Oppositional Defiant Disorder in Children and Teenagers

Addressing Oppositional Defiant Disorder (ODD) in Children and Adolescents

Behavioral issues in children and adolescents can sometimes indicate an underlying mental health condition. To understand and address these concerns effectively, professional assessment is crucial. By seeking the right treatment and support, you can work towards achieving the best outcomes for your child.

Understanding Oppositional Defiant Disorder (ODD)

If you have noticed behavioral problems in your child or have been advised to seek help due to concerns about ODD (Oppositional Defiant Disorder), we are here to assist you.

ODD is a behavioral disorder that is most commonly diagnosed in children under the age of 10. It refers to children who consistently display anger, irritability, and behaviors that seem cruel or vindictive, significantly impacting their lives.

Symptoms of ODD

ODD symptoms can be categorized into three main areas:

• Irritability
• Frequently losing their temper
• Being easily annoyed or overly touchy
• Regularly experiencing anger, tantrums, or meltdowns
• Hurtful behavior
• Deliberately annoying or provoking others
• Blaming others for their own mistakes
• Exhibiting spiteful or vindictive behaviors
• Headstrong behavior
• Defying requests or rules from adults
• Arguing with authority figures or adults

While it is natural for children to exhibit some of these behaviors at various stages of their development, meeting the diagnostic criteria for ODD requires the persistent display of these behaviors for at least six months. The frequency and impact of these behaviors on the child's life are also important factors in making a diagnosis.

ODD behaviors may primarily occur at home for some children, where they feel more in control and can achieve desired outcomes. However, for children with severe ODD, these behaviors may manifest in various settings and with higher frequency.

Seeking Help for ODD

Early intervention is essential in preventing the escalation of ODD behaviors. It is common for parents to hope that their child's behavior is just a phase or hesitate to seek help due to shame or embarrassment. However, behavioral problems are widespread, and seeking treatment can make a significant difference in your child's life.

The benefits of seeking help for ODD include:

Preventing future problems: Addressing behavioral difficulties in childhood can reduce the likelihood of mood or anxiety disorders later in life, such as conduct disorder.

Increasing understanding: Early assessment helps parents understand the best treatment options for their child and how to prevent future issues from worsening. Sharing this information with the child's school enables teachers to provide appropriate support.

Improving family life: Behavioral problems can have a toll on family dynamics, leading to marital discord, constant arguments, strained parent-child relationships, and difficulty in carrying out normal family activities. Seeking help can alleviate these challenges.

Ensuring your child's future: ODD can have serious consequences for a child's long-term well-being. While some children may outgrow these behaviors, others may develop conditions like antisocial personality disorder, which can impact their ability to maintain employment, relationships, or lead to involvement in criminal activities.

Addressing underlying mental health: Around 50% of children with ODD also have another mental health condition, such as ADHD, depression, bipolar disorder, or anxiety. Treating the underlying condition can improve your child's behavior.

Available Help for Children and Adolescents with ODD

Assessment of ODD:

Determining if your child has ODD or another underlying mental health condition causing their behavioral problems can be challenging. Consulting with a Child and Adolescent Psychiatrist is recommended, as they are experts in child mental health. They will conduct a thorough assessment and develop an effective treatment plan tailored to your child's needs.

Family therapy and parenting skills training:

Having a child with behavioral issues can create significant stress for the entire family. Daily life may be filled with arguments, confrontations, and heightened stress levels. Siblings may be affected, and marriages may experience strain. Family therapy and parenting support have been shown to reduce disruptive behaviors and can teach parents effective strategies for managing their child's aggressive behaviors.

With the guidance of a parenting coach, therapist, family therapist, or psychologist, you can learn techniques such as:

• Praising appropriate behavior
• Effective communication
• Ignoring problem behaviors seeking attention
• Consistent use of consequences
• Supporting and reinforcing skills learned in therapy

Participating in sessions as a couple can be particularly powerful, fostering a united approach at home and alleviating pressure within the family. This allows everyone to contribute to helping the affected child.

Addressing Behavioral Issues: Family Therapy and Parenting Skills Training

Having a child with behavioral issues can create immense stress for the entire family. Daily life may be filled with arguments, confrontations, and overall tension. Siblings often bear the brunt of their brother or sister's behavioral challenges, while marriages can be strained under the weight of this stress. Marital discord can further exacerbate the child's behavior, as they may wrongly believe they are to blame but remain unsure of how to change.

