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Oppositional Defiance or Faulty Neuroception?

September 28th, 2016 | 71 Comments | Blog

Over the years I have come to believe that oppositional defiant disorder (ODD) is not a label that should be used to describe young children. As a developmental psychologist, I view oppositional defiance as a child’s response to stress. Viewing children’s challenging behaviors on a continuum of stress and stress recovery reveals a whole new way to think about this stigmatizing disorder, as well as a new way to support children, informed by neuroscience.

Consider the case of Timmy, an 8 year-old boy in the foster care system, who was diagnosed with ODD when he was four years old. His numerous behavioral treatment plans seldom improved his oppositional behaviors. Prone to constantly disagree, run away and hit others, the child had been placed in three different foster homes in a single year. At school, after he found out that a beloved PE teacher was suddenly transferred, he refused all class work and eventually threw over his desk, frantic, when the teacher asked him to line up for lunch.

Oppositional defiance? Hardly. The child was in a stress response due to challenges in his neuroception, the automatic and subconscious detection of threat, described by pre-eminent neuroscientist Stephen Porges, Ph.D.

Neuroception is the brain’s ability to detect danger. It’s how we distinguish whether situations or people are safe or threatening. Porges believes that faulty neuroception is at the root of many psychiatric disorders, including ODD. For many vulnerable children, neuroception is biased towards detecting danger when there is no real danger.  Faulty neuroception shifts the child involuntarily into a defensive position, resulting in a variety of challenging behaviors. This can result from a host of causes (but not limited to) constitutional; genetic or brain wiring differences; biomedical issues; environmental stress; or sensory processing challenges, which cause a child to perceive ordinary sensations as threatening.

It is essential to determine the exact cause on an individual basis. The sources of faulty neuroception are wide- ranging and depend on each child’s individual differences.  In order to help children, we need to provide the proper support to address the cause, rather than simply applying behavioral management techniques in isolation.

Currently, our most vulnerable oppositional and defiant children are generally managed with plans that work on eliminating unwanted behaviors, rewarding desired behaviors, or withholding treasured objects or experiences (such as screen time) as consequences to those behaviors. These techniques are often ineffective because they are based on a faulty premise: that the child has intentional control over those behaviors. If faulty neuroception is to blame, however, behaviors will be a reflection of an immediate, “fight or flight” response and not purposeful misbehavior. In such cases, punishment can potentially cause more distress, triggering additional feelings of threat rather than safety.

It will benefit all children when mental health and social service systems recognize faulty neuroception as an underlying commonality of many psychiatric disorders. This shift will help providers and caregivers move beyond current, often ineffective strategies for treating conditions such as oppositional defiance. Treatment techniques such as ignoring and withholding attention or desired objects are inappropriate when a child’s brain is experiencing the message that he is not safe.

As the first priority in treatment, we need to turn instead to the foundation of mental health for all human beings: nurturing relationships that consistently provide the healing messages of safety.  Working with qualified professionals, it is possible to help children with the most challenging behaviors.  Effective and long-lasting ways to help our most vulnerable children thrive should:

  1. Build or rebuild a sense of connection with trusted caregivers

All children, regardless of age, need consistent attention to their emotional and physical needs. This includes loving attention when they distress and the consistent support of an adult who will understand when challenging behaviors are a sign of faulty neuroception.

  1. Discover each child’s vulnerabilities and individual differences

Some children have unique characteristics that make calming more difficult including over or under- reactivity to touch, sound smell, movement, emotions, experiences of trauma, etc. Understanding each child’s individual differences and history will provide a roadmap to supporting a neuroception of safety.

  1. Help the child signal when he needs help and feels vulnerable

Oppositional defiance is often a reaction to feeling small, helpless and out of control. Encourage each child’s ability to signal (verbally or non –verbally) that he is beginning to feel uncomfortable or anxious.

  1. Provide the correct support for each child

Determine the best way to help children feel calm. Each child is different, so try a variety of methods to see what she enjoys. Play, cuddle, dance, sing, and try to figure out what brings the child joy. This will allow spontaneous social engagement behaviors to emerge that will support connectedness and biobehavioral co-regulation, resulting in her body and mind calming down and feeling safe.

