I encourage parents to reward the use of the skills when escalated, as opposed to just compliant behaviors as being a necessary catalyst to being able to help the child to succeed in more environments. So it’s a very difficult but kind of funny situation sometimes where a kid starts arguing, but they get rewarded for being upset and arguing in a way that is beneficial, rather than in old, maladaptive sorts of ways.

  Katie Vernoy 56:17
  Before we hit record, you talked about this in addressing the actual oppositionality versus the non compliant behavior, and I really liked that. So I want to bring it up here. It’s looking at, where is the spiteful or vindictive behavior coming in? What is, what are the emotions that are behind what’s happening here? What is the perspective of the kiddo? And being able to be with them in the emotional situation, versus only looking at behavioral compliance and showing up in a way that’s quote, unquote acceptable, it’s really looking at iterative positive behaviors that may still look bad to some folks, and being able to parse through and identify what’s going better. And that’s challenging, and that’s another whole huge segment of teaching within, I think, the parent skills and so valuable.

  Curt Widhalm 57:23
  And you did a great job of summarizing what I spent a lot more time talking about before we hit record. So I’m going to just briefly expand on this a little bit. Is this is getting into what is the function of the child’s behavior, and being able to do a chain analysis, and to see where it is that a child is coming from, rather than just expecting immediate compliance out of a child. And it takes a lot of time, and it’s frustrating, and it is not something that happens in one conversation. It’s something that needs to happen again nearly all conversations to be able to work on some of those attachment issues that might be percolating underneath, to be able to regain some trust. And that is something that is also teaching the parents to be able to do that. And for a great resource on that, I’ll refer people to our podcast episode with Bryana Kappakunnel and her whole program around parent yourself first, that is kind of the conjunctive parent work that goes alongside this. In addition to that, you may end up finding yourself also working with some of the classroom environments in the education settings and recommending some of the treatments that have shown to be effective in those environments. For example, there’s quite a bit of research around something called the Good Behavior Game, which rewards positive behaviors. And as much as we know that teachers are spending their days time in and time out. Most of the time that a child is going to have would be with a teacher in most situations that it’s being able to show that, yeah, most kids are going to respond well this. Kids with odd are going to take a little while to catch up into this. But there is a lot of promising research around using the Good Behavior Game in some more of those classroom type environments.

  Katie Vernoy 59:26
  I just want to comment on that, because I think there’s probably individual differences, potentially cultural differences, and I think that at times, praising a kid or putting some sort of positive reinforcement in place may be very uncomfortable and may not and may be counterproductive. And so I think in every way, these treatment plans need to be very individualized. They need to be very progressive at the pace that the kiddos at. And, and and really understanding that some kids do not want to be called out. They don’t want to even for positive things. Their their ODD may be so entrenched that rewarding compliance may actually increase defiance. I think it’s just really making sure that you’re paying attention to that, that individual kiddo, and understanding what’s going to actually help them feel that attachment and that connection, and not assuming that, you know, quote, unquote, a sticker chart is going to solve it.

  Curt Widhalm 1:00:32
  The Hawes et all article also specifically lists some ineffective or harmful interventions that don’t seem to address this, and these include play therapy, individual non directive counseling, psychodynamic psychotherapy, and dietary interventions.

  Katie Vernoy 1:00:52
  Which I think a lot of people do, but…

  Curt Widhalm 1:00:56
  Let’s just reduce the sugar, and then they won’t respond as much.

  Katie Vernoy 1:01:00
  Yeah, yeah, being able to understand what you’re doing is important. We had a mini debate because we’re getting long on time. I’ll just summarize it quickly. We had a mini debate on what is actually non directive talk therapy or counseling or whatever. And for me, I think the attachment work, and the the moves to try to understand the kiddo can seem non directive. And so I was like, wait, wait a second, what is this non directive thing that you’re talking about? Who is assessing it? And it really comes down to, if you have a treatment plan that supports these goals of helping with attachment wounds, understanding the kid, helping them to obtain better relationships with their parents, and strategies to manage big feelings. I think that that’s not non directive, but I oftentimes will sit back a lot more with anyone across the age spectrum that has kind of an ODD presentation, so that they are not feeling attacked or feeling dictated to, and that can, I think, appear non directive. So did I miss any of that from our previous like argument before we started?

  Curt Widhalm 1:02:18
  I don’t think so. And I think it basically boils down to that to successfully work with children in this kind of a capacity, that there does have to be a focus on skill building, and that is something that does involve some directive treatment planning, as far as being able to bring some of the skills in, to be able to handle some of the situations, and that might feel more psycho educational or more teaching, but it is something where you have to be proactive in bringing up some of these skills, rather than just waiting for the moments for these things to show up in a less directive style. This is described in an article called ‘Evidence-Based Psychosocial Treatments for Adolescents With Disruptive Behavior’ by McCart and Sheidow, and this is in the Journal of Clinical Child and Adolescent Psychology from 2016 but merely just waiting for some of these behaviors to show up in a non directive style, you may never see them. It may lead to some ideas that therapy isn’t working. Spoiler alert, because it’s not, and it’s only ever in a preferred type of child directed environment, then that non directional approach doesn’t necessarily work. I also want to emphasize that this article also talks about the ineffectiveness of psychodynamic psychotherapy here, and a lot of that seems to largely boil down to looking at the internal drives and motivations to a systemic problem doesn’t go on to deal with the systemic problems that cause these things in the first place. And so this is one of the clinical aspects where you actually do need to take a proactive approach in dealing with the system around the child as well.

