Oppositional Defiance or Faulty Neuroception? Part 2

*Updated: April 2023

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  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. But this is a complex situation, way too complex for a single article, so I share more about the lens shift in understanding & supporting children in Brain-Body Parenting, and in the paradigm shifting book,  Beyond Behaviors. 

For more information, check out the Resources tab and we also have a supportive membership for parents and providers interested in the Beyond Behaviors and Brain-Body Approach.


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What do we do when we have an ODD child who is completely shut down to the parents and won’t go and do anything fun or safe and will actively refuse anything “bonding” in anyway, even refusing food cooked by the parents? Thank you for your article by the way, I have been fighting for my child to be treated as “ill” rather than naughty for a long time and I am tired.

I feel so much empathy for you Jane. Unfortunately I can’t comment specifically as each child needs to be evaluated individually. It’s wonderful that you advocate for your child and understand there is a big difference between purposeful misbehaviors and stress responses. I hope you have visibility with the professionals and that they trust that you know your child.
There are resources listed on my site that may be helpful..

My son is 10 we have known that there was a problem from about age 4 of course nobody would help me, at one place I was told there is nothing wrong with him his problems come from the stress in the home. Really? So around age 6 I was at my breaking point he didn’t sleep at night he w as destroying toys hitting people screaming at people he would sit down and hit his head with his hand and ” I said darren what are you doing?” He said it feels like there are little bugs in my head and they won’t stop! Oh lord help me I said. I called every beahvirol hospital and all they said was if he wasn’t cause harm to him self or others we can’t help you. Ok? So I finally found a doctor and he was diagnosed with ADHD, ODD, SEVERE ANIEXTY now I had ADHD when I was younger also . Over the past 4 years he is now taking six different medications vyvanse, aderal, zoloft, trazadone, clonidine, triliptol. Also in that 4 years he has been diagnosed with wagnors syndrome which is a retinal detachment disease that runs on my side of the family he has lost eye sight completely, has 8 surgeries on his eyes he started going to the blind school. He is very out going doesn’t meet a stranger however his behaviors are getting worse and some are better than others some days I am able to calm some days not at all and excuse me for saying however my life is hell when I can’t help him . Please give me tricks to use to help my child deal with all of this. This is more than one person should have to deal wiyh… thanks so much in advance .

I am so sorry to hear of the struggles and challenges. I can’t give you advice on your child, but I have listed helpful resources and websites at the end of the post. I hope you can find some answers and good support from a well trained clinician in your area.

My son is 11, and I’m on the same seemingly endless quest for that one solution that ‘has’ to exist somewhere, right? I just wish I could give you a hug, and tell you it’s all okay.

THIS IS MY HUSBAND!!! He was labeled as ODD as a kid. Now, he struggles with anxiety and sometimes can perform well under emotional stress and sometimes falls apart or over- or under-reacts inexplicably. I’m a special ed teacher myself, so I’ve been looking for clues to the cause for years, and I read these posts and recognized the behaviors intimately. I printed them off and gave them to my husband and he the blood drained from his face as he connected with the feelings described in the articles. We are taking this to the therapist this week. Thank you for helping us find some answers!

Wow. I am glad it’s helpful. Yes, these concepts about emotional regulation absolutely apply to all of us, regardless of age! Wishing you all well!