Let’s move beyond the categorical checklists that describe symptoms in the absence of their causes, and view oppositional defiance in a way that respects the complexity of the human brain and the adaptations human beings make to feel safe in a world that often feels threatening. All children will benefit from this important shift in our understanding of oppositional defiance.

*Immense appreciation to Dr. Porges for reviewing this post and for his groundbreaking work.

*My new book explains the shift in understanding challenging behaviors and how we can utilize the powerful tools Dr. Porges and other neuroscientists provide to support children.

*I invite you to comment and join my Facebook page and community newsletter, for future blog post updates.

 

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  • B3long Blog

    Great article. I am a psychotherapist and foster/adoptive parent and write about therapeutic fostering and adoption. I’m going to share this great post on my blog social media – http://www.b3longblog.com
    Thank you!

  • Great! I’ll post this on LinkedIn!

  • mdelahooke

    Thank you so much! Our foster and adopted kids so need this compassionate understanding of safety and threat.
    Greatly appreciate your sharing.

  • mdelahooke

    Thank you Ella!

  • Fran S. Waters

    I think the most deleterious cause of faulty neruoception is child maltreatment-including emotional abuse and neglect. Abuse causes changes in the brain and children develop sensitivity to minor stimuli in which they see situations from fear based trauma lens.

  • mdelahooke

    Hi Fran, I agree with you. I’m very concerned for the children in systems of care, including the foster system, who have had trauma histories and are often treated with techniques targeting behaviors without consideration of their neurodevelopmental vulnerability.

  • Fran S. Waters

    I treat those children as well. You might be interested in my newly released book, Healing the fractured child: Assessing and treating youth with dissociation. I have dozens of cases on severely traumatized children and use Porges’ theory in treatment of these kids.

  • mdelahooke

    Congratulations! I look forward to reading it Fran. My book, also incorporating Porges’ work in for professionals working in early intervention will be out early next year. Glad these newer options are out there for parents and professionals.

  • Fran S. Waters

    Mona, Great! Please tell me the name of your book? I will look for it.

  • B3long Blog

    Thank you!

  • Julie Hahn

    I believe this ties in really well with the work of Richard Tremblay. His hypothesis is that ‘We do not learn to aggress. We learn to NOT aggress.’ His studies of men in prison demonstrated that they had in common that they had not learnt or been taught how to express their needs or emotions in a socially appropriate way during the first few years of their lives.

  • mdelahooke

    Fascinating. I have heard of him, and I’ll look up his work. Thanks Julie.

  • Liah

    I don’t know anyone who deals with ODD by punishment. Is that a USA thing?

  • mdelahooke

    Here in the U.S. challenging behaviors are often managed by reinforcing desired behaviors and ignoring non-preferred behaviors, which many feel is a type of punishment (ignoring). So it’s not the treatment for ODD per se, rather the way many systems in the U.S. view treatment approaches to challenging or non-compliant behaviors in vulnerable children.

  • sarahholdway

    lots do or fake rewards anyway in the UK and USA

  • 3xMommo

    This can be INFECTION based. Heal the infection, stop the behavior. Look up PANDAS/PANS http://www.pandas-syndrome.webs.com or this Harvard Study: http://www.health.harvard.edu/blog/can-an-infection-suddenly-cause-ocd-201202274417 Stanford has a clinic. ODD is many times based on an infection that has no outward symptoms, and blood titers must be checked. Start with strep, micoplasma, and HHV6 titers and go from there. Lyme is also a common cause. Looks behavioral on the outside, but it’s really a reaction to infection where the antibodies affect behavior. Weird, but true. There’s a new center opening in AZ. Sue Swedo of the NIMH is supporting it. https://www.youtube.com/watch?v=45tYYK5TAaA

  • mdelahooke

    Great point, and as I said in the article, sources of oppositional behaviors are limitless. This would fit in the biomedical category. Important information!

