As mentioned earlier, making the rules tighter, and enforcing them stronger, as is done at a camp or a military school, only makes things worse. We saw this at the Max program, which had "zero tolerance" for almost everything. John only lasted a couple weeks. Obviously these programs do help some people. You have to "guess" what percentage of your child's ODD is under his control, and what percent is biochemical and/or subconscious. If you knew he had a serious mental illness, for instance, you wouldn't enroll him in a program to make him follow the rules - because he can't. This only leads to learned helplessness, and depression, which often manifests itself in yet more antisocial and self-destructive behavior.
There are many reasons that seemingly willful defiance may not be willful after all: a defect in the wiring of the brain, a reaction to food or food additives, a traumatic event, or patterns that have been laid down over many years. In John's case all four reasons apply.
Naturally you want to look for correlations. Is he worse some days than others? Is it connected with any foods or additives? Can you get him to eat more wholesome foods? But it may not be food related at all. Many of John's remaining symptoms are not. They are now classified as "I did this for 15 years, that's all I know."
I started a new program, of my own creation, called "progressive responsibility". This is a long term program that could take years to complete. It assumes you can easily deny him something he likes, without fear of violent reprisals or other reactions that would be dangerous. Trust me, it took me a while to come up with something like that. But I have the ability to turn off the internet in the house, and John loves the internet. I can withhold this privilege from a distance, without any physical contact. He doesn't feel "threatened" as I flip a switch from another room. Thus the internet will be his incentive to behave.
Next, you select one modest behavior that drives you crazy; something that he can easily fix. Start with asking him to do something, rather than asking him not to do something. The "don't do x" constraints will come later. My first rule is, "turn off lights when you come upstairs to bed." It's not hard, he can do it, it just isn't important to him, or it isn't uppermost in his mind when he is going to bed. (Or perhaps he is afraid of the dark - in which case he needs to talk to us about it, and we'll let him leave one light on downstairs, preferably one with a cfl bulb.) In any case, I am making him respond to this one rule in particular. I'm not overwhelming him with a lot of rules; just one. I've heard a typical teen ager has more rules to follow than a U.S. soldier. Because of his ADHD, he can't hold 100 rules in his head simultaneously, but he can remember this one rule. He can succeed by following this one rule. If he leaves lights on, there is no internet the next day. If he turns lights off every night for five nights in a row, I'll praise him to the heavens, and I'll bring in one more rule. Again, it should be simple and objective. "When you go to bed, don't leave any dishes or food items in the family room or office." That's it, lights and dishes before bed. If he fails at either task, there is no internet the next day. If both succeed for 5 days, I'll bring in a third rule. And the process of progressive responsibility continues.
This reminds me of learning a foreign language, which is, by coincidence, much easier to do when you're young. You don't learn 100 words in the first day. You learn a couple words, and cement those in, then you learn a couple more words next week, but you continue to review the earlier words. And on it goes. After a couple years you have a basic grasp of the language. Compliance is a foreign language for these kids. They've never been able to follow all the rules, so they don't follow any of them. Teach them how to follow one rule, then another, then another. In a year they will follow the 70 (or so) rules that are commonplace around your home - around any civilized home. You have no idea how many rules there are, just like you can't imagine how many words are in the English language, because it's all a part of your being. He can't follow all the rules today, he just can't; so bring them in one at a time.
This is quite different from the boot-camp approach, where kids are expected to follow a long list of rules from day one, and harsh punishments are applied for simple infractions. Mine is a step by step approach, and it takes a long time and a lot of patience. Many times you will say to yourself, possibly at a subconscious level, "Good God, if he can follow these 4 rules, why can't he follow the rest? Why does he continue to swear, and bike without his helmet? Do I really have to let him get away with all this crap, just because he turned the lights off last night? Do I really have to wait ten months before I can expect him to follow rule 47, which drives me crazy! My other child follows all the rules. My nieces and nephews and neighbors and friends all follow the rules. Why must it take two years to civilize this kid? Isn't there a better/faster way?" I don't think there is, just as there is no faster way to learn a second language.
It is important to be honest with your child at the outset. "I'm starting a new program with you, called progressive responsibility. I know you can't follow all the rules from day one, so here is what we're going to do..." He's not a lab rat; he's almost an adult. Make him part of the process. "Yes, you can function in my home, and you don't have to be in trouble all the time. Here is the plan; let's work on it together."
In addition, I will be discussing each rule as it is brought in, just as you would conjugate each new verb, even the regular verbs, in Spanish. "Is there anything physical or psychological that would make it difficult for you to follow this rule? Can you reach the light switches? Are you afraid of the dark? Could we leave just one light on over the stairs?" Each step has to be a success, to lead to the next.
For several years I felt like I was blazing a trail through the world of neurobiology, <gut flora>, and the <effect of gut bacteria> on physical and mental health. "I've been a doctor for 22 years; I've never seen a blood test like that." recounts his pediatrician. "Medicine will need a couple more decades to catch up to what you are doing." Now I am breaking new ground in the area of child psychology. I guess it's my Karma.
NFF: This didn't work quite as well as I had hoped. When he was faced with the reality of the system, he railed against the "no internet all day" consequence. He almost escalated to a physical tantrum, something I can't afford. I had to back it off - now he only loses the internet for a few hours. Then he started coming up with excuses why he couldn't turn off the lights, a different excuse each night. And he was convinced each one was absolutely justified, so any form of punishment was cruel and unwarranted. His mind can twist things so fast, that any form of conditioning is nearly impossible. Still, it's a good idea at its core, and I'm trying to stick with it.