HEALTH PLUS There are many factors that can lead to disruptive behaviour
SOME CHILDREN are always in trouble. They cannot obey rules and seem unable to control themselves or to be controlled by others.
They test the limits. They are described as angry, stubborn, resentful and easily provoked, blaming everyone else for whatever happens to them. They have poor impulse control. They seem to deliberately cause disruption.
These children can flare up and lash out. Placating does not work. Enough is never enough because no matter what is given, something more is wanted and they ignite if refused. They are children who need immediate help because of the distress they cause to themselves and others as they become more angry and alienated.
Their parents say that their attempts to mollify and pacify are ineffective or temporary and that the family waits on tenterhooks for the next tantrum. Everyone is held to emotional ransom.
Children around them are asked to give in to them: let them have the toy, allow them to go first. Everyone gives in because they are unable to cope with the repercussions if they do not.
Parents are also distressed to find their troubled child can be vindictive in ways that alarm other children and shock adults. They can be cruel. They become disliked in school. Family life becomes miserable: defiance usually increases as adults try to curb it.
Among the so-called externalising disorders and disruptive disorders, oppositional defiant disorder (ODD) is categorised by the collection of anti-social behaviours described above, with a persistent pattern of negativism, non-cooperation and hostility.
Early preschool indicators in boys include high reactivity, an inability to be soothed and excessive motor activity, and although children may grow out of these behaviours, a number of studies have shown a correlation between early aggressive behaviour and later aggression problems if not addressed. Therefore, it is important that children receive help as soon as any signs of inability to cope are shown.
Sadly in the past, children who behaved in out-of-control ways were often regarded as bad. Now there is under- standing of the many complex and diverse interacting factors that can lead to disruptive behaviour in children.
The research literature includes: family problems; neurological damage caused by birth complications; low birth weight; social deprivation; learning impairments; early experience of neglect, rejection, violence or abuse; early institutionalisation; and the trauma of separations in early life. A genetic component may be involved and the disorder often runs in families.
Mothers who are depressed are more likely to have children with oppositional defiance difficulties as the mother-child dynamics are changed. It is hard for anyone who is depressed to manage young children, let alone cope with "disruptive" children and the chicken-and-egg nature of the problem needs to be teased out with help for both mother and child.
Also, whether it is the cause of the child's problem or caused by it, ODD is much more common in families when parents are fighting.
Disrupted childcare, with a succession of different carers to which the child either cannot form attachments or with whom attachments are sequentially ruptured, is implicated in children's disruptive behaviour.
Inconsistent child rearing is significant. As parents become exhausted by the daily battles, many say that they either give in or react extremely depending on their own energy levels and they know that this inconsistency makes it worse.
Children who, for whatever variety of reasons, behave in disruptive ways can be helped. Couples' psychotherapy and parenting programmes ensure gentle, consistent parenting, which focuses on rewards for desirable behaviour and fair but firm consequences for disruptive behaviour that the child understands and that are constantly applied.
Children also benefit by programmes to help their social interaction with other children. Multisystemic home-based family therapy is effective and it is important for families to see this as a family problem to be resolved, rather than a problem child to be subdued.
Any concerned parent should consult their GP for referral to their local child guidance or family therapy clinic.
mmurray@irish-times.ie Clinical psychologist Marie Murray is director of the Student Counselling Services in UCD