  • mum in oz

    Instead of taking “screen time ” for 1 hour which by the end of the episode is one day. What should we do. (son 12) Australia.

  • mdelahooke

    If negative consequences and reinforcers aren’t working, then looking at other strategies may be in order.

  • sarah

    The genetic cause would most likely be Pathological Demand Avoidance, an autism sub-type. Natural parenting techniques wouldn’t work with these children as the combination of autism and heightened anxiety makes learning natural cause and effect very difficult. Punishment based techniques often make behaviour worse as like you say, the cause is the fight, flight, freeze response, punishments will only further exacerbate existing fear. For these children the best techniques to use is to reduce demands, give the child more control over their environment and promote positive thinking. The best place for more information is the PDA society website.

  • mdelahooke

    This is very interesting Sarah. Here in the US PDA hasn’t had much exposure yet. I do see a subtype of children like this who experience stress responses on a frequent basis. Thank you for sharing!

  • Susan Hopkins

    To the readers interested in this topic: Here is Dr. Stuart Shanker’s blog from earlier this year that may be of interest: https://self-reg.ca/2016/06/05/self-reg-view-diagnosing-oppositional-defiant-disorder/

  • mdelahooke

    Thank you so much Susan! I will add the Mehrit Centre to my resource list. Excellent article.

  • Kelly

    I find this article very intriguing. My son, age 10, has about 10 different diagnosis to date. There are no two psychologists or psychiatrists that will totally agree. They are constantly throwing the other under the bus, particularly the psychiatrists throwing the psychologists diagnosis out the window. It is very frustrating as a parent and it leads to my distrust of the whole mental health field. We have gone leaps and bounds with OT and a pediatric ophthalmologist. He has sensory disturbances as a diagnosis……the OT and ped ophthalmologist agree. Yet the psychiatrist is refusing to take the label of ODD off his record claiming “it is just a label to describe behavior”. I agree with the anxiety diagnosis 100% yet his behavior is not out of defiance but out of anxiety and his sensory overload. We have also discovered he has vision teaming issues to boot. All of his senses are out of whack. My question is this, what will cognitive behavior therapy do for him? The psych recommends this to target his anxiety. We’ve been to two different therapists so far for help with his behavior. Not sure if this road is the one we want to take. Any advice would be great.

  • Susan Tang

    CBT therapy got rid of my panic attacks in under 6 weeks.

  • mdelahooke

    Dear Kelly,
    I understand your confusion as a parent! I have the same skepticism of my own field as far as these types of diagnoses and that is why I wrote the post. I wish I could give you specific advice, but alas I can’t. What I can say is trust your instincts and find mental health providers who understand the role of multi-sensory processing challenges and the role of inconsistent sensory processing in mental health issues. Its so important! There is a list of organizations in at the end of the piece and on the new post with clinicians in most states. Thank you for commenting and I wish you the best!

  • Thank you for a really interesting article! I have always HATED the diagnosis of ODD in younger kids. I would also say that your first solution — to foster trusted relationships — is SO key to many of my clients. Making sure schools have established a go-to “team” (so to speak) for kids with exaggerated stress responses is so key — they know and trust that there are 4-5 people in the school who “get them” and who have their best interest at heart is SO important and can change a lot. I’d also love to hear your thoughts on mindfulness, as the more I learn the more I think that there is NO time too early to learn mindfulness practices AND that kids are MUCH more capable of these concepts than we think. Thanks! I’ll be sure to share this article!

  • mdelahooke

    Thanks so much Erin! I totally agree about the “go to” team for kids, they need to feel safe in relationships especially at school. And yes, on mindfulness. In fact, in the book I’m finishing up right now I have a chapter on it. I think its helpful for parents, kids and professionals. And it helps soothe stress responses.

  • rbeckley10

    One such child suffered from continual dehydration and lack of exercise. His elementary school offered no PE, but only recess with good weather, and he was no good at traditional sports. So when he started carrying a water bottle, took up hip hop dancing and had PE in middle school, he was fine. As a parent, grandparent and teacher, I first look for physical reasons for continously difficult behavior.

