How naughty is naughty? Noncompliance, O.D.D., and Conduct Disorder

All children will have times when they disobey the adults who care for them – at home, at school, with relatives, or in the supermarket canned-goods aisle. The effects of a young child’s misbehaviour can range from mild embarrassment to broken goods, minor wounds and damaged friendships. How much naughtiness is normal and when does it become a problem that needs treatment or intervention?

In psychology, there are degrees of naughtiness that are defined somewhat by a child’s age, but more so by the number and types of “naughty” behaviours that they do:

  • how frequent,
  • how disrespectful,
  • how damaging/dangerous, and
  • how much thought went into the behaviour.

With young children – toddlers to the early school years – naughtiness usually takes the form of not doing what you are told, not keeping the rules, or having a tantrum. This is called noncompliance.

There are mild degrees of tantrums and noncompliance observed in most children. It is typical that noncompliance begins at 18 months, and peaks at between 3 and 6 years before declining and is more frequent in boys than girls. Parents generally report that their children are noncompliant between 25{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} and 65{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} of the time. 80{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de} of families with children between 6 and 12 years old report tantrums occurring once a month and 11{ba4639bc087185d97391fd5d15a50de89571c56f25425ee41c30a195518528de}, once a day.

If a child is being noncompliant on a more frequent level, a psychologist may be called to assist and will start with getting a good background of the child’s health and developmental milestones, perhaps organise a hearing or language assessment to check that they understand and then work with the adults about the best ways to deliver a command and follow through.

If we turn the dial up from noncompliance, the next level of naughtiness is usually referred to as Oppositional Defiant Disorder, or ODD. When we are talking about ODD, we are normally referring to a well-established pattern of behaviour that has lasted for at least six months and may include, tempers, arguments with adults, refusing to do what they are asked, deliberately annoying and blaming others for misbehaviour. By the time we are dealing with ODD, it is not unusual to hear words such as “angry”, “resentful”, “spiteful” or “vindictive”.

The types of intervention psychologists can offer a child with ODD should always begin with a thorough assessment. ODD can have biological beginnings and can be linked to adversity.

For example, children who have survived childhood cancers but have had various treatments can often present with ODD symptoms. Also, children who have been through early life neglect or trauma can exhibit ODD symptoms. For instance, children who are exposed to intimate partner violence in their earliest years (before the age of three) can have problems that lie dormant for a few years as their behaviours usually start to escalate by around 8 years of age. Often, children with ODD will have other issues with their communication, mood or attention span as well, so treatment also needs to cater for these co-morbid issues.

Many children, with support, will start to settle their noncompliance and ODD type behaviours by adolescence, but some will continue on. There’s also another group who have started life on a different trajectory. Some children have behaviour that has previously been uncomplicated, but starts to worsen during adolescence. If behaviours start to escalate and get more serious and dangerous from ODD, the behaviours start to be labelled as Conduct Disorder. Conduct Disorder is seen as repetitive behaviours that continue to violate the basic rights, norms and rules. Children with Conduct Disorder can display aggression (to people or animals), property destruction (including fire lighting), theft and serious violations of the rules that will normally attract the attention of the Law.

While many would advocate punishment as the main response to disordered conduct, it is often experienced, but rarely effective for these children.

Part of the problem with tailoring treatment or understanding naughty, or very naughty kids, is that they are a really mixed group. Having a diagnosis of ODD or Conduct Disorder does not tell us the cause. A diagnosis just describes the behaviours that flow.

Different types of naughty or wrong behaviour may have separate causal pathways. Some researchers have looked and grouped oppositional children into clusters based on when they started to be naughty. Some children, when you look at their history, have been naughty most of their lives and some seem to wait until adolescence. It seems that the different timing of the onset is linked to different types of behaviour, too. Those who have had it since early in their childhood are more likely to be impulsive. Those who have conduct issues that start in adolescence are likely to be more aggressive.

Some have looked at the type of naughty behaviour – pre-contemplated aggression is different from those who lash out in reaction to something upsetting, so there is a difference in the amount of forethought and perceived control over “wrong” decisions. Others might use more relational aggression where harm is caused by attacking someone’s relationships or social status. Relational aggression is more often perpetrated by girls than boys. While boys are two to four times more likely than girls to have conduct issues in primary school years, adolescence leads to an increase in the number of girls with conduct issues.

So, in all, children with angelic behaviour are rare. Most will test the limits where they can, but if a child is repeatedly flaunting the rules and causing considerable damage to property or relationships, then they need some help to get things back on the right track. When the complexities of a very naughty child are understood, it becomes much clearer that punishment is not treatment. There is no one-size-fits-all treatment, but it makes sense that keeping children safe and well and investigating frequent misbehaviour early will help keep most from escalating to truly problematic levels of naughtiness.