Research has demonstrated that family therapy and parenting support can effectively address and reduce disruptive or problematic behaviors. These approaches often focus on how parents respond immediately following their child's aggressive behavior.

By working with a parenting coach, therapist, family therapist, or psychologist, you will learn:

• Praising appropriate behavior: Effective ways to acknowledge and reinforce positive behaviors demonstrated by your child.
• Effective communication: Techniques to improve communication within the family, fostering understanding and cooperation.
• Managing attention-seeking behaviors: Strategies to ignore problematic behaviors that seek attention, thus discouraging their repetition.
• Consistent consequences: Guidance on maintaining consistent and appropriate consequences for your child's behavior.
• Reinforcing therapy skills: Methods to reinforce and support the skills your child is learning through their therapy sessions.

Participating in therapy sessions as a couple can have a significant impact, fostering a united front at home. This can alleviate pressure within the family and provide everyone with the space they need to support the affected child.

Understanding the Causes of Behavioral Problems

One of the most frequently asked questions is, "Why does my child behave like this?" It's natural to seek an understanding of the underlying causes of your child's behavioral issues in order to provide appropriate support. We are here to help.

Behavioral problems, such as Oppositional Defiant Disorder (ODD) or Conduct Disorders, do not have a single cause. Instead, they result from a complex interplay of various factors.

While the prevalence of behavioral concerns is significant (approximately 8% of teenage boys and 5% of children under ten), the precise reasons behind them are not always clear.

As a parent, it can be incredibly frustrating to deal with these challenges. You may experience worry, stress, embarrassment, or even feelings of shame due to your child's behavior. It is essential to recognize that these emotions are understandable but rarely justified. Behavioral disorders arise from complex causes.

 

Contributing Factors to Behavioral Issues

Several factors can contribute to a child or teenager's behavioral patterns, including:

• Genetic factors: Some children are more predisposed to behavioral problems due to their genetic makeup. A family history of mental disorders can increase the risk.
• Co-occurring mental health conditions: Conditions like ADHD, Autism, depression, and anxiety are often accompanied by behavioral problems, such as shyness, anger, or school avoidance.
• Physical issues: Damage to specific brain regions can impair a child's impulse control or make them more prone to aggression.
• Bullying or school difficulties: Negative experiences at school, such as bullying, can lead a child to act out through aggressive or violent behaviors.
• Home environment: Discord between parents, family bereavements or illnesses, and parental mental health issues can contribute to the development of behavioral problems in children and teenagers.
• Learning difficulties: Challenges in learning socially acceptable behaviors, often stemming from learning difficulties or language problems, can hinder a child's ability to adopt appropriate behaviors.
• Trauma or abuse: Early experiences of trauma or abuse can increase the likelihood of behavioral problems.
• Substance abuse: Alcohol and drug usage among children can trigger behavioral issues. Parents may not always be aware of their child's substance use, but research has shown that substances like cannabis can significantly impact a child's behaviour

Understanding and Addressing Anger, Aggression, and Violence in Children and Teenagers

As a concerned parent, it can be deeply distressing to witness your child or teenager displaying anger, aggression, or even violent behavior. Knowing how to seek help in such situations may not always be clear. Our team of behavioral experts is here to assist families like yours, providing support either face-to-face or online.

Causes of Anger, Aggression, and Tantrums in Young Children:

Anger and aggression in young children can stem from various factors, including difficulties at school, challenges in their home life, or issues with friends. Stressors such as bullying, social pressures, and home-related problems can significantly impact children, leading them to express their emotions through explosive outbursts. Additionally, conditions like ADHD, depression, anxiety, or other complex emotional and mental health issues may contribute to aggressive behavior. Young children often struggle to articulate their emotions verbally, resorting to anger and aggression as a means of communication. Learning to regulate and calm their emotions is a developmental process, and their inability to manage intense emotions may result in anger and aggressive behavior.