  • mdelahooke

    This is such a good reminder that we must always look for those reasons behind behaviors and not make assumptions. Thank you for commenting.

  • Homeschooling2e

    Wow, thank you for this! One of my son’s doctors believes he has ODD, and I don’t think it fits. I believe that he has PDA – pathological demand avoidance (and the other specialists thinks he’s on the spectrum despite acting neurotypical most of the time.) I’m his mom – I know he’s constantly in fight/flight mode despite everything we do. Anxiety and SPD are so difficult for the child to handle. Especially at 5 years old!

  • mdelahooke

    Thanks for commenting. I couldn’t agree more that as his mom you know him better than anyone else does! It’s so important to look at the developmental pathways that lead to anxiety (fight or flight mode). I hope that you find professionals in your area who can be helpfully supportive to your family and precious son.

  • Sharon Vandivere

    I am new to your blog and I COMPLETELY agree with your post. Another report that is consistent with your assessment comes from the Society for Research in Child Development: http://www.srcd.org/sites/default/files/documents/spr_28_1.pdf

    As a researcher, I am also concerned with the emphasis on evidence-based interventions. Of course I value research, but I fear that many evaluations do not focus on the right outcomes (for example, they focus on behavioral symptoms, as you say) and they have too short a follow-up period. This can result in interventions that are not helpful–or that possibly may even be harmful in the long run–becoming popular. I wonder if one example might be Parent Child Interaction Therapy (PCIT). While the child-directed interaction of PCIT is likely helpful with attachment, because it focuses on building the parent-child relationship in a positive way, I am worried about the parent-directed portion (which is an approach for managing behaviors with time-outs, and is negative and controlling). Yet without such behavior management strategies, parents are at a loss about what to do! I am also a parent of two children adopted from foster care who have trauma histories, and I struggle with maintaining my own emotional regulation in the face of their defiant behaviors which are pretty darned annoying.

    Over the last decade or so, as I am sure you know, there has been a push toward legal permanency for kids in foster care, resulting in higher rates of adoption. But we have no idea what happens to these kids after the adoption is legally finalized. I am really worried that many of the kids who may have been adopted–even those adopted at young ages, but who experienced neglect as infants and toddlers–may end up with problems due to trauma histories that aren’t too hard too deal with when children are young, but become overwhelming for parents as the children reach adolescence. And after the adoption is finalized, the system has generally washed their hands of these families (not that the system knows how to help them). I think some progress is being made–e.g, with Trauma Focused Cognitive Behavior Therapy, Trauma Systems Therapy, and the ARC (attachment, regulation, and competency framework), but not enough, and not fast enough!

  • mdelahooke

    Hi Sharon, YES to everything you wrote! I share your concerns and the concern for our most vulnerable children in the foster system. Thank you for writing. A colleague of mine, Connie Lillas is doing a pilot program with the foster system. If you email me I would like to introduce you to her and her work. I”m thrilled to hear about your concerns with emphasis on evidence based programs. The complexity involved in research on relationship-based developmental models makes it more difficult but it doesn’t mean there are not significant benefits. Especially in the case of trauma. So glad to know of your work… stay in touch.

  • Janet Schultz

    Could this be the issue in a 15 nearly 16 year old?

  • mdelahooke

    Hi Janet, Absolutely, this is a developmental, as opposed to chronological issue.

  • Fanny James Collings

    Is this another more extreme form of disordered attachment? If an attachment pattern is triggered as a stressor response that activates flight/fight mode (depending on avoidant or ambivalent pattern)
    Interested as a therapist and educator currently doing an MA Developmental and Therapeutic Play

  • mdelahooke

    Hi, and fabulous question. The way I see it is that there is a feedback loop between relationships, and physiological and emotional state regulation. So the neuroception of threat is experienced by children with relationships that are not safe. It’s a more wide angle view of attachment and more informative to parents and professionals, in my opinion. Congrats on your interesting program and MA! Stay in touch!

