3 Ontwikkelingsverklaringen voor het “uitdagende” kind

3 Ontwikkelingsverklaringen voor het “uitdagende” kind

mei 18, 2020 0 Door admin

Translating…


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This post was co-authored with Rachel Hardy, M.A.

In this three-part post, we seek to explore alternate explanations for childhood defiance/misbehavior. In Part 1, childhood misbehavior was conceptualized as potentially normative and may even be indicative of healthy psychological development. In Part 2, childhood misbehavior was considered as a potential symptom of an otherwise difficult-to-notice mental health problem.

As stated in the previous two parts, parents and clinicians alike may be tempted to label children who exhibit repeated acts of defiance or misbehavior as “oppositional/defiant.” Oppositional defiant disorder (ODD), with an estimated adolescent prevalence of up to 12.6 percent [1], is a diagnosis that encompasses many behavioral symptoms relating to misbehavior, angry/irritable mood, argumentativeness/defiance, and vindictiveness. This means that children who meet the criteria for ODD often lose their temper, get annoyed easily, argue, defy requests/rules, and act in a spiteful, aggressive manner towards others. In short, children labeled with ODD are often seen as inherently oppositional and temperamentally difficult or vindictive.

However, making these types of characterological attributions could do more harm than good—they don’t produce any workable solutions and may even distract from a real underlying psychological problem. In fact, ODD itself is likely best understood as a label for a cluster of behavioral symptoms rather than an underlying cause of those behavioral symptoms. While this post has no intention to delve into the moral implications of childhood misbehavior, it’s worthwhile to explore other clinical explanations of childhood defiance that may help parents address the real root of the problem.

This post uses clinical and research evidence to suggest three ways developmental disability may manifest as childhood misbehavior in an effort to defend the character of the so-called “defiant child” and help parents stay aware that acting out can be a symptom of an underlying clinically significant problem that might otherwise go unnoticed.

1.     Defiance may be a correlate symptom of a learning disorder (LD)

Who among us remains unbothered by the experience of constant frustration? For kids with a learning disorder, facing challenging experiences is a daily occurrence. Schoolwork is one particularly challenging daily task that is routine for other children.

Intuitively, chronic frustration can lead to irritability, defiance, and at times, even aggression—and this is no exception when it comes to something as ever-present in a child’s life as schoolwork. But how would parents go about figuring out if their child’s defiance is rooted in academic difficulties? First, parents may benefit from paying close attention to the time of day that the problem behavior occurs. If a child only acts out repeatedly in school and in response to having to do homework in the evenings, it is possible that his or her behavior stems from an undiagnosed learning disorder or developmental disability [3]. Is the same behavior present on weekends or over spring break?

Imagine the following. Jack has a reading disorder (a type of LD) and cannot understand word problems and reading assignments as quickly or as thoroughly as his peers. No matter how long he labors over his work, he simply ends up frustrated and irritable every time he has to read. He might get angry, rip up his paper, storm out of the room, or start disrupting other students nearby simply to create a diversion and/or to express his frustration. This child likely gets sent to the principal’s office or receives some other type of disciplinary action. Only after repeated failed reading assignments might Jack’s teacher alert his parents to the possibility of a learning disorder. In this case, mislabeling normative frustration as oppositional or defiance hinders Johnny’s academic progress and fails to serve his needs appropriately. In this scenario, and real-world scenarios like it, it is imperative for parents and professionals to recognize that defiance and other disruptive behaviors may be a manifestation of an underlying learning disorder in order to facilitate proper treatment.

2.     Defiance may be a correlate symptom of intellectual disability (ID)

Taken from the definition linked above, intellectual disability “is a disorder marked by below-average intellectual function and a lack of skills necessary for independent daily living. The condition begins in the developmental period […] people with intellectual disability may struggle with the skills needed to function in daily life, such as communication, social participation, and independent living without ongoing support.” 

While defiance is not a direct sign of intellectual disability and we seek to be clear in stating that while people who have intellectual disabilities are not necessarily more likely to exhibit defiance in childhood than their peers, the logical process outlined in the learning disorder section remains the same. For a child with undiagnosed ID, the normative expectation for academic performance is likely unattainable without an intensified, individualized education program. As a result, this kiddo finds herself endlessly frustrated with school and may act out (or conversely, internalize and withdraw) in order to cope with the unmanageable stressor of academic work. 

Similarly, children with ID may struggle in adapting to the quickly evolving social environment of early childhood education. While other children begin to learn normative skills like teamwork, sharing, and responding to cues from caretakers, kids with ID may fall behind. For a child diagnosed with ID, systemic intervention and individualized support will be necessary. 

3.     Defiance may be a symptom of Attention Deficit/Hyperactivity Disorder (ADHD)

Finally, defiant behavior may be a by-product of ADHD symptoms, a disorder characterized (as its name suggests) by inattention and impulsivity/hyperactivity. However, we want to be extremely clear in saying that defiant behavior does not imply the presence of ADHD, and ADHD does not mean that defiant behavior will necessarily be present. Given that caveat, the research literature finds an extremely high comorbidity rate between the two [2], as well as between ADHD and anxiety. This points to the possibility that, for some children, defiant behavior may actually have its etiology in ADHD.  