 

Causes of Anger, Aggression, and Violence in Teenagers:

The teenage years are characterized by significant changes in the brain, including the rewiring of the pre-frontal cortex, responsible for decision-making, social behavior, and personality expression. During adolescence, this rewiring process can lead to unconventional behavior as the brain undergoes rapid development. The pre-frontal cortex may experience slower development compared to the limbic system, which houses chemicals related to alertness, pleasure, and risk-taking. This imbalance can contribute to impulsive behavior, angry outbursts, and difficulty empathizing with others. Teenagers also strive to establish their identity, often challenging boundaries set during their childhood. Difficulties at school, home, or with friends can further contribute to anger and aggressive behavior. Additionally, conditions such as ADHD, autism, depression, or anxiety can manifest as angry outbursts or violence in teenagers.

Recognizing When to Seek Help for Your Child's Anger:

Determining when to seek professional help for your child's behavior can be a complex decision. There is no definitive checklist, as each child's normal behavior and the severity of their actions may vary. However, it is crucial to consider whether the behavior significantly impacts their life, including their home, school, friendships, and extracurricular activities. Studies indicate that children displaying persistent anger or aggression may face difficulties in adulthood. Furthermore, childhood anger and aggression can serve as indicators of underlying mental health conditions such as ADHD, depression, or anxiety. To ease your concerns, we recommend consulting a child behavioral specialist if you observe any of the following red flags:

Behavioral Red Flags:

• Engaging in risky activities that endanger themselves or others.
• Displaying violent behaviors, such as fighting, carrying weapons, or planning attacks.
• Exhibiting unusual or atypical behaviors, such as social withdrawal, increased tearfulness, loss of interest in previously enjoyed activities, or diminished overall enjoyment of life.
• Involvement in illegal activities such as theft or substance abuse.
• Concerns raised by the school, such as fights, lack of engagement in class, incomplete homework, or truancy.
• Consistently refusing to comply with reasonable requests or boundaries.

Understanding Gaming Addiction

Although gaming addiction is not yet officially recognized as a formal diagnosis, it has garnered significant interest among mental health professionals. Families with children or teenagers struggling with online gaming addiction often face challenges in finding appropriate support and treatment.

What is gaming addiction?

Similar to gambling addiction, gaming addiction is a behavioral condition in which a person's daily life is significantly impacted by compulsive use of internet-based games or gaming consoles.

Behavioral addictions, including gaming addiction, are usually caused by multiple factors. In the case of video games, the primary reason is that they are designed to be addictive. Video games often provide rewards that are challenging to attain but still possible. The anticipation of receiving these rewards and the satisfaction of completing tasks lead to the release of dopamine, a neurotransmitter associated with pleasure. The pleasurable experience of playing the game, fueled by dopamine release, makes individuals want to play repeatedly.

This creates a vicious cycle where the individual needs to play the game more and more to experience the same level of gratification as before. Many online games incorporate reward systems that require players to accumulate points or skills to progress further. Achieving these goals often demands extensive playing time, causing individuals to spend more hours engaged in the game than intended.

It's important to note that gaming addiction is often accompanied by underlying mental health issues, with mental health problems often being the cause of gaming addiction rather than the other way around.

Risks associated with gaming addiction

Parents commonly worry about their children's screen time, considering the prevalence of internet access at school, home, and on the go. It becomes challenging to monitor exactly what children are doing online and how much time they spend playing games.

While concerns about the content of games were previously predominant (with research on the link between violent games and their impact on behavior), the focus has now shifted towards the excessive amount of time spent gaming.

Gaming addiction poses several risks in various aspects of life, including social, educational, emotional, behavioral, and relational domains. In many ways, gaming addiction is similar to substance addiction or gambling addiction and should be treated early to achieve the most effective outcomes.

Moreover, gaming addiction can indicate the presence of other mental health conditions, such as depression, autism, or anxiety. Individuals may use gaming, like any other addiction, as a way to cope with difficult emotions or to escape from reality.

Without proper treatment, the underlying causes of gaming addiction can worsen over time, making it more challenging to find effective solutions.

Symptoms of gaming addiction

Children and teenagers are increasingly spending more time on the internet or in front of screens. As parents, it can be difficult to determine what amount of screen time is excessive. However, a general guideline is to consider its impact on other aspects of your child's life. Internet usage should only occupy a small percentage of their daily activities.

