ENG_ODD Oppositional Defiant Disorder – Primary school

ODD - Oppositional Defiant DisorderPrimary School

INTRODUCTION

By the term ‘Behavioural Disorders’ we refer to the condition of children who display aggressive behaviour, difficulty to regulate their emotions and little respect for the rules given by teachers and parents.

These characteristics must be present almost every day for at least six months and usually occur in both the family and school environment.

Some children develop this symptomatology due to a lack of basic emotion regulation, often associated with marked difficulties in attentional skills; others tend to show their greatest difficulties in the area of compliance with rules and are also characterised by deficits in empathic skills.

Oppositional behaviour is part of a typical developmental trajectory as it is one of the expressions of the child’s desire for autonomy.

In typical development, oppositional behaviour therefore has the function of seeking autonomy and one’s own identity: in these cases, the child opposes rules because she/he sees them as restricting her/his will to explore.

This behavioural pattern usually tends to give way to more controlled and mature patterns of behaviour, associated with a set of norms that allow one to manoeuvre within different life contexts.

When this does not happen and this tendency towards hostility becomes chronic, difficulties also appear with regard to adaptation, family relationships and later social relationships with the peer group.

Oppositional Defiant Disorder (ODD) takes the form of a pattern of irritable and choleric moods with provocative, argumentative, vindictive and defiant behaviour. One of its fundamental characteristics is that these patterns are frequent, persistent and generally pervasive, i.e. present in multiple environmental contexts.

It is precisely the pervasiveness of the disorder’s symptoms that is generally an indicator of its severity. In addition to pervasiveness, another specific indicator for distinguishing age-typical behaviour from symptomatic behaviour is the numerical threshold of identified behaviour.

An important aspect to consider is that children with ODD often do not see themselves as short-tempered or irritable but tend to view their negative behaviour as a response to excessive demands from the environment and often justify it as a consequence of the malicious intentions of others. Due to poor emotional/behavioural control and evaluation bias towards the intentions of the external environment, children with ODD experience frequent conflicts both with authority figures, whatever they may be, and with peers within friendship relationships.

The disorder has a higher incidence in families in which rigid, coercive and ineffective educational strategies are used, as well as in families with a disadvantaged socio-economic situation, and this indicates that the family constitutes a very important risk/ protective factor in the development of the disorder. However, it is difficult to define with certainty the contribution of the two parties (the caregivers and the child) in modifying the likelihood of the child developing certain symptoms: is it the caregivers, with negative parenting styles and inadequate educational strategies, or is it the child who influences parenting styles due to a difficult and tenacious temperament?

The prevalence of ODD is around 4% of the primary school age population. The disorder seems to have a higher prevalence in boys than in girls (4:1); some authors claim this to be 3-4% for boys and 1-2% for girls. It also appears that girls generally display oppositional characteristics compared to boys, who are more often seen as aggressive children.

In the majority of cases, the symptoms of ODD occur during early childhood, rarely after adolescence; often ODD precedes the development of a Conduct Disorder (CD), although not all children and adolescents with ODD evolve in this direction. DC is a severe conduct disorder in which symptoms include aggression towards people and/or animals, theft, deception or destruction of objects or property. It is recognised that the transition from ODD to DC is all the more likely the earlier the onset of symptoms and that some of the symptom-behaviours tend to increase, both in frequency and intensity, during primary school.

The risk factors that the scientific literature indicates as underlying the etiology of PDO are diverse and of a different nature.

Temperamental factors: these are constitutional characteristics of the child, partially modulated by the environment. A child with a temperament with difficulties in regulating emotions of fear and sadness would be at greater risk.

Environmental factors: as previously told, the family context and parenting play an important role, being both risk factors, when inadequate, and protective factors, when appropriate. It has been observed that quite often, in families of children with ODD, the parenting style uses inconsistent, coercive and/or rigid educational practices.

Genetic and physiological factors: several genetic markers are associated with this disorder, which then define functional and/ or structural abnormalities of the individual’s nervous system. Some of these markers are linked to poor attentional skills, while others indicate difficulty in developing empathy and interest in others.

