«Sally Patton UNITARIAN UNIVERSALIST ASSOCIATION BOSTON Copyright © 2004 by the Unitarian Universalist Association of Congregations. All rights ...»
Even when it is necessary to remove a disruptive child from a group situation, it is critical to continue ministering to him or her and to seek other ways that he or she can participate in church activities. In fact, the church may be the best place for this type of child to learn what it means to be part of a community of love that will never give up on him or her.
Description Disruptive behavior disorders is the overall category that generally includes oppositional defiance disorder (ODD) and conduct disorder (CD), for children and adolescents, and antisocial personality disorder, for people over age eighteen. Attention-deficit disorder (ADD) is also sometimes placed in this category; however, it is important to remember that most children with ADD are not oppositional.
As we will discuss later in this section, there is significant behavioral overlap between oppositional defiant disorder and conduct disorder. The most significant difference between the two is that extreme, destructive behavior is considered a manifestation of CD. For instance, youth with CD are often cruel to animals and people. Most youth with ODD eventually outgrow their oppositional behavior, although about one-third go on to develop conduct disorders.1 As Ross Greene points out in The Explosive Child, a diagnosis does not tell us much about the precise difficulties a child is experiencing or what is needed to help the child.2 Some experts believe that most children’s behavioral disorders are triggered by biochemical/neurological causes that may be genetically transmitted.
Whatever the cause, there is a group of children and youth whose disturbing behavior can be termed as either oppositional defiance disorder or conduct disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association.3 158 Welcoming Children Oppositional defiance disorder is characterized by behavior that is consistently hostile and aggressive over a long period of time and detrimental to family, social, and school life. According to the American Academy of Child and Adolescent Psychiatry (AACAP), children with ODD have an ongoing pattern of uncooperative, defiant, and hostile behavior toward authority figures that lasts at
least six months. The specific symptoms of ODD include:
• frequent temper tantrums
• excessive arguing with adults
• active defiance and refusal to comply with adult requests and rules
• deliberate attempts to annoy or upset people
• blaming others for mistakes or misbehavior
• often being touchy or easily annoyed by others
• frequent anger and resentment
• mean and hateful talking when upset
• seeking revenge4 It is rare for a child to have ODD alone. Usually, he or she also has some other neuropsychiatric disorder or comorbid (coexistent) condition, such as ADD, depression, bipolar disorder, Tourette’s syndrome, or an anxiety disorder. The most common pattern of comorbidity is ODD with ADD, which occurs in about 30 to 40 percent of children with ADD. The next most common combination is ODD with depression or anxiety. According to Jim Chandler, many young children with ODD go on to develop ADD or a mood disorder.5 Conduct disorder usually manifests itself in late childhood or early adolescence. ODD appears to be a precursor of conduct disorder. In many ways, CD is a more dangerous version of ODD. It is considered the most serious of the childhood psychiatric disorders and the most difficult to treat. Approximately 70 percent of adolescents with CD will grow out of it, but a comorbid condition, such as bipolar disorder, may worsen and continue into adulthood.
Conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or the major rules and 159 Disruptive Behavior Disorders values of society are violated, causing significant and recurring problems in the adolescent’s family, social, and school lives. This disorder is demonstrated by the presence of three or more of the following behavior patterns in the past twelve months, with at
least one behavior pattern present in the past six months:
• aggression toward people and animals
• frequent bullying, threatening, or intimidation of others
• frequent initiation of physical fights
• use of a weapon that can cause serious physical harm to others (for example, a bat, brick, broken bottle, knife, gun)
• physical cruelty toward people
• physical cruelty toward animals
• stealing while confronting a victim (for example, mugging, purse snatching, extortion, armed robbery)
• forcing someone into sexual activity Conduct disorder is often characterized by destruction of
property, involving acts such as these:
• deliberately setting a fire with the intention of causing serious damage
• deliberately destroying others’ property (other than fire setting)
• deceitfulness or theft
• breaking into someone else’s house, building, or car
• frequent lying to obtain goods or favors or to avoid obligations (in other words, “conning” others)
• stealing items of value without confronting a victim (for example, shoplifting, forgery)
The serious violations of rules typical of CD include:
• staying out at night despite parental prohibitions, beginning before age thirteen
• running away from home overnight at least twice while living with parents or parental surrogates (or once without returning for a lengthy period)
• frequent truancy from school, beginning before age thirteen6 160 Welcoming Children Children with conduct disorder seem to have difficulty reading the intentions of others; they often imagine that other people are threatening them or putting them down. They typically react to perceived threats with aggression and very little show of regret or remorse. They do not tolerate frustration and tend to behave recklessly. Children with conduct disorder frequently threaten suicide, and these threats should be taken seriously.
Boys with CD are more likely than girls to fight, steal, and participate in acts of vandalism. Girls with CD are more likely than boys to lie, run away, and act out sexually, including engaging in prostitution. All children with CD are at extremely high risk for substance abuse.
Many people equate CD with juvenile delinquency, even though youth who get into trouble with the law are not always oppositional and do not always display the extreme antisocial behaviors of CD. In fact, however, most young people with CD will eventually end up in the juvenile justice system.
Discussion The disruptive behavior disorders are complicated, and there is professional disagreement about both their causes and diagnoses.
Children with ODD may also have attention-deficit disorder (ADD) or another learning disability that may exacerbate or even be the cause of negative, uncontrollable behavior. Research is also beginning to show that behaviors often attributed to ODD and CD may be motivated by a mood disorder, and there is increasing evidence that conduct disorder may be a component of bipolar disorder.