  • Robert Bowman

    Hi, what a terrific article. Thank you. As parents of a nine year old boy who is quick to see danger in any situation and resorts to the flight or fight mode, this is such a useful article and I’ll be forwarding it to his teachers. We’ve had a hunch and been working on our reaction to his reactions over the years and the calmer we can be and get into rapport with him in those moments, the easier it seems to bring him to a place of happiness and calmness. His current teacher struggles with his ‘swings’ and we’ve been trying to coach her, but this article will be a really useful for her and the other teachers at his school. Thank you again!!!

  • mdelahooke

    Thanks Robert. I’m so glad that it may be useful, and truly hope that more teachers will see these reactions in kids as adaptations and not purposeful misbehavior. Thank you for commenting!

  • Tamara Rae

    Have you heard about pathalogical demand avoidance? It’s only recognized in parts of the UK but it’s on the asd spectrum and it’s very similar and the approaches you suggest are also similar to what works with pda, I think that the two are just different ways to see the same neuro divergence. I think avoidant personality and borderline are part of it too.

  • Kevin Schonrog

    I am an elementary school social worker and I was so glad to find this article. I am a currently working with teachers to develop trauma informed classroom practices and this article is a very nice addition to our discussion and toolbox. Thank you!

  • mdelahooke

    Yes, I have and I think there are so many similarities, especially in the underlying causality. Good point.

  • mdelahooke

    You are so welcome and thanks for commenting. I hope my book will be useful as well. It is in line with trauma informed practice– so needed in educational settings. Kudos on your work in this area Kevin!

  • Tamara Rae

    Thanks!

    I’m a mom (who likely is pda as are my kids (all three one dx asd one ADHD odd gad and gifted) and I’ve been dx borderline and my brother avoidant personality) so this means a lot to me. There’s so many of us who felt a wave of relief when we learned about pda. Now we need awareness and for the research bodies to research all of these label together rather than in a vaccuum.

    Even npd I think may be realated my dad growing up easily could have gotten an NPD dx but he actually changed the last two years of his life he gained awareness and rather than facing those feelings of remorse and regret he let himself go with his diabeties- ultimate avoidance. Pretty sure he was pda too.

    One more thought, we also have Ehlers danlos and mast cell activation and there’s new research coming out linking asd with both eds and mcad. I’m greatful that I’m alive in this time most of my life I’ve been brushed off and dismissed and these things are real. So much hope for all of us even the pandas kids because really I think that’s just one way mcad manifests in some (allergic response to a pathogen)

  • wgb

    I believe my son has a rather severe oppositional defiance disorder, but when he takes ADHD medication, I would say the symptoms almost completely vanish. Do you have an opinion about the effects of ADHD medication on ODD?

  • wgb

    I believe my son suffers from ODD. When he takes ADHD medication, the ODD symptoms seem to vanish. Do you have an opinion about the effects of ADHD medication on ODD?

  • mdelahooke

    I”m not a physician so I can’t comment on that, but it’s important to consider patterns as you are doing, and share your observations with your child’s healthcare providers.
    Wishing you and your son the best..

  • singlemumselfemployed

    You may find that removing certain foods from his diet will have the same affect and medication is no longer needed which is known to cause serious long term harm. The common foods are gluten and casein (milk protein). For some children also removing soya, msg, sweeteners esp aspartame can also help. Also giving B supplements and fish oils.

  • singlemumselfemployed

    The schooling system treats children in such a way that causes more stress to these children and the behaviours talked about in this article. They use punishments including taking away their play time which is essential for their well being and often isolating them which causes more stress and fear. I home educate my children and they are free to learn what they choose and follow their passions and interests. I never punish them but we work together to find solutions so everyone is happy. They are children with high anxiety and this way of life has helped them so much so i absolutely agree with what this article is saying.

  • mdelahooke

    Thank you, and I agree about the downside of taking away play time. It is the opposite of what vulnerable children need. Thanks for commenting!