There are several conditions in which ODD coexists with another diagnostic entity, first and foremost ADHD: in fact, in samples of children, young people and adults with ADHD, there is a high number of subjects also diagnosed with ODD, probably due to risk factors shared by the two diagnostic entities. We could say that about one in two children with ODD also has an attention problem. In these cases, the primary problem is the attention deficit, which causes the child greater difficulty in meeting the demands of the environment and respecting the time dictated by adults, whether these are related to learning or behaviour. Such difficulties expose her/him to numerous experiences of frustration and it is precisely that frustration that is the spark that ignites oppositional and aggressive behaviour. A further characteristic often observed in children with attention difficulties and ODD is low self-esteem. Frustration after frustration, failure after failure, these children become convinced that there is something wrong with themselves and this can lead them to avoid and oppose any requests that come from adults.

Each of us has something that we are convinced we will never learn to do. Now, try to imagine for a moment that you find yourself every day in a context that asks you to do that very thing; imagine that you find yourself every day next to other individuals who manage to do that very thing. How would you feel? Wouldn’t you feel frustrated and sad? Wouldn’t your self-esteem worsen day by day? Although perhaps the more important question is: what would you need?

A different characteristic, often present in children with ODD, may be poor empathy towards others and little sense of guilt and remorse after doing something wrong. In the latest diagnostic classification manuals, they are described as children with oppositional and aggressive behaviour also characterised by poor pro-social emotions. Some children with ODD, therefore, manifest episodes of behavioural difficulty alongside anaffectivity, little sense of guilt or remorse after having made someone suffer, little

interest in their school performance, and low sensitivity to punishment. These children with ODD tend to manifest cooler aggressive behaviour than other children, premeditated behaviour aimed at gaining some kind of advantage or domination over others. This is why it can be particularly difficult to relate to children with ODD and little empathy. Biological vulnerabilities and peculiar family contexts have made these children uninterested in relating to others and apparently insensitive to what is going on around them. Our hope is to offer some useful pointers so that school and the relationship with the teacher becomes a training ground for them in which to develop their empathy.

What if it doesn’t work? The importance of perseverance and compassion for oneself

When a child manifests his or her discomfort through behaviour at school, this discomfort reverberates in the teacher’s body and mind. This discomfort is difficult for the child to explain and impossible for the adult to fully comprehend. The teacher thus goes about seeking and designing the best way to help the child in distress and the class in which he or she is placed.

This book aims to indicate some ways to ease the difficulties of children and their teachers. It can be seen as a recipe book that aims to mix the best ingredients that science and clinical experience show to be the most effective. But anyone who has ever set to the cooker is well aware that - even if they buy the best raw materials and refer to the recipes of starred chefs and put their heart and soul into the preparation of that dish, the result is never solely under the control of the ‘cook’. Experience helps, just as it does in the kitchen, in dealing with the difficult child, but it is no guarantee of a result. If we do a job that is based on human relationships, everything is unpredictable and much depends on factors that are beyond our control: the mood of the child or events in his or her

life as well as the mood of the adult involved in the relationship and events in his or her life.

The teacher’s job is even more complex because he or she has to cope not only with the unpredictability inherent in relationships with each of the children in their classes but also with the unpredictability of the school environment. Not to mention all the events that in recent years seem to have made the life of every human being more unpredictable and complex.

All this leads one to consider the teaching profession as a job that brings stress as well as joy and satisfaction. Whenever a human being perceives a situation of unpredictability, she/he perceives this situation as a threat, which automatically activates all the alert systems present in the human central nervous system. It is no guilt to feel under threat: it is a psychophysical state determined by what our central nervous system automatically reads in context. Whenever a child engages in one of the many behaviours described in this book, we feel triggering sensations in our body (accelerated heartbeat, sweating, increased body temperature). In such cases, the first thing to do is not to do. This does not mean to remain impassive and calm, but to be aware of one’s agitations and to take a break for a few seconds before acting. What is the advice? Whenever you notice in a child any of the behaviours described in this book, first centre your attention on your body and try to take three slow breaths, then try to remember what you have read or what your experience suggests. It may seem a trivial suggestion, but numerous studies show that following the breath can help with less emotional activation.

