The cases featured in this article (Case 1, Case 2, Case 3) indicate different pathways to the same end: they show how different environmental factors impinging on children with individual differences all can fuel the evolution of ODD. These cases provide a springboard for a discussion of family interactional factors that may contribute to the evolution and maintenance of disruptive behavior.
TJ's mother (see Case 1), because of her own guilt about her failed marriage, had become an indulgent parent. She failed to maintain boundaries, limits, and expectations because of her discomfort "to see her child in distress." TJ's internal working model of the world was thus one that reinforced immediate gratification; his acquisition of frustration tolerance and self-soothing had been thwarted. ADHD symptoms contributed to his oppositionality and defiance, probably because he needed more structure and limits to contain his impulses.
AT's situation (see Case 2) illustrates several common reactions of parents who have exhausted their efforts to attempt to manage disruptive behavior. AT's parents were more comfortable using authoritative approaches to effect change, and once these methods failed, they were at a loss about what to do. Her father's frustration and sense of powerlessness were evidenced by his comment that "my father would have beat me if I acted this way, but we can't treat kids like that anymore." AT's parents did not err on the side of indulgence; rather, they lacked an awareness of the power of positive reinforcement and praise. Their anxiety about losing control led to their reactive, harsh parenting stance.
JS and his siblings (see Case 3) illustrate the challenges a chaotic home presents for the children who live there. Their mother's consultation with a psychiatrist seemed to be a turning point. When she received a diagnosis of ADHD and began treatment, her parenting improved. The home became a more predictable environment, and the increased structure was associated with calming of all the children's disruptive behavior.
These cases suggest that children's disruptive behavior (ADHD and ODD) can arise via different pathways. However, these different paths of development share a common interactional end point: the need for familial environments that provide external regulation of behavior