  • Denielle Carie

    My daughter was diagnosed with ODD & ADD @ 10 yes old. After seeing the negative effects of the medicine, we decided to change her diet. I only allow my children milk in baked items (so not often) and don’t notice the behavior escalating when they have it. Although we eliminated artificial sweeteners, preservatives, food coloring & artificial flavoring. In doing this the symptoms disappeared. We started 6 years ago. My other 3 children are fine until they eat something with the ingredients above. But since my daughter started working & eating @ work her ODD @ ADD issues have come back 10-fold. Being a month shy of 18, I cannot do much. But I do know that my younger 3 are doing fine and no meds. 2 have ADHD.

  • Anne Duke

    My son was diagnosed with ODD (I also think he has ADHD but no diagnosis) he is now 22. School was a very difficult and damaging experience. Life is still challenging for him and for us as parents, especially during times of stress we see an increase in ODD behaviours. I would like to know your thoughts on ODD in young adults and how to manage these tendencies.

  • mdelahooke

    It is true that school is so difficult for children with this vulnerability and I’m so sorry to hear of his struggles. I”m doing all I can do to help educators, beginning in preschool, to have a new lens and see these behaviors as stress responses and not purposeful misbehavior. As far as managing, the process is the same regardless of the age. Have a support team and qualified professionals that respect individual differences, view parents with respect and use compassionate, relationship- based approaches that are consistent with neuroscience. Wishing you all the best.

  • suevv

    What a fine articulation of something that is so hard to explain. My shorthand for this is “can’t, not won’t.” I think my son’s life changed when he was 5 and suffering in kindergarten so profoundly. Seeing his grief over his struggles helped me adopt “can’t, not won’t” as my DEFAULT assumption when he had trouble. I couldn’t believe he’d keep “making bad choices” when those purported “choices” made him so, so sad. Sometimes it really was “won’t,” and we handled that with routine discipline. But when I started paying attention I realized how often it really was “can’t.” And every single behavior modification strategy in schools is premised on the idea that the child just “won’t.” How utterly devastating for a kid who is trying so hard, seeing others succeed, and repeatedly being told that his failed efforts mean he is BAD. Having one trusted adult with the “can’t, not won’t” starting assumption seemed to give my son what he needed to finally exit the perpetual fight or flight mode he had entered. And then he was able to start building a fuse that gave him room to catch himself. Or signal for help. Or all the other things we expect these kids to do, even when their brains are pushing them into that instinctive, defensive, nearly animal place. Can’t. Not won’t. All is not perfect – but it’s so much better. Thanks for this article.

  • mdelahooke

    Beautifully stated! How wonderful that you understood this for him. Thanks for sharing!

  • ‘Can’t help won’t’ is a common phrase used by those living with children who have PDA – Pathological Demand Avoidance, a type of autism spectrum condition. These children (and adults) show extreme anxiety when they feel they are not in control, and they struggle to meet everyday demands. There has been a lot of research done on this in the UK and you can find several bloggers telling their story and explaining in more detail..

  • Angela

    Singlemumself employed: Can you list the long term harm and identity the source of your info please??

  • Bridget Spaeth

    Iv been diagnosed with ODD when I was about 7-8. Back then they didnt really know much about it or the cause of me behavioral issues. When you grow up having ODD you know right from wrong but that doesnt stop you from acting out or doing the negative behavior. Its truely a fight or flight response and kids with ODD seem to get in all sorts of issues. Growing up iv been in and out of hospitals, special schools, on so many meds it was very overwhelming and stressful. Im glad i found this page because i can finally understand more of why i couldnt ‘learn from my mistakes’ why i was a ‘problem child’ and it makes much more sense. Its all about how people handle the child with ODD. Like this artical said you need to find what is best for that specific child. Just like Autism each need is defferent and each child takes critism, corrections, and responses differently which effects their stress triggers. I was like a lab rat to the phychiatrist n doctors. But it all came down to a structure enviroment that i knew well. Dealt with same teacher, same schedule, same relationships. Eventually, in my own experience, i learned to adapt to change and stress with basic stress relief stategies over the years. Im 25 right now and living on my own and doing well. However i missed out on mostly all of my childhood because the adults in my life wasnt sure how to help me until i was almost in highschool. Thats why we need to share this info about ODD and Autism and any other special needs a person may experience so others will know other ways to help them in the long run. I dont want any child going thru what i did growing up. Dont get me wrong i have a loving and supportive family and they risked alot trying to help me however we now have the means to understand more about this disorder and we should share the suport to those families needing it. Love yall????