On the other hand, it is unthinkable that breathing works with absolute certainty and under all circumstances. So we come to the starting question of this paragraph: what if it does not work? When the human being fails at something, she/he has three enemies that arise in her/his mind. The first is the negative judgement towards oneself: ‘I was not good enough’. The second is the feeling of loneliness: ‘These things only happen to me’. The third is the feeling of not being able to detach oneself from the negative

emotions that seize us at the moment of failure. This happens as much in the mind of the adult as in that of the child.

As human beings we have a great resource that can act as an antidote to these poisons of the mind and this resource is compassion. The first step to activate it is to recognise failure and share it with the child: “We didn’t make it today. I am sorry and I think you are sorry too”. The second is to turn this compassion towards ourselves by saying in our minds kind words: “You tried your best, I understand that you feel this way”, while also trying to think that probably during those same hours many other teachers experienced the same feeling of defeat. Numerous studies in the field of self-compassion show how persevering in this attitude towards ourselves brings well-being to the human being and her/his relationships. It can certainly help to judge ourselves less negatively when the interventions we try to put in place for the well-being of children do not work as we expect.

FREQUENT FITS of rage

WHAT TO DO WHY DOES SHE/HE DO THIS?

Because she/he experiences emotions, especially fear and anger, in an all-encompassing way. For example, the fear of not being able to cope with a task, or anger resulting from rejection by a companion, generate very intense emotions and make it difficult for her/him to adopt the most functional attitude to deal with these emotional storms.

Observe and wait before intervening. Every word said while the child is ‘in crisis’ amounts to petrol on the fire

Validate the fact that one can feel anger when things do not go our way. Making her/him feel understood, and not different, will help her/him regulate her/himself.

Also pay attention to the rest of the class, making everyone realise that this is a passing storm

WHAT TO AVOID

DO NOT raise your voice and do not get too close to the child to try to contain the crisis

DO NOT emphasise the difficulty in adjustment without proposing useful alternatives

DO NOT punish the child during the crisis: you will only increase anger and frustration

What to keep in mind

The child who often has fits of rage suffers greatly in all those moments of dysregulation. If she/he could regulate her/himself she/he would. Surely, therefore, she/he does not do it on purpose. Trying to tune in to her/his suffering can help her/him maintain the self-control necessary to deal with the situation in the classroom. How to do this? Try to think of an episode in your life when you were overwhelmed by an emotion: did you not suffer? Wouldn’t you simply have wanted someone to be there for you?

Intense emotion activates the body: it is energy seeking an outlet. Promote functional ways of expressing anger, which help to release the energy: running in place, clutching a stress ball, crumpling one or more papers, scribbling freely.

If the child is too emotionally ‘excited’, it will be useless to try to activate self-regulation mechanisms in her/him based on cognitive strategies and dialogue. It will be useful, rather, to let her/ him partly vent this energy and, when she/he is calmer, talk to her/him and understand the reasons for the crisis and/or provide more ‘cognitive’ tools and indications. Trying to talk to her/him when her/his emotion is at its peak would be like trying to communicate from the ground with someone on an aeroplane: we can shout or shout all we want, but she/he cannot hear us.

It can be useful to explain to the other pupils

in the class what lies behind these crises. The question “Have you ever felt a very strong emotion?” can be either the starting point for structured activities to be done in class or an explanation to be offered to the class during a child’s crisis..

Also pay attention to your emotions and try to regulate them as best you can. Continuing with the aeroplane metaphor, it is like when flight attendants advise the adult to put on the oxygen mask before putting it on the child, in case of an emergency: at that moment, it is crucial for the adult to be conscious and able to think clearly in order to ensure the child’s safety.

Also, remember that emotions - no matter how intense or prolonged - are temporary: they cannot last forever. The way the physiology of human emotions works, fits of anger will naturally subside in about five to ten minutes.