Here are some common signs that your child may be struggling with gaming addiction:

• Preoccupation with gaming
• Constantly talking about games, unable to discuss other topics
• Loss of interest in activities they once enjoyed
• Increasing need for more gaming time to feel satisfied (tolerance)
• Making excuses to have more gaming time
• Lying or stealing to access gaming resources or time
• Losing track of time while gaming
• Reduced sleep duration
• Secretly gaming
• Agitation or anger issues, especially when prevented from gaming
• Dreaming about games
• Experiencing headaches, muscle aches, or repetitive strain injuries
• Feeling anxiety or depression when separated from the game
• Neglecting personal hygiene

If you recognize four or more of these symptoms in your child or teenager, it may be worth seeking help.

Addressing Drug and Alcohol Abuse in Adolescents and Children

Discovering or suspecting drug or alcohol abuse in your child or teenager can be an alarming experience for parents. Not only is it challenging to determine the best way to help your child, but concerns about the long-term effects on their health and well-being also arise. Fortunately, we are here to offer assistance.

Recognizing Signs of Drug or Alcohol Use in Your Child or Teenager

Adolescence is a critical period of brain development, making substance use, such as cannabis, legal highs, or cocaine, potentially more impactful on teenagers than on fully developed adults1. The signs of drug or alcohol use in your child or teenager will vary depending on factors like the substances they are using and their individual personality.

If you notice the following signs in your child and suspect something is amiss, it is advisable to investigate further. However, please note that these signs could also indicate other disorders like depression or anxiety.

Behavioral Signs Indicating Possible Drug or Alcohol Use in Teenagers:

• Frequently skipping school (truancy)
• Associating with a new social group
• Increased frequency of going out or staying out late
• Changes in personality
• Hostility or violence towards others
• Heightened secrecy
• Engaging in stealing, lying, or missing valuables
• Elevated risk-taking behavior
• Decreased motivation
• Symptoms of anxiety and depression
• Paranoia
• Experiencing psychosis, such as hearing voices or hallucinations

Physical Signs Suggesting Possible Drug or Alcohol Use in Teenagers:

• Bloodshot eyes
• Fatigue and lethargy
• Disturbed sleep patterns
• Impaired coordination
• Memory problems
• Respiratory complaints
• Discovering or detecting the smell of drugs or alcohol on them
• Causes of Drug and Alcohol Use in Children and Teenagers

The reasons behind substance use in your child or teenager are likely multifaceted and may include:

• Experimentation
• Boredom
• Peer pressure
• Academic or school-related stress
• Testing boundaries
• Coping with difficult emotions or feelings
• Co-occurring mental health conditions

Research indicates a strong correlation between substance use and the presence of another mental health condition in children and teenagers. Behavioral disorders, such as conduct disorder (CD) or oppositional defiant disorder (ODD), are prevalent among young substance abusers. Additionally, depression, anxiety, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD) are commonly associated.

Studies involving twins have highlighted a substantial genetic link to drug and alcohol use, suggesting that approximately 50% of children or teenagers engaging in substance abuse have a close family member with addiction issues.

It is not uncommon for young individuals to start with substances like cannabis or occasional drinking, which can escalate in terms of severity and frequency. Given that addiction is a progressive disease with long-term physical and mental health consequences, early intervention plays a crucial role in preventing further deterioration.

Support for Children Engaging in Stealing and Lying

If your child's stealing and lying behaviors have become frequent or are accompanied by other concerning signs, it may be beneficial to seek guidance from a child behavior expert. We are here to provide assistance in such situations.

Lying in children and adolescents

Telling lies is a unique human ability and is considered an important milestone in a child's emotional development. On average, adults admit to lying approximately 13 times a week. The process of lying involves a child's understanding of their separate identity from their parents, which typically occurs around the age of 2 or 3.

While young children may lie due to difficulty distinguishing between fantasy and truth, most children by the age of 6 understand the moral implications of lying. Persistent lying can indicate various underlying factors, such as:

• Unrealistic parental expectations
• Fear of the consequences associated with telling the truth
• Inability to explain their actions in any other way
• Desire for attention
• While some lies may be insignificant, if your child frequently lies or if the lies lead to trouble for them or others, it may indicate an underlying problem that could benefit from professional intervention.