  • mdelahooke

    Bridget thank you so much for this beautiful narrative of your life journey. I’m sorry that the systems failed to help you in the way you truly needed, and so happy to hear that you are doing well now. That is exactly why I started this blog, to let parents and individuals know that there is a whole new way to view developmental and mental health differences. It goes to compassion, understanding and love. Thank you, wishing you the very best!

  • sister_h

    Dealing with young children who are anxious or who have needs that they cannot articulate requires a parent/caregiver who is observant, self-aware, empathetic, analytical and who has confidence and self-control as well as a willingness and ability to do a lot of problem-solving. This is difficult!! Many parents opt for a one-size-fits-all (or none) parenting philosophy in which any failure belongs to the child. The article has great insights. I hope that parents will get the help and training that they need. My husband and I went to joint counseling to help whip us into the best possible shape for addressing our young son’s difficult needs. We were really into it, and yet I think we only did “okay.” At least our son still loves us and is receptive to us, an outcome that seems impossible (we’ve seen this in some families we know) if the child’s emotional needs are not satisfied in the rush to discipline and manipulate him/her. Good luck, parents! Leave no stone unturned in the effort to figure out this difficult but crucial problem!

  • mdelahooke

    Well said! And self-compassion as parents is so critical, as this road is not easy. Thank you for commenting!

  • mdelahooke

    Yes, thank you! I agree that these labels are all describing the same underlying processes, difficulty regulating emotional and physiological state. Thanks for sharing!

  • mdelahooke

    Thank you!!

  • Suzanne Daly

    Excellent articleSo much easier to put a label and then use bandaid such as prescription medication as an excuse for not taking the time to understand the source of the behaviour in an individual ..I do hynotherapy and teach patients to llearn to relax as an off shoot and it is amazing how many” bad behaviours “”,development delays
    “and ‘autism spectrum disordets are ameliorated.

  • Rachel Hoskins

    YES!!!!!!!!!!!!!!!

  • mdelahooke

    Yes, I do agree Suzanne– Thanks for commenting!

  • mdelahooke

    Thank you Rachel!

  • DeSpence

    My son is 8 and has been thrown all sorts of letters for what’s wrong with him. I have a nagging question at the back of my mind, because I’m a working mom and constantly feel guilty. This, and so many other diagnoses, seem to have popped up in the last 30 or so years (I’m 35 and my 3 year younger brother was probably a mix of some letters himself, but no one ever thought anything of it other than “boys will be boys”). Does the increase in all of these behavioral “conditions” correlate with the increase in women working while raising kids and other societal influences/factors? I’m guilty enough about that aspect that we are trying to relocate to an area where I can stay home and just be a mom and wife for my kids. But with my husband’s job, it can take months to have an answer, so we are in limbo. Our school system locally is awful when it comes to outside-the-box kids, even if they’re an IEP in place. I don’t know whether to even try in a new area for public schools, or not, or just try homeschooling so that I can actually get to know my son on that level. Can you tell I’m one stressed out mom?

  • mdelahooke

    Yes, I can but know that you are not alone in experiencing maternal guilt. Relationships matter, but studies do not show that children whose mothers work necessarily have more challenges. Having said that, as this article said, I agree with Dr. Porges that the child who struggles needs massive cues of relational safety throughout the day. This should be the responsibility of everyone in the child’s life, including school. Wishing you the best, take care of yourself, mom. You are so valuable to your child and everyone around you!

  • DeSpence

    Thank you for responding!! I really appreciate your advice. 🙂

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