In an ideal world, one could let the child vent her/his anger without anyone intervening with harsh words or non-functional behaviour, then guide her/him to become aware of the overreaction she/he has had, accepting it and validating her/his suffe-

ring at that moment, and return to class in peace. We are aware that the reality is very different: there are a lot of children in the classroom, programmes and timetables to respect. Every step towards a more functional behaviour is however useful, it is a concrete help towards a greater ability to regulate oneself, towards building a meaningful relationship that can motivate the child towards the school environment.

How to intervene

The first thing to do when faced with an anger crisis is to discipline yourself: breathe! Try telling yourself: ‘I am in a difficult situation; it is normal that I feel fear, anger and worry, but I want to find a way to help my pupil’. Try to notice all the thoughts crowding into your head without letting them catch you. It is normal for the mind to generate worrisome thoughts at such times - it happens to all human beings - but they are not useful thoughts, so one should not devote one’s energies to them. Instead, focus on your breathing and deliberately slow it down. This simple behaviour can have calming effects on your heart and mind; it allows you to maintain a more welcoming tone of voice, posture and attitude and can help you find more ingenious strategies to help your child adjust. Later, at the end of the acute crisis phase, this experience can also be shared with her/ him.A few hours after the crisis, it is useful to consider the antecedents. Create a diary in

which you note down what happened immediately before the crisis. After a few weeks, these notes will enable you to identify specific activities or times of the day when the crisis is most likely to occur and thus to pay more attention to their management. Create a ‘strong emotions corner’ in the classroom (or school) where children can go to ‘vent’ when they feel them.

A good idea

Provide an ‘anti-fire’ box in which all children in the class can share tips and strategies for calming emotions. Once or twice a week set aside time to read them in class.

SHE/HE DESTROYS school material

Because this behaviour is part of the core of provocativeness.

Because she/he clumsily tries to get attention.

Because she/he feels strong anger or frustration and vents it destructively on objects.

WHAT TO DO WHY DOES SHE/HE DO THIS?

Promote respect and kindness not only towards people but also towards things

Set up a corner of the classroom or a box in which to keep anti-stress material

If the destruction of the material becomes excessive or dangerous for her/him or her/his teammates, intervene with a timeout, stopping it firmly

WHAT TO AVOID

DO NOT immediately resort to punishment: if the child was acting impulsively driven by anger or frustration, she/he will feel more of it; if she/ he was doing it as a dysfunctional attentionseeking strategy, you will reinforce the behaviour

DO NOT pay too much attention to these behaviours when they occur in a minor form

DO NOT raise your voice and do not devalue her/ him with phrases like ‘You are always the same’.

What to keep in mind

Most of the time, a child with ODD has not acquired a sense of his/her own value as a person, let alone that of external objects. Often parents, especially when they are particularly fatigued/ exasperated in dealing with their child, tend to buy her/him things or leave her/him free to use whatever she/he wants, at home, in order to ‹keep her/him quiet›, see her/him calm for a while and avoid yet another argument. The message they thus convey is more or less ‹these things are of no value, just keep quiet›. While providing a few moments of peace in the short term, and therefore understandable, these strategies do not train one to tolerate frustration, nor do they educate one to value and respect things. Moreover, together with other factors, they can lead to the development of narcissistic traits: everything is due to me.

It is important, therefore, that other adult educational figures, primarily teachers, try to convey a different, more functional message about the respect and kindness that both people and things around us deserve. Studies on communication have shown that the verbal content of messages has - compared to non-verbal content, tone of voice, posture, facial expression - a far lesser impact on what is understood and processed by those who receive them. It follows that if we want to express credible invitations to kindness, we must do so by showing kindness.

Remembering that it is our task to be models of what we want to see in our pupils is a good guide for working on our own behaviour. Children’s behaviour is often a mirror of that of their reference adults; as teachers, you have the opportunity - and the gre-

at responsibility - to provide a different example for several hours of the day and 9 months of the year, and with it the best learning opportunity for many children. Similarly, set a good example by tidying up materials at the end of a lesson and reinforcing kind behaviour towards them, even in a blatant manner. For example, while putting away a notebook in your bag you could say: ‘I have to be careful how I put this notebook away, otherwise it will get ruined’, in a clear and kind tone of voice.