If lying is accompanied by any of the following signs, seeking assistance from an expert may be advisable:

• Depression or low mood
• Lack of empathy for others
• Low self-esteem
• Intentionally harming others or animals
• Hyperactivity
• Fire setting or engaging in risky behaviors
• Child and adolescent stealing
• Discovering that your child or teenager is stealing can be deeply concerning, and it's understandable for parents to feel guilt or shame about their parenting role.
• Stealing in children can stem from various causes, including:
• Emotional problems
• Peer pressure
• Low self-esteem
• Difficulties with friendships
• Desiring popularity
• Seeking a sense of self-worth
• Neglect (acquiring items they lack)
• Bullying experiences

If stealing is accompanied by any of the following signs, consulting an expert may be beneficial:

• Depression or low mood
• Lack of remorse
• Frequent stealing incidents
• Stealing expensive items
• Low self-esteem
• Intentionally harming others or animals
• Hyperactivity
• Fire setting or engaging in risky behaviors

Understanding the reasons behind your child's stealing or lying is essential. Some of these behaviors are a normal part of growing up and learning from mistakes. Lying can be a way for adolescents to test boundaries, while stealing may provide a temporary sense of power or control.

Seeking professional help for stealing and lying

Initiating an assessment with a child and adolescent psychiatrist is often a helpful first step for parents. It allows for the identification of any underlying issues contributing to the stealing and lying behaviors. Research indicates that children engaging in such behaviors may have conditions like conduct disorder, oppositional defiant disorder (ODD), or an emerging personality disorder, all of which can be addressed through therapy and, in some cases, medication.

Working with a psychologist or psychotherapist can assist your child in managing emotions more effectively and developing lifelong skills. In some situations, medication may be recommended to address underlying issues.

School exclusion and behavioral problems

Behavioral issues are a significant cause of school exclusions and suspensions for children and teenagers. Experiencing these consequences can have far-reaching effects on families. It creates high stress levels, often resulting in family conflicts, and can impact the child's academic performance and the parents' ability to carry out their daily routines, such as work.

Causes of school expulsions and suspensions are often related to emotional difficulties or mental health problems, such as undiagnosed attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorders, special educational needs, anxiety,.

Seeking Help for School-Related Behavioral Problems and Bullying

When a child or teenager exhibits behavioral problems at school, it can be a sign of underlying issues such as undiagnosed ADHD, ASD, conduct disorders, special educational needs, anxiety, or ODD. Understanding the causes behind these behaviors is crucial, but sometimes children may have difficulty articulating their reasons. In such cases, seeking help from an expert who can assess the underlying causes becomes essential.

Support for School Exclusions and Suspensions

If your child has been excluded from school or is at risk of exclusion, it's important for parents to gain a thorough understanding of the issues involved. A psychiatric assessment conducted by a child and adolescent psychiatrist can help identify any underlying causes, such as ODD or ADHD. Working together with you and your child, the psychiatrist will aim to gain a clear understanding of what has led to this situation. Depending on the assessment, medication or talking therapies may be recommended.

Psychological therapies, including cognitive-behavioral therapy (CBT), can be highly effective in helping children overcome their fears and develop healthier behaviors. Our experienced psychologists and psychotherapists specialize in addressing school-related issues and have a comprehensive understanding of their complexities. Parenting support can also be invaluable, offering guidance on handling difficult situations in ways that support your child's progress. It also provides a safe space for parents to discuss their experiences and frustrations with a child behavior expert, as it can be challenging to openly discuss these matters with family and friends.

Teenage and Child Bullying

Bullying can take various forms and may not always be apparent to adults in a child's life. For the child being bullied, the implications can be serious, leading to unhappiness, stress, loss of concentration, low self-esteem, and even physical health problems.

Recognizing the signs that your child may be experiencing bullying can be crucial, as children often hesitate to disclose such experiences due to feelings of humiliation, self-blame, or fear of worsening the situation. Some common signs include stomach aches or headaches caused by stress, sleep disturbances or nightmares, moodiness or irritability, overreacting to situations and taking it out on siblings, damaged or missing belongings, declining academic performance, reluctance to attend school or go out, changes in friendships or routines, social withdrawal, tears, low mood, and physical marks or tears on clothing.

The Long-Term Impacts of Bullying

Being bullied can have a profound negative impact on a child's life. Studies have shown that those who have been bullied are more likely to develop anxiety disorders, depression, and even paranoid thoughts in the long term. These conditions may not manifest immediately and can emerge years later.

