Turns out his orneriness has a label. Oppositional Defiance Disorder. Now a few months ago I would have scoffed at the idea that general childhood orneriness could be classified as a medical issue that could be "fixed" with therapy. You fix orneriness with discipline, not therapy. What my kid needed was a mixture of strong consistant parenting on my behalf, and deep felt love and respect from everyone in the family. A firm diet of love and discipline will fix everything right?
That my friends is one of the subtle differences between ODD and general orneriness. After 9 months of consistant predictable parenting on my part he is still not responding to my authority. He doesn't respond to discipline, time outs, natural consequences, or positive rewards, you name it I've done it. None of it worked. He honestly didn't seem to care if he was about to be in trouble or if he was being punished. It was all a big game just to make us all mad.
Another difference that I can point out is his ability to turn it on and off at will. His disorder only presents itself when we are at home and I'm the only adult in the house, or we're in a setting where he thinks he can get away with it (like in a classroom full of children when his parents aren't visible). In either of those settings if I change one variable (such as a neighbor stops by our house for a chat) his misbehavior disappears until things return to status quo.
One more difference that I can point out is that on a normal day has about 6 hours of rage/anger/general meanness that don't have a clear target. He just wants to pick a fight with someone about something. When he's worked through his meanness for the day he's capable of playing happily for a good 2-3 hours with little to no supervision.
So what do you do with this kind of behavior? When consequences and discipline fail. The doctor recommends some sort of parent child interaction program. We'll keep an open mind about it, but I feel like I'm already doing all the stuff that they'll recommend. My special needs advisor (aka Grandma) had a handful of sensory activities that sound considerably more promising. This week we've tried starting our day out by playing with 6 lb hand weights, with mixed results. So we'll keep trying to figure out Max's sensory diet and hopefully we can get him back to a happier, healthier place.