How to intervene

It can be useful to keep a few plants in the classroom - or to have a small vegetable garden at school - to take it in turns to take care of, so as to have a practical reminder of what it means to ‘take care’: if I treat the plant well, water it, keep it in the light, remove dry leaves, it will grow luxuriantly; on the contrary, if I give it too much water or too little, neglect it, it will turn yellow and then probably die. In the same way, many other classroom and material care activities can be promoted, with the rotation of responsible children, such as waste separation, cleaning up after recess, tidying up common school material, and the lost and found basket.

Adopt, among the class rules, those of ‘being polite’ and ‘having respect’, so that there are clear and shared points to refer to in the event of difficulties or destructive behaviour towards school material (be it one’s own, common or others’). If necessary, use the timeout, a short period of time in which the child can stop, calm down and possibly apologise.

Much of the destructive behaviour towards the material catches the attention of classmates and is a source of hilarity for them. It is important, while remaining calm, to discourage the rest of the class from giving further attention to these inappropriate behaviours, because doing so eliminates the most powerful source of reinforcement: the attention of others. At the same time, ‘reward’ the children, especially the one with ODD, by giving them attention when they behave appropriately, when they tidy up, when they pick up a dropped object from a classmate, when they differentiate waste correctly, etc..

Provide an alternative to destroying or throwing objects, one’s own or those of one’s classmates, as a strategy to vent during a crisis of anger or frustration. Collect, bring and make available in the classroom an ‘emergency kit’ with stress balls, pillows, soft toys or squishies to squeeze, objects to squeeze that do not deform much, or anything else that can be useful for venting energy without being destructive and that all the children in the class can use when they start to feel very strong emotions. Objects to blow into can also be useful, so that they can regulate their breathing and, consequently, their anger.

If the child damages someone else’s object, it is useful to explore, without judgement or accusatory tones, how they might feel if they had ruined one of their own objects and the possible alternatives, since we do not all react in the same way, then lead a discussion on how the other really felt and promote ‘repairing the damage’ with an apology or concrete acts to restore the situation.

A good idea

Think up and propose activities that value school material, which is often taken for granted or devalued. For example, “I observe the object for the first time”, a small competition in which the winner is the person who finds the most details in a school object chosen from among those that the children in the class own. Similarly, you can invite them to find as many possible uses for it as possible, from the most traditional to the most imaginative. The activity can be concluded by thanking the object for having entertained us.

SHE/HE IS deliberately spitefull

Because spitefulness acts unfiltered, partly due to marked impulsiveness, partly due to heedlessness of consequences.

WHAT TO DO WHY DOES SHE/HE DO THIS?

Because the reinforcement she/he gets from peers, in terms of attention, and from the interruption of a ‘boring’ activity helps to maintain the behaviour.

Try to make the child reflect on what he or she has done, promoting a discussion of the emotions felt by the other child and encouraging an apology as reparation for the ‘damage’

SEstablish together with the children a gesture that represents a ‘stop sign’ to communicate that you are not willing to take a joke

Reinforce the child as he/she relates to the other in an appropriate manner

WHAT TO AVOID

DO NOT give attention, however negative, to the child only at the moment of spite, you risk encouraging this mode of relationship

DO NOT use devaluing phrases against the child, such as ‘This is childish behaviour’.

DO NOT side with classmates who complain about the child’s behaviour

What to keep in mind

All children love to tease, play by making others laugh and make themselves the centre of attention. During development they learn that these behaviours can also have negative consequences, first because they can be associated with punishment for themselves and then because they can hurt the other person. In typical development, the desire to avoid negative consequences for oneself and empathy for the suffering of others help the child learn to keep the urge to spite at bay. Some children with ODD are insensitive to punishment and disinclined to tune into the suffering of others.

As already mentioned, these children find it hard to realistically imagine the consequences of their actions, so they often have difficulty understanding where to draw the line in jokes. Guilt is limited, as is the resonance of the other’s emotions. Very often the emotional response of the other is not actively monitored, so they do not even realise what emotions they are arousing in the ‘victim’. While in typical development, automatic brakes are formed on behaviour that might hurt the other person, some children with ODD have them underdeveloped.