If Your Child Is the Bully

Discovering that your child is bullying others can be distressing, and it's important for parents to respond in a constructive and supportive manner. Confrontation and punishment may be natural reactions, but it's crucial to recognize that bullying behavior can indicate underlying issues that need to be addressed.

Why seek help for behavioural problems?

Seeking help for a child who bullies can have several benefits. It allows for teaching alternative behaviors, addressing any underlying mental health issues your child may have (such as conduct disorder, ODD, ADHD, or anxiety), engaging in assessments with experts who can understand the causes of the bullying behavior without judgment, and considering talking therapies like CBT to help children manage their emotions and understand the consequences of their actions. Involving a third party in your child's treatment can also improve your relationship with them, as you're no longer the sole person trying to address the problems.

Seeking Help Early

Taking early action to seek help is crucial in preventing negative behaviors from escalating or becoming deeply ingrained. Our services are available nationwide, with the option for in-person or online appointments. Session durations typically range from 60 to 120 minutes, depending on the type of appointment. After the assessment, you'll receive a comprehensive report that includes a diagnosis (if clear) and treatment recommendations.

Before the assessment, it's natural for you and your child to feel some apprehension, but our clinicians are selected based on their expertise and ability to create a comfortable environment. If your child feels nervous about talking to a stranger, they can bring notes or drawings that express their emotions, as these can be helpful when verbalizing thoughts and feelings becomes challenging.

For children under 18, we request that parents attend the assessment with their child. This allows the consultant to gather information about your child's history and current health. However, the consultant may also require some time alone with your child to assess their behavior without parental influence.

Following the appointment, we will provide you with a comprehensive psychiatric report. The time required to produce the report may vary depending on questionnaire responses. The report will include a detailed diagnosis, if applicable, and any recommended treatments.

If medication is recommended, we suggest discussing it with your local NHS GP to inquire if they would be willing to prescribe it. In most cases, GPs will prescribe medication upon receipt of the psychiatrist's report, but there may be limitations regarding more expensive medications, such as those used to treat ADHD.

After the assessment with the psychiatrist, further treatment with a psychologist or psychotherapist may be recommended. We can assist in arranging private treatment or, if desired, you may opt for treatment through the NHS.

In conclusion, seeking help for school-related behavioral problems and bullying is crucial for the well-being of children and teenagers. By addressing underlying causes, providing appropriate therapies, and involving experts, we can support their emotional and behavioral development, ensuring that negative behaviors are addressed early on and do not become entrenched.

Treating Behavioral Issues in Children and Teenagers

There is a wide range of effective treatment options available for children and young people struggling with behavioral issues. Understanding the underlying causes and seeking appropriate interventions can greatly support their well-being and development. Here are some key approaches to consider:

Assessment:

A crucial first step is gaining a deeper understanding of the issues your child or teenager is facing. Behavioral difficulties often serve as a means of communication, indicating challenges in other areas of their life, such as school or self-esteem. It is common for children displaying anger or aggression to have underlying conditions like ADHD, depression, or anxiety. Seeking an assessment with a child and adolescent psychiatrist can identify any underlying causes and guide the best treatment approach.

Medication:

In some cases, medication can be helpful in managing anger or aggression issues. For example, stimulant medication has shown effectiveness in treating underlying ADHD, improving concentration and reducing hyperactivity. Atypical antipsychotics, like Risperidone, may be considered for reducing severe aggression in individuals with autism. Medication should be carefully evaluated, considering potential side effects, and often used in combination with other interventions such as therapy.

Talking Therapy:

Engaging in therapy with a qualified therapist or psychologist can provide significant benefits for your child or teenager. Therapy offers a safe space for them to address emotional and behavioral issues. Cognitive Behavioral Therapy (CBT) has proven effective in helping individuals regulate excessive anger, learn social problem-solving strategies, and develop alternative social skills beyond anger. Talking therapies are generally regarded as a safe and preferred option, offering long-lasting skills that can benefit them throughout life.

Family Therapy and Parenting Skills Training:

Behavioral issues can cause significant stress and strain on the entire family. Family therapy and parenting support can play a crucial role in addressing and reducing disruptive behaviors. These interventions focus on how parents respond immediately after their child's aggressive behavior, providing guidance on effective communication, setting consistent consequences, and supporting the skills learned in therapy. Couples therapy can also be beneficial, fostering a united front within the family and alleviating additional pressure.