Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / Understanding Oppositional Defiant Disorder From The Inside Out

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Understanding Oppositional Defiant Disorder From The Inside Out · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello, this is Kim Lee, child and adolescent psychotherapist.
• 0:03
  SPEAKER_00: I'd like to welcome you back to this second episode in the series concerning ODD or oppositional defiance disorder.
• 0:14
  SPEAKER_00: And what I want to try and do in this episode is just to give you a sort of foundational view of how this rather complex disorder is put together.
• 0:25
  SPEAKER_00: And I'm doing this because I think that, you know, understandably parents, teachers see the behavior, but don't really understand it because it is so often incredibly disproportionate, hard to manage, and hard to stem.
• 0:46
  SPEAKER_00: It just keeps repeating.
• 0:48
  SPEAKER_00: And so what I want to try and do is to give you an insight into what is underneath this neurodevelopmentally, neuropsychologically, emotionally, and otherwise.
• 1:01
  SPEAKER_00: So really we're into the territory of causes, and this condition doesn't appear randomly.
• 1:09
  SPEAKER_00: It develops through an interaction between biology or neurobiology, temperament, relationships, and the environment.
• 1:20
  SPEAKER_00: Children with ODD have temperaments which are made up of high emotional reactivity, low frustration tolerance, a strong autonomy drive, which is more like a kind of inability to tolerate anybody's anybody else's perceptions or involvement.
• 1:39
  SPEAKER_00: And they have a sensitivity to perceived control.
• 1:43
  SPEAKER_00: Now these children feel intensely, they react quickly and they struggle to calm.
• 1:50
  SPEAKER_00: So this is a really good example of the the the the term dysregulation.
• 1:56
  SPEAKER_00: But it's a kind of dysregulation that that doesn't soothe easily.
• 2:02
  SPEAKER_00: Now from a neurodevelopmental perspective, we see that ODD is what we can describe as a co-occurring condition, meaning that it sits alongside and is part of something else.
• 2:17
  SPEAKER_00: For example, ADHD, that's probably one of the most common, one of the most common co co-occurring or foundation conditions.
• 2:28
  SPEAKER_00: We also see that the child will have executive dysfunction, by which I mean the part of the brain that is responsible for thinking, regulating, is compromised.
• 2:40
  SPEAKER_00: There will, as you will well know, impulse control difficulties, emotional regulation impairment.
• 2:49
  SPEAKER_00: And the brain systems, the three parts that are really important here is the prefrontal cortex, which is the regulating and impulse control part of the brain.
• 3:01
  SPEAKER_00: Well, that gets overwhelmed or just doesn't function.
• 3:04
  SPEAKER_00: The limbic system, which is about emotional reactivity and that's the the feelings and felt brain, that becomes flooded.
• 3:14
  SPEAKER_00: And the dopamine pathways, which are responsible for reward and sensitivity, aren't necessarily functioning at a level that is great enough.
• 3:27
  SPEAKER_00: What we also see as aggravating contributors and significant potentially causal factors are attachments and relationships which are inconsistent, power-based, emotionally misattuned, chronically critical, and result in the child experiencing a lack of felt safety.
• 3:51
  SPEAKER_00: So defiance becomes a defensive position, and they learn that connection is unsafe and control is safer.
• 4:01
  SPEAKER_00: This isn't thought, this is more like a program that develops that the child is unaware of.
• 4:09
  SPEAKER_00: There are also environmental stresses, family conflict, trauma, instability, problems with school that can become really quite worrying, and repeated failure experiences which actually tell the child that there's something wrong with you, there's something bad about you.
• 4:28
  SPEAKER_00: And these things then become internalized in such a way that the child develops this kind of self-protective identity.
• 4:36
  SPEAKER_00: So that's some foundation thinking.
• 4:40
  SPEAKER_00: We'll be coming back to it in subsequent episodes, in part, but I I think it's really important that we have a sense of what are the predominant features underneath the behavior.
• 4:53
  SPEAKER_00: And I know I say this a lot, but we have to understand what is beneath.
• 4:57
  SPEAKER_00: Because once we do, that opens up all manner of possibilities in terms of helping these children.
• 5:05
  SPEAKER_00: In the next episode, we will be looking at how this condition is treated, the different ways in which it can be treated, and what you as parents will will be able to do, not in isolation, I agree, but certainly as part of a treatment process.
• 5:25
  SPEAKER_00: I hope this helps.
• 5:26
  SPEAKER_00: Thank you for listening.