Oppositional Defiance or Faulty Neuroception? Part 2

I was gratified to see how many thousands of parents and professionals read and resonated with my post about oppositional defiant disorder (ODD).   I wrote it because I see too many professionals misinterpret children’s behavior as intentionally hurting, disrespecting, or offending others. And because so many parents are stymied by their children’s behaviors and how to help them.

The families and organizations I serve typically seek my help because traditional ways of working with these children simply haven’t worked. They are often frustrated and confused about children who can sometimes reason and maintain their emotions, but at other times strike out and act in ways that appear defiant and often disturbing.

My previous post described how variations in neuroception, (the subconscious detection of safety and threat) may underlie many psychiatric “disorders” including ODD. In this post, I will address some of the excellent questions and comments you sent in response:

Is ODD caused by abuse or neglect?

Oppositional defiant behaviors likely have many contributing causes. I chose the story of Timmy—who was in the foster-care system—because large numbers of children in social care systems receive the diagnosis. However, many children diagnosed with ODD come from intact, stable families in which the child’s behaviors seem out of place, causing distress and confusion for both child and parents.  There is likely a myriad of causes of oppositional or defiant behaviors that reflect the complexity of the human brain, mind, body, and spirit. As some readers commented, undiagnosed medical conditions (such as pediatric streptococcal infections) can also cause suddenly challenging behaviors. No two children are alike, and we need to address the underlying sources of the behaviors on an individual basis.

Are there any clues in a child’s history about a predisposition towards these difficulties?

In my clinical experience, I have observed commonalities in children with challenging behaviors. These include a history of difficulties with emotional regulation (calmness in mind and body) as infants or toddlers; parents or caregivers who regularly feel confused about the child’s behaviors; a history of attempting to settle and calm the child without consistent success, and unpredictability in the child’s emotional states or moods. The main quality they share, in my experience, is difficulty with emotional regulation.

My child’s behaviors occur only at home (or only at school). Doesn’t this imply conscious control of behaviors rather than a “fight or flight” response?

Certainly, these behaviors can be difficult to understand. One answer is that a child’s ability (or inability) to “hold it together” shifts throughout the day. A child may be able to tolerate a certain experience, feeling, or request one minute (or hour or day) and have an extreme reaction the next. That doesn’t mean that the child always has conscious control over behaviors.

Just because a child can control her behavior some of the time, doesn’t mean she can control herself all of the time. Many factors influence children’s tolerance levels, including how their brains are wired and how they take in and make sense of what they see, hear, feel, intuit, touch, smell, taste, or otherwise make sense of the world.

Often, a child’s stress response follows a series of stressors that didn’t cause the child to lose control. What looks like one inconsequential stressor may be the tipping point, the single trigger that occurs when reserves become depleted.

In summary, there is no single cause of ODD. Its designation as a disorder incorrectly implies causality. A label doesn’t cause a disorder. It is simply a description of a category of children who are observed to have difficulty with behaviors and compliance. This has often led professionals to blame the child, parent, or caregiver inappropriately, and to recommend treatment plans that fail to solve the problem.

The ODD label is an indicator that a child is struggling. Many parents of children diagnosed with ODD report difficulties in calming the child emotionally. We need to examine this capacity more closely and focus on strengthening it as a foundation of social and emotional development in each child. For children who are successful in talking about their thoughts and feelings, programs such as Ross Greene’s Collaborative Problem Solving approach represent a necessary paradigm shift away from blaming children for their behaviors. My own clinical focus, however, is with children who are not yet able to collaborate, and who are most confusing to parents and professionals. I believe that the construct of faulty neuroception is key in supporting such children and creating treatment plans to help them find their way back to emotional regulation.

And if you are wondering if there is anything you can do right now to help your child, there is. Go and do something together that brings joy to both of you, even for a few moments. Nothing works better to reduce stress for children than relational joy.

In my next post, I will describe some examples of the causes of faulty neuroception and how to develop a treatment roadmap for each child. In the meantime, I look forward to your thoughts and questions!

*I invite you to join my community newsletter, for blog post updates and excerpts from my upcoming book; and my Facebook page, where I post helpful resources for parents and professionals.

*These organizations and individuals incorporate neurodevelopmental and mind/body principles in supporting children’s mental health: www.profectum.org, www.icdl.com, www.tinabryson.com, www.nrfgc.com.