Take the bus test. Imagine sitting on a public bus along side a nine-year-old child. There might be a variety of behaviors the child might engage in that would disturb or disrupt you. There might be other aspects of the child’s behavior, while not disruptive that might cause you concern or worry about the child’s development, adjustment or welfare. Thus, from this common sense perspective children can exhibit two basic kinds of problems. Those that disturb, disrupt or annoy adults and those that cause adults to worry about the child’s welfare, adjustment or behavior. The latter set of behaviors are usually not disturbing or disruptive. We can easily sit along side a child experiencing depression and learning disability without being disturbed or disrupted on our ride. Yet we would worry about that child’s welfare and adjustment. In contrast, we become disturbed and often angered when children act in hyperactive, impulsive, defiant or aggressive ways. At one time, all of these descriptions were considered part and parcel of Attention Deficit Hyperactivity Disorder. It is not difficult to understand why this belief existed. Certainly a child experiencing problems sustaining attention, prone to act in hyperactive and impulsive ways most certainly will exhibit aggressive and oppositional behavior.
Over the past ten years, however, an emerging solid body of research literature has demonstrated that not all disruptive behavior is symptomatic nor consequential of ADHD. From a common sense perspective I choose to view ADHD as resulting from incompetence as opposed to non-compliance. Because of their impulsive, often unthinking ways of interacting with their environment children with ADHD are prone to behave in resistant or oppositional ways. However, oppositional behavior, we have come to understand, is also fueled by environmental adversity, including parents’ behavior and psychiatric status, parenting strategies and even more important, the consistency with which discipline is provided. Thus, while many children with ADHD are described as oppositional and in fact in clinic settings perhaps as many as half also receive a diagnosis of Oppositional Defiant Disorder, an equal if not greater number of children exhibiting oppositional behavior do so in the absence of experiencing Attention Deficit Hyperactivity Disorder. In this month’s article, I will briefly review the condition we have come to describe as Oppositional Defiant Disorder.
All children misbehave occasionally. In many circumstances when this misbehavior defies adults’ rules, limits or directions, we refer to the behavior as oppositional. All children are oppositional at times. Certainly oppositionality could in part be viewed as a process by which children begin to develop independence. Most of us, however, recognize when a child’s defiant behavior is not the normal, predictable assertion of independence but arises instead from resentment, anger, unhappiness or impulsivity. Excessively oppositional children are extremely negative and provocative in their behavior. At times they can even be spiteful or vindictive based upon how they are treated. Such children lose their tempers frequently and without good reason. They argue with adults, appear angry, resentful and are easily irritated. They often blame others for their misbehavior, defy rules, deliberately annoy people and may use inappropriate language. At times adults view this pattern of behavior as not only resistant but an effort on the child’s part to draw negative attention, suspecting these behaviors resulted from the child’s inability to draw positive attention. Some children exhibit what has been described as passive aggressive behavior, agreeing to comply but never following through. Children with the inattentive type of ADHD are often accused of this problem despite the fact that their difficulties result from lack of focus rather than planned resistance.
Oppositional and delinquent behavior are not one in the same. Although their attitudes may be negative and even hostile, children with oppositionality tend to direct their negative behaviors towards and adults and children with whom they interact on a regular basis at home or at school. They tend to be very pleasant with strangers or other individuals they don’t know well. Delinquent children by contrast behave badly towards unfamiliar adults and children as well as their families. They often do so in public settings and with an aggressive component.
More often than not when children experience school problems, they also experience emotional or behavioral problems at home. However, they are much more likely to let it all hang out at home where they feel comfortable rather than at school where a teacher might think badly of them. When called by the school to discuss their child’s academic problems, parents may come away with the distinct impression that the conference was about two entirely different children. The well behaved, cooperative student the teacher sees at school and the defiant, angry and temperamental child parents view at home. This is especially true when children experience anxiety as well. Such children would never consider misbehaving in school yet at home their anxiety and anger translates into negative behavior. When children in fact act out at school, they have usually crossed a line emotionally and display a willingness to let the world view their problems and unhappiness. A significant number of these children appear at great risk for developing outright delinquent behaviors.
It is not completely understood why children become excessively oppositional. As noted, oppositionality may be contributed to by four primary factors, including the child’s temperament, parents’ temperament, parenting strategy and consistency of discipline. There may in fact be a biological basis to this problem as well. Many youngsters exhibiting oppositional behavior as Dr. Barbara Ingersoll has described, appear to be looking for a fight almost from the moment of birth.
esearchers report that some adopted children, even though they live with calm and accommodating adoptive parents in a supportive environment behave in an oppositional manner that closely resembles the behavior of their birth parents. The fact is, some children appear to come to the world wired to be oppositional. As infants they can be fussy and difficult to comfort. Their terrible two stages are truly terrible with every frustration leading to a tantrum. As they grow older they continue to be quick to anger and do not seem to care about the feelings of others. Some of these children are defiant in all situations. Others can be defiant in one or another situation. Some appear to be easy going until they begin to experience school problems, at which point they become angry, negative and deliberately oppositional at home as well as at school. After years of being calm and easy to please they suddenly appear to be spoiling for a fight.
It is also not surprising that children struggling at school academically frequently develop defiant patterns of behavior. Their academic performance may not meet the expectation of the environment. This leads them to regularly receive huge doses of negative feedback and criticism. Eventually this constant flow leads to frustration and these children begin pushing back in retaliation. Parents may come to believe that these children are merely being disobedient and that disobedience is the cause rather than the consequence of school problems. Closer scrutiny frequently reveals, however, that the behavior has followed rather than preceded poor school performance.
For many children with ADHD also experiencing oppositional behavior, a positive, robust response to medication often leads to increased self-control and subsequently reduced oppositionality. Nonetheless, oppositional behavior with or without ADHD places children at increased risk for later life problems and thus this pattern of behavior must be addressed. There are a number of good texts and parent training resources. Here are a few of my favorites.
