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Patients diagnosed with oppositional defiant disorder (ODD) can exhibit constant and excessive anger and aggravation. Symptoms of ODD typically arise by the age of 8, as children become defiant and uncooperative, which can lead to challenging situations in homes, schools, and with authorities.
With intervention, improvement can occur within approximately three years. However, if ODD is not treated properly and promptly, future conduct and personality disorders may emerge, such as antisocial personality disorder.
Children with ODD may also require treatment for commonly associated conditions such as depression and/or anxiety. But in many cases, ODD is a solitary issue, and behavioral therapies are the main strategies to help children with this diagnosis.
Individual and/or group therapies involving cognitive-behavioral therapy have been shown to be helpful. Since living with a child who has ODD can be challenging for caretakers and siblings, family therapy can also be useful.
A recent method of group therapy for children has involved the incorporation of stuffed toys, also known as stuffies or plushies. These toys can provide support and comfort to children undergoing unfamiliar or stressful situations. Toys have been used to encourage children to do things they have trouble doing, such as creating better sleeping habits, inspiring them to read more often, and tone down aggression.
In my counseling practice, I have been working with an 11-year-old boy with ODD. His defiance and associated anger when asked to participate in family activities and perform chores has affected the behavior of his three younger siblings, and been a source of acrimony within the family.
This patient was taught how to use hypnosis to calm himself. In the first session, he learned how to imagine being at his favorite, relaxing, safe place, which he picked as the beach, and to recall his calm feeling when he was not in hypnosis, by crossing his fingers, which was a hand gesture of his choice.
He was instructed to practice his hypnotic relaxation on a daily basis for at least two weeks, and to employ the hand gesture as a way of calming himself when he began to become agitated.
A month later, the patient and his mother reported that with use of the hand gesture, the patient was able to decrease the intensity of his anger outbursts, but their frequency was still unabated.
At a second hypnosis session at that time, the patient was taught how to interact with his subconscious through ideomotor signaling. The subconscious advised the patient that he can control his behavior, and that he can do it through believing in himself. The subconscious also identified itself as “George” (which was not the patient’s name.)
Two weeks later there was a slight decrease in the frequency of the patient’s outbursts, but the dynamics at home remained very difficult for the parents to manage.
Subsequent therapy with the patient involved rewarding him for improved behavior with Pokémon, food, and favorite activities, and ignoring his negative behavior as much as possible. However, the patient continued to act defiantly much of the time.
The patient explained that in general he wanted to follow his parents’ instructions but could not bring himself to do so. Therefore, as toys have been used to help in therapy with children, it was suggested that the patient designate a “Stuffie Spokesperson” every day. His parents were instructed to talk to the stuffie about what they would like the patient to do, rather than addressing the patient directly.
The patient’s compliance with his parents’ instructions improved dramatically thereafter. His mother reported that the frequency and intensity of his outbursts decreased by 90 percent.
As an alternative to speaking to the stuffie the parents were instructed to speak with “George,” which was the designated name of the patient’s subconscious. Speaking to George yielded the same results as speaking to the stuffie. However, when the parents gave the patient direct instructions, the patient remained defiant even when he was instructed to ask George to help him.
Subsequently, I worked with a 5-year-old boy who expressed pride in not listening to his parents or his kindergarten teacher. He said, “I was sent to the principal’s office 100 times last year, and if I get sent there 500 times I’ll be expelled.”
Given his young age, I elected against teaching him formal use of hypnosis and how to interact with his subconscious. Instead, I offered to teach him how his favorite stuffed toy, Mario from Donkey Kong, could help him. Following my advice, his mother started instructing Mario what the patient should do, and immediately the child became cooperative.
We discussed that in school it might be awkward for a teacher to speak with Mario. Therefore, we modified the therapy by having his family buy him a watch with a picture of Mario on the face. The patient then was instructed as follows: “Tap the watch twice, and then I will tell Mario what you need to do.” The patient continued to be cooperative at home and at school with the shorthand version of this phrase: “Tap the watch twice” and follow instructions.
The observed improvement in behavior with use of stuffed toys or their representations in patients with ODD may be related to a prompted change in their mindset. For example, perhaps addressing the toy or subconscious activates brain pathways that lead to children’s cooperation rather than those usually involved in their reflexive negative ODD-associated responses.
Clinical studies are required to document whether use of a Stuffie Spokesperson can be useful in helping many children with ODD become more cooperative.
Much of the information in this blog was first published in an article I co-authored in Clinical Pediatrics (Anbar & Zand, 2023).