Inattention can manifest as what appears to be mere noncompliance—children who have ADHD often fail to follow through on instructions from parents and teachers, do not seem to listen when spoken to directly, and are often forgetful in daily activities. These behaviors are a function of poor concentration and attention to detail, not an oppositional or defiant temperament. However, as a frustrated parent repeats their request for a third time, they likely allow their emotional state to shape a belief that their child is being intentionally defiant—or, at the very least, so inconsiderate that their behavior is rude. While it is entirely reasonable to come to such conclusions, there is a case to be made for also considering that their child may instead have ADHD, inattentive type.

Another hallmark symptom of ADHD, hyperactivity/impulsivity, may also manifest as defiance. Indeed, telling the difference between defiance and impulsivity/hyperactivity can be tricky, however, they differ on one key aspect: intentionality. Whereas defiance implies a conscious decision to subvert a parent’s instruction, impulsivity implies a more spur-of-the-moment behavior that is characterized by little to no forethought. There’s no question that a parent knows their child far more intimately than anyone else in the child’s life, and as such, the parent may have an (often) accurate gut feeling about whether the child’s misbehavior is defiance or impulsivity. Nevertheless, mistaking impulsive/hyperactive behavior for defiance could cause parents unnecessary frustration when typical behavior interventions fail to make progress because they don’t address this possible underlying cause—ADHD.

Sam, asked by his teacher to complete a worksheet, sits at his desk seemingly ignoring these instructions and doodling instead. Defiant or inattentive? Maddy, eager to get her parent’s consent to play outside, rudely interrupts a conversation. Defiant or impulsive? Max, overwhelmed during his first time eating at a buffet, eagerly takes way too much of every type of food even when his mom warned him not to. Defiant or hyperactive? A clear-cut answer to these questions doesn’t exist. But parents and professionals frustrated by these sorts of behaviors may do well to consider non-characterological attributions instead of jumping directly to the assumption that a child is intentionally being defiant for the sake of being defiant. As is the case with children struggling with ADHD, the root of misbehavior lies in impaired executive functioning, and not necessarily intentional opposition to authority.

August de Richelieu/Pexels

Source: August de Richelieu/Pexels

Much is written about over-pathologizing normative experiences and behaviors (see here for a review).  And in the case of childhood defiance, we want to look deeper and see what is motivating or predisposing the child towards misbehavior before we slap the ODD label on them. Are they experiencing significant anxiety? Are they frustrated by trying to keep up with their assignments and other peers in school? Do they have a neurological deficit in controlling their impulses? These are all questions that are often overlooked when parents (and clinicians) get ready to label a child as defiant.

So why is labeling accurately so meaningful? As stated in part one of this series, the defiant label stigmatizes the child as inherently “bad” or comparatively worse than other children. This has implications relating to self-esteem, self-fulfilling prophecy, and parental interventions. Additionally, viewing defiance as a fundamental personality flaw could lead to two equally dangerous outcomes: 1) it could absolve parents and child of responsibility to be agents of change since personality is viewed as relatively stable, or 2) it could lead to parents feeling hopeless about ever-improving their child’s behavior and perhaps even giving up trying.

Moreover, accurate diagnosis is important in order to facilitate proper treatment that gets at the root of the problem. Too often, slapping the ODD label on a child ignores the presence of underlying emotional or cognitive issues that can be, and should be, dealt with effectively. Surely, it would be a shame to leave a child untreated for anxiety, LD or ID, or ADHD because someone had labeled them as merely oppositional/defiant, ensuring that all future teachers, coaches, and other adults in their life saw him or her through that faulty lens.

In closing on this three-part series, empirical research evidence along with clinical observations suggest that symptoms of ODD may be either developmentally appropriate or stemming from other underlying issues. While we do not suggest that ODD should be removed from the DSM nor that it should never be diagnosed, we argue that it is important to consider other aspects that often motivate child misbehavior before inaccurately labeling a child with a behavioral health disorder such as ODD. In part one, we outlined several possible causes of defiance that are rooted in normative childhood experiences. In part two, we identified how clinical problems such as anxiety, depression, or trauma symptoms may serve as better explanations for defiant behavior. Finally, part three explored how learning disorder and intellectual disability could lead to acting out in response to academic pressures and how ADHD symptoms can be easily confused with defiant behavior. Our hope is not to discourage parents from seeking treatment for their child’s misbehavior, but rather to empower parents with knowledge about the etiology of defiant behavior so that they are better equipped to tackle their child’s behavior problems.

See Part 1 of The “Defiant” Child here and Part 2 here.

References

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry. 2010;49(10):980–989

Nock, M. K., Kazdin, A. E., Hiripi, E., & Kessler, R. C. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. Journal of Child Psychology and Psychiatry, 48(7):703-713.

Learning Disabilities Association of America. (2013). Symptoms of learning disabilities. Retrieved March 21, 2020, from https://ldaamerica.org/symptoms-of-learning-disabilities/

Greene, R. W., Biederman, J., Zerwas, S., Monuteaux, M., Goring, J. C., & Faraone, S. V. (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with Oppositional Defiant Disorder. American Journal of Psychiatry, 159,  1214-1224.


CBD Olie kan helpen bij ADHD. Lees hoe op MHBioShop.com


Huile de CBD peut aider avec TDAH. Visite HuileCBD.be


 
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