Canceled Clients (4762)

Additional Info

• Segment Number 1
• Audio File centra_health/1503ct3a.mp3
• Doctors Sibcy, Gary
• Featured Speaker Gary Sibcy, PhD, LPC
• Guest Bio Gary Sibcy, Ph.D., LPC, obtained his degree in clinical psychology at Union Institute and University.  He is co-author of three books, Attachments, Why You Do the Things You Do and Loving Your Child Too Much.  His specialty areas include cognitive therapy for treatment of depression, anxiety, trauma and trauma-related disorders, attachment theory and treatment of attachment-related disorders in children and families and treating explosive children and their families.
• Transcription Bill Klaproth (Host):  Parenting can be stressful enough day in and day out. But parenting a child with ODD can be especially difficult. ODD is oppositional defiant disorder, which consists of defiance, anger and irritability and negativity. With us is Dr Gary Sibcy, clinical psychologist at Centre Health. Co-author of 3 books and an expert in treating explosive disorder in children. Dr Sibcy, thanks so much for being on with us. So give us some insight into a child with ODD. Is this where they can fly off into a rage for no apparent reason.  
  
  Dr. Gary Sibcy (Guest):  Well, it’s usually with ODD, these kids tend to be irritable and touchy and sensitive. They also tend to be quite headstrong. It’s very difficult for them to sort of change directions once they get their minds set on doing one thing. If somebody tries to get them off track or tries to get them to do things they don’t want to do or people won’t do what they wanted to do, then they get really combative and irritable and can throw temper tantrums and be disobedient. In many regards, their day-to-day life usually centers around these kind of battles, around a lot of the transition points in the day, like getting up, getting ready for school, getting out the door on time, coming home, and then having to do homework or get ready for bed or do chores. Usually, it’s in the sort of transition periods of the day that you find these behavioral problems coming up. 
  
  Bill:  This is a constant struggle throughout the day. It’s not as if the child or person is kind of normal throughout the day and one thing sets him off. This is a constant, ongoing back-and-forth throughout the day.
  
  Dr. Sibcy:  When things are going the way they want them to go, when they’re doing the things they want to do, then they seem to do okay, but it’s usually in relation to things that they don’t want to do or they’re trying to get you to do things they want to do and you don’t want to do them. If things are going pretty well for an ODD kid, they’re getting the things that they normally want and nobody’s putting any pressure on them to do things they don’t want to do, they can be quite pleasant, which is different though than, as we had mentioned, at some other point in time that some… there’s a different related disorder that just came out in the DSM-5, known as disruptive mood dysregulation disorder.
  
  Bill:  Okay, tell us a little bit about that. 
  
  Dr. Sibcy:  Well, these kids are in contrast. The child with ODD can be grumpy and irritable, and like I said, most of the time what sets them off is something not really going the way that they want or expect. The kids with ODD can be angry and vindictive, so it’s sometimes just directed toward one or two people, not necessarily toward everyone. The child with disruptive mood dysregulation disorder is a child who is grumpy and irritable most of the time. Even when things are going their way, they’re still grumpy and irritable. Their temper tantrums are much more excessive, much more over the top, if you will. They’re throwing things or even trying to hit people or kick people or spit at people and they go on for very long periods of time, for hours sometimes. Parents feel really overwhelmed by these kids, more so than irritated and frustrated as they are with an ODD child.
  
  Bill:  It would be safe to say those children and their behavior is a little more violent? 
  
  Dr. Sibcy:  Yeah, I mean in the sense that their anger outbursts are violent; they are explosive. We sometimes refer to these as explosive kids.
  
  Bill:  Let me ask you a couple of quick questions here. When does this manifest itself? Is this something that’s from birth on, or do you usually see this in a toddler, or a child that’s six or seven years old? When do you start seeing this behavior start?
  
