As a child enters adolescence, one of her greatest developmental tasks is to individuate from her parents—a necessary process that helps her move from the dependence of childhood toward the independence of successful adulthood. She might become more private, begin questioning old limits and rules or debate parental instructions. This transition, while normal, is new and therefore awkward territory both for the teen and her parents. Even mildly resistant behavior can feel like defiance to all involved, leading to parental frustration and teenage resentment and guilt.
When one member of a family goes through significant changes, it’s easy to forget that everyone else must change as well. Change is scary and requires a lot of energy, so the most natural response to significant change in another family member—often even positive change—is to resist it. As humans we crave constancy, predictability and equilibrium, especially on the home front! So when a teen starts to change and her family resists that change, the result is often conflict.
But as long as there is a sense of mutual negotiation and adaptation on the part of the teen and her parents, this kind of conflict and low-grade defiance is normal. Parents whose discomfort with this process reaches a high pitch do well to consult with a family therapist who can help them with strategies for accommodating their child’s growth without abdicating their parental authority.
When normal, mild individuation becomes chronic and disruptive defiance, a teenager may be suffering from oppositional defiant disorder (ODD). ODD is typically caused by a combination of familial, environmental, trauma-based, neurological and/or chemical factors. It sometimes co-occurs with or is misdiagnosed as ADHD, depression, or other emotional disorders. A teenager with ODD may be easily annoyed by others, intentionally provoke peers, exhibit chronic defiance or non-compliance toward adults, have a short temper, blame others for her own mistakes or be highly vindictive. To be diagnosable as ODD, several such behaviors must be present on a consistent basis for at least six months.
When defiant behaviors are less predictable and more explosive and episodic, an adolescent may be suffering from intermittent explosive disorder (IED). IED is characterized by bursts of rage that may last 10 -20 minutes and often involve violence such as fighting or destroying property. A combination of familial, chemical and/or genetic factors may contribute to this disorder, leading the sufferer to express their frustrations in explosive and disproportionate ways.
When a young person exhibits the chronic defiance of ODD along with the destructiveness of IED, she may be suffering from a yet more severe disorder called conduct disorder. The defiance exhibited by an adolescent with conduct disorder may include chronic lying, frequent violent or destructive behavior, stealing, bullying, cruelty to people or animals, breaking serious rules or laws and/or blatant defiance of authority. Like any such disorder, conduct disorder fits into a continuum of severity, so sufferers vary greatly in terms of the number, severity and frequency of symptoms. Adolescents with conduct disorder are at a high risk for incarceration and of harm to themselves or others. Often these young people are not bothered by their behavior even though it is profoundly disruptive to those around them.
While different defiant disorders, and different sufferers of the same disorders, may require different treatment, some themes run through all successful treatment plans. The best approach to treating defiant disorders is a multi-modal approach that hits the issue from a variety of complementary angles. For more serious forms of defiance, such as ODD or conduct disorder, a combination of pharmacological treatment, individual therapy, group therapy, parent training and family therapy is a good idea. Often, this kind of robust multi-modal treatment is most manageable in a residential treatment setting. Pharmacological treatments may include the use of stimulant medication to treat ADHD like symptoms and reduce impulsivity, or SSRIs to treat underlying depression.
In addition to reducing defiant and destructive behaviors, medication treatment can, in some cases, reduce internal distress enough to allow the teen to better tolerate other therapies, such as cognitive therapy, social-skills training, individual therapy and family therapy. Regardless of severity, however, parental involvement in the treatment process is critical. Family systems therapy, parent training, and parent-child interaction therapy (PCIT) are cornerstones to addressing the struggles of a defiant teen. Parental engagement in their child’s treatment, their own treatment and their family’s treatment greatly increases the likelihood of healing and growth for the defiant teen.