Children with ODD often have poor interpersonal skills and know few ways to establish and maintain relationships as well as to engage the other person or talk to them. Their strong impulsiveness and low ability to read the other person’s mind mean that they may propose themselves in inappropriate or frankly annoying ways. Constant recourse to spite or teasing is one of the main ways in which they obtain attention and closeness, without the

slightest consideration that the other may not appreciate such ‘displays of affection’. Sometimes, parents’ ways of relating are very much based on joking and more or less playful denigration, so that children tend to repeat, in their own way, the models observed and experienced in the family. Teasing, joking or provoking the other person succeeds very well for them: it allows them to get attention, often to make the people around them laugh, to create a moment of respite during class. This - compared to the frustration they often feel at school because they cannot behave adequately for the whole hour or morning, the experience of exclusion by their classmates due to constant over-the-top behaviour, or the difficulties at school - is particularly attractive to them. Spite, joking or teasing have the precise function of gaining recognition: they are one of the few ways in which it is possible for them to feel capable or at least considered. The ways in which they manifest these behaviours are varied and often depend on the response they get in the various environments: if they continue to make a certain kind of joke, it is almost certain that in at least one context they have obtained laughter or attention, thus feeling well-liked or considered.

This mode is a bit like their ‘peacock tail’. The peacock certainly doesn’t have a pleasant song like a nightingale, but it does have a huge and beautiful tail: in moments of attention-seeking, or courtship, or even just boredom, it opens it so that others notice it. Keeping in mind that we are dealing with a peacock, capable and prized mainly for its tail-wheel, can help us empathise with these children, grasping the vulnerability and the real reason behind often detestable or disrespectful behaviour.

How to intervene

It is a common experience for everyone to lose one›s temper when faced with the umpteenth joke or spite suffered or seen done by the same person. It is just as common to discover that this type of response is not helpful in reducing the frequency of such pranks, on the contrary: often the other person›s ‹anger› is experienced as confirmation that the spite or prank was effective, thus reinforcing the problematic behaviour.

It may be useful, with the whole class, to identify a common signal that represents a ‘stop’ for any kind of activity or interaction present. Secondly, it is important to start training to also verbally express one’s displeasure or willingness to interrupt certain communication cycles in which the children do not feel comfortable.

It is undeniable that children with ODD are good at playing pranks or spitefulness: they have imagination and inventiveness, but they generally get the timing, intensity, or frequency wrong. Completely forbidding teasing or pranks on classmates is neither conceivable nor useful: forbidding something makes it irresistible to everyone, especially to oppositional children. Instead, it is possible to think of a time to put a child in the centre of attention in turn (not just the one with ODD), perhaps by asking them to tell a joke or propose short sketches that make them laugh. In this way the child can get the same attention because it makes them laugh, but in a more functional and appropriate way. It is also communicated through this activity that things are often funny if they are short. A key point is that of attention-seeking: all too often, children with ODD only receive attention when they engage in dysfunctional behaviour, when they are reprimanded

or scolded. Spite and teasing often elicit laughter, if not from the person concerned, from others who are watching. Giving positive attention to the child at other times can help to satisfy the child›s need for consideration, decreasing dysfunctional attention-seeking behaviour. As soon as you notice appropriate behaviour in the child with ODD, you can emphasise it in front of the whole class, as well as face-to-face with her/him. This will help her/him to create an image of herself/himself as capable, as ‹seen› by others for what she/he does positively, whether it is a lot or a little. The risk for these children is that of being seen only for their own dysfunctional conduct and thus perceiving themselves as ‹condemned› to play that part, with no possibility of doing anything else.

A good idea

Create an ‘apology corner’ in the classroom. Hang a poster with kind words and phrases (‘Sorry’, ‘I’m sorry’, ‘I ask for your forgiveness’) in this space and invite the children involved in an argument to go there and choose a word/phrase of reconciliation. Invite them to reflect on how they feel after taking a brief moment to seek peace and kindness.

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