  Katie Vernoy 1:04:22
  Which I think is great. I I’ve worked with a lot of families who did not want to be in therapy. They were court ordered, or DCFS ordered or whatever it was. And some of the things that you’re talking about around parent training or skills building training for kiddos were just not available. They did not want to do it. They did not want to be in the therapy room. They didn’t trust me. They didn’t know why some white girl was coming in and telling them what to do. And there was also societal rewards for being cautious, not trusting folks, having your own mind. There were so many reinforcements that authority figures are not to be trusted. And I just want to talk about that before we finish up, because I think that there are things that we still can do for families who are deeply entrenched in: therapy is not going to work. And I want to acknowledge that there are families that this, you know, kind of beautiful thing of, hey, we’re all going to work together to try to stop this dynamic. Just isn’t going to happen. So, you know what, what I talked about beforehand, but, but I’m going to put you on the spot. Like you always put me on the spot. Curt, like, what are, what are your thoughts when you have a family that’s basically saying, No, I’m not going to do that.

  Curt Widhalm 1:05:43
  My response at this point in my career is this is something that is best and most easily treated the younger that a child is. And the longer that we can have a positive interaction system with your child, the more likely that they are going to learn some of these skills that will set them up for success for the rest of their lives. Your child will be no younger ever than they are today, and the longer that we wait, the more entrenched that these things are going to become. Now the inverse of this is that the longer that we wait to treat children in this situation, the harder and more difficult it is going to become, and especially if parents are checked out of the system. And I think that part of your own countertransference reactions and ideas about how successful that you can be working with a child in this situation, does look at how cooperative and willing is the system around this child going to be engaged in the treatment process?

  Katie Vernoy 1:06:53
  To expand on that, I think when I encountered families that were deeply entrenched, very mistrusting of the system, and rightly so, it really became about meeting them where they were, understanding their particular context and putting a framing of the situation or the problem, necessarily in more of a motivational interviewing perspective, what is it that they want to shift? And potentially it’s only to no longer be required to come to see you, Katie.

  Curt Widhalm 1:07:28
  Yeah.

  Katie Vernoy 1:07:29
  But I think that looking at where is their movement towards humanity and connection, where can trust building occur, what are the underlying structures that make this particularly difficult and what behaviors need to remain? Because I think oftentimes the system may say this kid is oppositional, but their family and their their close connections are saying this kid is protecting him or herself very well. They’re they’re doing a good job for themselves, and it’s the system that is faulty in finding them at fault for something. And so I think really just acknowledging we don’t necessarily have the answers of what is going to be the healthiest solution for every family, and being able to come in and support them in whatever their path is towards the healthiest version that they want to be and that they can safely be within their environment, I think, is potentially the best work we can do. And that may not look like quick progress. It may be slowly becoming a person that they trust and are willing to consult with, and who may have some resources or coping skills to share that they can then parse through and decide if they want to learn it or not. And I think that’s as far and I do a lot of parent work because of that, because I think parents need to be able or caregivers need to be able to emotionally regulate themselves, to be there for their their kids. And that’s not easy in the environment that we live in, oftentimes.

  Curt Widhalm 1:09:17
  You can find our show notes over mtsgpodcast.com. You can also find out how to get your CE credits there, and you choose to get your CE through us, we appreciate it. And you should follow us on our social media, join our Facebook group, the Modern Therapist Group, to continue on with these kinds of discussions. And I work with kids and families and systems around ODD you can check out me in my practice at realhonesttherapy.com and Katie doesn’t so she would refer you back to me and…

  Katie Vernoy 1:09:52
  But if you’re a parent that needs some support, feel free to give me a little jingle as well at katievernoy.com.

  Curt Widhalm 1:09:58
  And until next time I’m Curt Widhalm with Katie Vernoy.

  … 1:10:01
  (Advertisement Break)

  Katie Vernoy 1:10:02
  Just a quick reminder, if you’d like one unit of continued education for listening to this episode, go to moderntherapistcommunity.com, purchase this course and pass the post test. A CE certificate will appear in your profile once you’ve successfully completed the steps.

  Curt Widhalm 1:10:17
  Once again, that’s moderntherapistcommunity.com

  Announcer 1:10:21
  Thank you for listening to the Modern Therapist’s Survival Guide. Learn more about who we are and what we do at mtsgpodcast.com. You can also join us on Facebook and Twitter, and please don’t forget to subscribe so you don’t miss any of our episodes.