  Dr. Sibcy:  ODD could pop up at any time during childhood. It may have a sudden onset, or there are times when it has a more subtle onset, and usually that’s when the child also has ADHD. A lot of kids who have ADHD will also develop oppositional defiant disorder. These tend to be more evident very early on, as a toddler even. They’re overactive and difficult to redirect. As far as the disruptive mood dysregulation disorder, again, that tends to start in early childhood, often before age five and six and it continues. It doesn’t usually have a late onset, after age 10.
  
  Bill:  At what point then should a parent worry or think, “Oh, gosh! There may be a problem here”? Because kids in every normal day life, they don’t want to get dressed, they don’t want to put their hat on to go outside, they don’t want to eat what you’re putting out on the table for them. At what point does a parent say, “Boy, this is beyond normal being a child. There’s something maybe wrong here”? What is that point?
  
  Dr. Sibcy:  Well, that’s a really great question because understanding the difference between normal and abnormal, there’s always that sort of fuzzy line. It’s not always quite clear cut, but if you’re seeing the oppositionality and the defiance that occurs every day and is very consistent over months of time and you have tried a number of different interventions that may have worked with your other children or worked with other children but they’re not progressing and it’s starting to interfere with the family and the child’s functioning within that family or with other contexts such as school, then certainly you may want to seek out some consultation, at the very least.  
  
  Bill:  Talk to me then about parent behavior. So we understand that, and so we think there may be a problem. How should a parent react to a child like this? Obviously, getting mad at the child probably isn’t going to help.
  
  Dr. Sibcy:  Well, this is a very important piece. We talk to parents about there’s normal parenting and effective normal parenting tries to balance two things. You got to set limits and you have to enforce limits, but at the same time, you also need to teach kids how to deal with strong emotions. Some kids are actually capable of doing this better than others. One of the problems that we run into is that sometimes parents get stuck into a mindset of one-size-fits-all parenting, where what worked for their easy-going, easy-temperamented first child is not going to work with the child who has got problems in these areas. Again, sometimes you have to develop specialized parenting skills to deal with kids who have problems with emotion regulation and problems with flexibility and in language skills, which most of these kids have, in addition to behavioral problem on the surface, beneath that, have these underlying skill deficits. Parents are going to have to develop some new skills for helping their child learn more frustration tolerance and learn how to be more flexible, learn how to be engaged in problem solving, those kind of things.  
  
  Bill:  What is that one thing a parent can do? If there’s one thing you tell parents, what would that be?
  
  Dr. Sibcy:  That’s a tough question to answer because it does really depend on the parent and the child and what the situation is. Many times, we find that parents have gotten so frustrated that now they’re just emotionally reacting to their child. If you find that you get constantly into a reactive mood where you’re angry, you’re yelling, or you do what we call vindictive parenting, where your child does something that makes you angry and then you do something to make them angry back just because you can, then you’re in a bad spot. We want to help them start to change that pattern. 
  
  Bill:  Great advice. Dr. Sibcy. And why should people choose Centra Health for their healthcare needs?
  
  Dr. Sibcy:  Well, Centra is committed to really provide an excellent array of care. From the psychiatric side, we might have one of the most comprehensive in the central Virginia areas, so we have psychiatrists, child psychiatrists, adult psychiatrists. We’ve got clinical psychologists so we can do psych assessment. We can also help you with the therapy side of the equation, but as well as the medication side. We also have, if things get out of hand, the inpatient adult and child psychiatric care, substance abuse care, emergency mental health. We got the whole spectrum and we work together as a team. I think we’re well integrated. We communicate. We’re flexible. We’re pretty open. We work with a lot of different folks from a lot of different approaches. It’s more of a comprehensive approach to treating these issues. 
  
  Bill:  Dr. Sibcy, thank you so much for your time today. Really appreciate it. For more information, visit centrahealth.com. That’s centrahealth.com. This is Centra Healthy Radio. Thanks so much for listening.
  
  
• Hosts Bill Klaproth