If you have a child in your program with excessive behavior problems, it is important to read the chapters on ADD and mood disorders. The child may be acting in explosive, negative ways because he or she does not know how to deal with an undiagnosed condition. Some professionals believe that ODD is not actually a discrete disorder but the result of other problems.
161 Disruptive Behavior Disorders Children and youth with disruptive behavior disorders may be in families who are coping with their behavior, or they may be in families that have given up on them. They may be on the fringes of school, or they may roam the streets, coping the best way they know how. Some of the youth who have dropped out do not fit the exact definition of ODD but are alienated from their families, school, and themselves. Society’s response to these alienated youth is often negative, controlling, and punitive. They are seen as lazy, aggressive, unteachable, and unreachable. Moreover, people tend to blame them rather than look at what led to the disruptive behavior. And this is exactly what the youth want adults to know— that they cannot be controlled.
Research appears to support the theory that a combination of genes and environment produces disruptive behavior disorders. In When You Worry about the Child You Love, Edward Hallowell suggests that some children’s brains cause them to have significantly less inhibition than others, so that they seem to be born thrillseekers and risk-takers. These children may be under-aroused physiologically and thus seek excitement in the external environment in order to become engaged or activated.7 Greene indicates that many of these children have sensory integration problems that lead to low tolerance for frustration. Boys are more likely to be aggressive than girls, and this difference becomes even more pronounced in adolescents with conduct disorder.
A child’s ability to manage anger is dependent on his or her ability to process language, both verbally and nonverbally. If children have difficulty understanding all the verbal information they are receiving, they can become confused and frustrated. Some children have difficulty managing emotions, thinking through sequences of events, solving problems, or reflecting on what they have heard. These weaknesses in language processing can lead to misunderstandings and difficulties in social interactions. Eventually the frustrations build up until the child becomes overwhelmed and explodes out of frustration. When we can recognize that these children have serious cognitive and emotional deficits, 162 Welcoming Children then we can change our vision of them to see their behavior as their way of coping with confusing and frustrating stimuli.
As Greene observes, it is difficult to view a child’s behavior as purposeful when we know that he or she is coping with extremely
frustrating circumstances and not thinking rationally:
It’s harder still to imagine why a child would intentionally behave in a way that makes other people respond in a manner that makes him miserable. I also don’t think these kids are especially angry, though I do think they’re extremely frustrated. When the term anger applies to them, it’s often because they’re angry at being misunderstood. They typically don’t understand their own behavior, but they’re quite certain no one else does either. 8 Ministering to Families Children and youth develop oppositional behavior as a way of protecting themselves from what they see as an unreasonable and hostile world of adults. While many oppositional children come from families that are struggling with addiction, abuse, and neglect, some come from intact families where there seems to be a poor fit between the temperament of the child and the parenting style of the parents. In Treating the Disruptive Adolescent, Eduardo Bustamante explains, A good fit with a difficult child is a patient and flexible parent. A poor fit is a demanding, aggressive, and controlling parent. A good fit with an easy child is a parent who is reasonably easy to satisfy. A poor fit is a parent who is excessively difficult to satisfy. Difficult children turned out just as healthy and successful as others when raised in an environment that provided goodness of fit.9
pain and grief. Russell Barkley and Christine Benton, in Your Defiant Child, state that the child’s environment offers the greatest potential for changing the oppositional behavior.10 Of course, the parents control an enormous part of the child’s environment. This does not mean that they are to be blamed for their child’s behavior, only that they are the people most able to affect it. When ministering to parents of oppositional children, it is important to understand that they may feel too overwhelmed to take on the task of changing their child’s environment and their role as parents. They may feel defensive about learning new skills if they feel blamed for their child’s problems. All we can suggest is that they seek professional help in order to look at their relationship with their child in a different way.
Experts are beginning to realize that the causes of the destructive and defiant behavior of oppositional children are very complex. Oppositional behavior is now seen as a precursor or an indicator of other conditions, such as ADD, depression, bipolar disorder, Tourette’s syndrome, learning disabilities, and obsessivecompulsive disorder. In fact, ODD rarely exists by itself. Whatever the label assigned to these children, they are characterized by inflexibility and a very low tolerance for frustration. Hallowell describes five general causes of aggressive behavior: biological and genetic factors, inability to use language well and to put feelings into words, insufficient structure, parental influence, and peer group influence.11 Most of the experts working with these young people agree with this assessment.
The lack of structure in children’s lives can be one of the accumulative causes of explosive and/or oppositional behavior. Structure can be rephrased as consistency. Barkley and Benton say that consistency in childrearing is more important than creativity. For parents living with an oppositional child, they strongly suggest that consistency in rule setting, expectations, consequences to bad behavior, and encouragement of good behavior are key to breaking the pattern of oppositional behavior.12 Hallowell says that many children do not understand rules because they change from 164 Welcoming Children situation to situation and there is no overall influence in their lives to explain and enforce structure and consistency. As result, they may become confused and angry and act without a good set of values as a base.13 No matter what the cause for oppositional behavior, the parents’ ability to learn techniques to create a “goodness of fit” environment is essential for healing the child.
Ideas for Teaching The children and youth in our religious education programs who have disruptive behavior disorders are perhaps our greatest challenge. They are the most difficult of the difficult children. A story by Emily Green, a former director of religious education,
illustrates this difficulty: