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Untangling ODD From Look-Alike Conditions · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: Hello and welcome back.
• 0:00
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist from the Children's Consultancy.
• 0:06
  SPEAKER_00: In this next episode, we're going to move into an area of oppositional defiance disorder, which has to do with the ways in which we can understand what they may be linked to, what they might be instead, and to try and clarify that.
• 0:25
  SPEAKER_00: Now I think what's important is to understand this isn't a lesson in clinical pathology.
• 0:32
  SPEAKER_00: This has to do instead with understanding developmental difficulties and really having a wider view rather than seeing the symptoms and making the understandable assumption that they all fit one picture.
• 0:52
  SPEAKER_00: So when I say that ODD can resemble several other conditions, this is why accurate diagnosis is essential.
• 1:02
  SPEAKER_00: The other term that is very often used is conduct disorder.
• 1:06
  SPEAKER_00: And there is a key difference with conduct disorder because normally that will involve a violation of rights and social rules.
• 1:15
  SPEAKER_00: So children and young people with conduct disorder have a similar and different profile in terms of what they present and what they do.
• 1:27
  SPEAKER_00: So you might, for example, see acts of aggression towards people and animals, deceitfulness, property destruction, and serious rule breaking.
• 1:39
  SPEAKER_00: So with ODD, what we tend to see is defiance towards authority, whether that's parental authority or any other kind of authority.
• 1:49
  SPEAKER_00: Whereas with conduct disorder, what we see is a much greater leaning towards antisocial behaviors.
• 1:57
  SPEAKER_00: Now, with ADHD, that's attention deficit, hyperactivity disorder, we might see an overlap.
• 2:05
  SPEAKER_00: Definitely we're going to see impulsivity, emotional outbursts, and poor frustration tolerance.
• 2:14
  SPEAKER_00: But ADHD is a primarily a regulation disorder rather than something that just has oppositional intent.
• 2:25
  SPEAKER_00: Now, as I've said previously, many children have both ADHD and ODD.
• 2:31
  SPEAKER_00: And that's a really initially a confusing picture because parents and teachers are very often left in a kind of well, is it this or is it that?
• 2:43
  SPEAKER_00: But in fact, the co-occurrence, the coexistence of the two is not uncommon.
• 2:51
  SPEAKER_00: The question we have to ask is how do we attend to these things?
• 2:56
  SPEAKER_00: How do we respond?
• 2:59
  SPEAKER_00: The other thing that we sometimes see is a co-occurrence with autistic spectrum disorder.
• 3:07
  SPEAKER_00: And we might very well see defiance through rigidity, sensory overwhelm, transition difficulty, which is a very, very common feature in ASD, and communication frustration.
• 3:22
  SPEAKER_00: Now, in autistic spectrum disorders, the behavior is neurologically driven.
• 3:28
  SPEAKER_00: It's not relational opposition.
• 3:31
  SPEAKER_00: Even though the behaviors may seem oppositional or resistant, it's not the same thing at all.
• 3:38
  SPEAKER_00: Another condition, DMDD, is called disruptive mood dysregulation disorder.
• 3:47
  SPEAKER_00: We also understand this developmentally as something called disorganized attachment, or at least the two things present very in very similar ways.
• 3:59
  SPEAKER_00: And certainly I've seen children who have who present with DMDD, that's the disruptive mood, dysregulation disorder.
• 4:10
  SPEAKER_00: But what I then see when I look into the background or look into the history, what I will very often find is that there has been significant and very complicated disruption in early attachment and throughout.
• 4:26
  SPEAKER_00: Such children will present as chaotic, hugely dregulated, and present a range of very conflicting symptoms.
• 4:35
  SPEAKER_00: So they will often have very severe chronic irritability and frequent explosive outbursts, and they're persistently angry in their mood between episodes.
• 4:49
  SPEAKER_00: Now, this is a mood disorder rather than primarily oppositional.
• 4:55
  SPEAKER_00: You see, this helps us because we think, well, actually, this is not the same as ODD.
• 5:00
  SPEAKER_00: It may be presenting in that way, but actually, this is about something to do with the mood.
• 5:05
  SPEAKER_00: Something here is disordered in that stage.
• 5:09
  SPEAKER_00: How do we understand it and how do we respond to it?
• 5:13
  SPEAKER_00: Now, interestingly, anxiety disorders can present with some of the symptoms of ODD.
• 5:23
  SPEAKER_00: That sometimes you will find children with anxiety disorders will present at times with defiance.
• 5:32
  SPEAKER_00: And that very often will mask avoidance, fear of failure, performance anxiety, and loss of control.
• 5:43
  SPEAKER_00: We also see that there is a very strong link with trauma-related disorders, and sometimes we'll see that oppositional behavior may reflect hypervigilance, control seeking, emotional dysregulation, and something we call defense hostility.
• 6:04
  SPEAKER_00: So in fact, the taking a position of hostile is a defense.
• 6:09
  SPEAKER_00: Children who have experienced cumulative or episodic trauma may very well present in this way.
• 6:19
  SPEAKER_00: And so, in a sense, I mean this this really neatly explains, I think, or hopefully neatly, that when we see behaviors which we try and make sense of, actually the explanations need to be more forensic, or the examination needs to be more forensic.
• 6:40
  SPEAKER_00: And this is what we in in mental health endeavour to do.
• 6:44
  SPEAKER_00: Now, I I realize that this is a much bigger area than most people will necessarily understand, but I think it's our ability to be curious, to ask questions, to look beyond what we see.
• 7:02
  SPEAKER_00: And very clearly, when such behaviors become so problematic and they're influencing the quality of family life, I think most parents very probably feel like I don't know what it is, I just want it to stop.
• 7:22
  SPEAKER_00: And I completely understand, but I think what we then have to say is, okay, but what is it we're trying to stop?
• 7:29
  SPEAKER_00: Obviously, we're trying to stop the behaviors because of the damage that they do.
• 7:34
  SPEAKER_00: But there's something that we have to quantify to understand why it's happening.
• 7:41
  SPEAKER_00: Many parents who come to me talking about these kinds of difficulties are very often worn out.
• 7:50
  SPEAKER_00: They become hyper-vigilant because they're bracing themselves for the next explosion.
• 7:56
  SPEAKER_00: They've tried everything and nothing's worked.
• 8:00
  SPEAKER_00: And this is why it's so important to take the opportunity to find the specialized understanding that can help you not only see and quantify what's wrong, but to learn how to approach it.
• 8:20
  SPEAKER_00: So in the next episode, we're going to look at prognosis and recovery.
• 8:28
  SPEAKER_00: Because ODD does not define a child or a family.
• 8:34
  SPEAKER_00: So for the moment, I hope this helps, and I will post the next episode shortly.
• 8:42
  SPEAKER_00: Thank you for listening.