Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / From Defiance To Regulation: A Practical Guide For Parents

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From Defiance To Regulation: A Practical Guide For Parents · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: And welcome back to this, the final of the five-part series on oppositional defiance disorder.
• 0:08
  SPEAKER_00: Now, what we've done so far is to walk through the significant aspects of this.
• 0:15
  SPEAKER_00: And so we've in the first episode looked at what the uh the term oppositional defiance disorder means, and the episode concerned looked at the way in which the term manifests through different behaviors, and that distinguishes from children and young people who are one might say developmentally defiant because that is part of the process of separating and being yourself, particularly noticeable through the adolescent developmental stage.
• 0:59
  SPEAKER_00: We've looked also at some other elements.
• 1:05
  SPEAKER_00: We looked at the causes of oppositional defiant disorder and the way in which other factors, whether they are neurodevelopmental or they are attachment or environment-oriented, may very well be aggravating or causal factors.
• 1:29
  SPEAKER_00: We looked at the treatment of the disorder, both in terms of what parents really can do with the right structured and clinically informed help, and we looked at other modalities, cognitive behavioral therapy, collaborative and proactive solutions, family therapy, and we looked at the role of medication.
• 1:55
  SPEAKER_00: I just want to say again that where medication is concerned, there is not a medication that is directly prescribed for ODD.
• 2:06
  SPEAKER_00: When there are what we call the co-occurring conditions, which could be ADHD, autistic spectrum disorder, mood dysregulation, and so on, then it may very well be the case that by prescribing for that we'll see a significant reduction in the behavioural expressions.
• 2:29
  SPEAKER_00: Once again, this does not treat, it manages.
• 2:34
  SPEAKER_00: So alongside that approach, something else psychoeducational needs to be happening.
• 2:47
  SPEAKER_00: And I think the important point here is that what I want to help parents understand is that taking a snapshot of the child, the child's behaviour, does not give you the full picture.
• 3:04
  SPEAKER_00: And parents aren't expected to know the full picture.
• 3:09
  SPEAKER_00: But many parents that I see want to know the full picture, they want to understand why this is happening, what else it might indicate.
• 3:20
  SPEAKER_00: And I think what differential diagnosis does is to really more forensically understand what's going on and to identify what it is that's required.
• 3:34
  SPEAKER_00: There are no silver bullet approaches in any form of mental health.
• 3:40
  SPEAKER_00: And although nice guidelines might point towards a particular type of approach for a particular kind of clinical formulation, that doesn't take into account the individual.
• 3:58
  SPEAKER_00: Therefore, a more informing approach is one which looks at the individual, not just the disorder.
• 4:09
  SPEAKER_00: In this final episode, I want to just talk about the prognosis for children and young people who have this difficulty.
• 4:20
  SPEAKER_00: And that includes recovery alongside prognosis.
• 4:26
  SPEAKER_00: I say again, disorders do not define children.
• 4:31
  SPEAKER_00: And with this particular disorder, many children will grow out of it with early intervention.
• 4:40
  SPEAKER_00: The problem, however, is that without the intervention, they grow into it.
• 4:46
  SPEAKER_00: This is true with all mental health difficulties.
• 4:51
  SPEAKER_00: People don't grow out of them, they grow into them.
• 4:55
  SPEAKER_00: So what we know from the evidence is that without support, ODD can progress towards conduct disorder, school failure, relationship breakdown, emotional dysregulation, and low self-esteem, acts of impulsivity, and moving into the potential for criminality.
• 5:22
  SPEAKER_00: And I say the potential rather than that it should be that's not a foregone conclusion.
• 5:30
  SPEAKER_00: But with treatment, emotional regulation improves, parent-child conflict reduces, cooperation increases, and identity stabilizes.
• 5:42
  SPEAKER_00: Now, this is really important because as sufferers begin to experience themselves differently, their capacity to engage more meaningfully and more successfully with other activities with life, the greater their growth potential becomes.
• 6:04
  SPEAKER_00: Now the deeper truth here is that defiant children are really difficult.
• 6:11
  SPEAKER_00: Well, the behavior's difficult, but certainly defiant children aren't intending to be difficult as much as it may appear otherwise.
• 6:21
  SPEAKER_00: They're more often emotionally overwhelmed, they're misunderstood, and they are sensitive in a way that is almost like a kind of intolerableness that they experience in certain situations that trigger the central nervous system.
• 6:44
  SPEAKER_00: They're more often likely to be struggling to feel safe or equal in a relationship.
• 6:52
  SPEAKER_00: So when the child feels heard, understood, contained, and respected, opposition softens.
• 7:01
  SPEAKER_00: What's really fascinating is I have seen this so many times in the consulting room, that my stance of hearing, understanding their perspective, being someone who is able to contain their emotional state and my own with respect neutralizes the oppositional stance.
• 7:27
  SPEAKER_00: It doesn't happen immediately, but it does happen, and it tends to be maintained.
• 7:35
  SPEAKER_00: I see this in children and young people, but I've also seen it with adults.
• 7:42
  SPEAKER_00: So defiance isn't about rebellion, it's often about regulation, relationship, and safety.
• 7:49
  SPEAKER_00: And when we understand the child beneath the behavior, change becomes possible.
• 7:57
  SPEAKER_00: Now I'm going to be doing a series on when conditions collide.
• 8:04
  SPEAKER_00: And the two that I have in mind, automatics, autistic spectrum disorder, and attention deficit hyperactivity disorder.
• 8:14
  SPEAKER_00: And I want to do this because this is a common co-occurring problem which I think is little understood.
• 8:26
  SPEAKER_00: I'd like to talk about the neurobiology of those two conditions because what's fascinating is that they have many opposing features.
• 8:37
  SPEAKER_00: It's almost like they exist inside the same person but are in conflict.
• 8:43
  SPEAKER_00: I'll explain that in more detail through the podcasts in that series.
• 8:50
  SPEAKER_00: And I do sincerely hope that there are more questions answered as a consequence.
• 8:58
  SPEAKER_00: And of course, I will always return to how parents can better understand and more effectively respond.
• 9:08
  SPEAKER_00: Thank you for listening.
• 9:09
  SPEAKER_00: Hope this series has been helpful for you.