The dance that is Separation Anxiety – wave, scream, cling, stay, repeat.

There are times when most young children are reluctant to say goodbye to their mum or dad and head off to crèche/kindergarten/school/child care. Some children are quite spectacular in their protests, while others prefer the silent, cling-like-an-oyster-to-a-rock arrangement.

Some children will experience an intense anxiety experience that is excessive and developmentally inappropriate (not quite right for their age).   Children with Separation Anxiety Disorder experience such intense anxiety that it interrupts their lives (and the lives of their family members) and causes an impairment in their education, their school and family relationships and thier social functioning.

Separation Anxiety Disorder is the earliest and most common mental disorder in childhood and, while it is true that many children may experience some anxiety from time to time, ongoing seprartaion anxiety issues have been repeatedly linked to problems with a child’s mental health throughout the life span. Clinical levels of separation anxiety are a risk factor for other mental issues in adulthood – anxiety, depression, and substance issues. It’s very important that separation issues that don’t resolve themselves get some early attention.

It has long been thought that parents who have mental health concerns and who have insecure attachment with their children will be more likely to raise children who are anxious. It makes sense, that if a child has an anxious temperament and then their attachment figure is unavailable or a bit “hit and miss” with the relationship, that they will feel less secure in the world.

However, while there is a link between maternal depression and separation anxiety, researchers have found that there is a stronger link for separation anxiety and the child who has greater than normal fear of strangers.  It is usual for all infants to have a period of stranger anxiety, but it would seem that those who do not properly resolve this early fear may be those most at risk of developing separation anxiety as they get older. It almost seems that the stranger anxiety “thing” is a good early learning ground for the child to master being able to assess and manage a threat. If they do not master this skill, separation anxiety can follow and be maintained.

To understand separation anxiety, you first need to understand how many psychologists currently view excessive fears and worries. Whilst it is important that we all remain fearful of things or situations that are truly dangerous to us, it is equally important that we learn how to turn down our anxious feelings in situations where there is actually no real threat. Children with separation anxiety most often are frightened by the idea that something will happen to them or to their carer in their absence and that they will never get to see the person again. If a child is living in a very dangerous environment, then these thoughts and feelings would make sense, but for some reason, children with Spearation Anxiety think and feel this way even though there is no imminant threat to them or their parent.

The other important part of anxiety is avoidance. Again, it’s important that we avoid dangerous things, but if we avoid things that are not really dangerous, we never get to challenge our fears or beliefs about our vulnerability and it can get in the way of leading a full and happy life. For children with Separation Anxiety, their behaviour often results in them not having to be separate from their caraer. Parents may abandon their own plans to stay with their child (because the parent is also avoiding the fear or inconvenience of a tantrum or distress) and the child avoids being separated. This avoidance perpetuates or keeps the anxiety going, and grows the anxiety.

So, the dance continues….detect a chance that Mum or Dad may go, scream (to communicate your distress), cling (to reassure and soothe you), stay (Mum or Dad stays and helps you avoid the scary idea if her going), repeat.

It is also fascinating to know that children with Separation Anxiety are like heat-seeking missiles to the idea they might be left alone and that things could go wrong or be dangerous. We call this being more “vigilant” or even “hyper-vigilant” to threat. Studies of children’s eye movements have shown that anxious children will more quickly pick up images about danger than their non-anxious peers. Also, anxious children will then be quicker to avoid looking at the threatening image than their non-anxious friends. Once detected, anxious children are quick to look away or avoid material that makes them feel uncomfortable. By avoiding the material, they do not give themselves a chance to think the whole thing through clearly and do an accurate assessment of risk.

To manage the “dance” that can be Separation Anxiety, most treatment includes parent training as well as child sessions. Treatment involves collecting information about the child and the child’s separation behaviour (and their thoughts/beliefs if they are old enough to share these) so that each step of the treatment can be comfortably paced. It can be handy to capture some details in a diary.

Current evidence suggests that Separation Anxiety needs work with parent and child and that both need to learn about anxiety – what is normal anxiety and what is clinical anxiety. They need to know how to focus on their body and their behaviours, measure their feelings and test the ideas that might be keeping things scary. This may mean working through a hierarchy of least scary to most scary situations

Again, though, if a child has been through a trauma and been in an unsafe situation it would make sense that they will likely be fearful for some time until they can be helped to discover that the world is mostly a safe place. However, for those children who are caught in a cycle of too-quickly noticing possible threat and then avoiding doing things about it, the effects can be debilitating if left unaddressed.

A child needs the world to be “filtered” by a loving parent or carer who will allow a child to face fears, where appropriate, in a gradual and guided way.

Gentle, supported and guided exploration of things that may be a little scary makes for a much more enjoyable and healthy “dance” between adult and child.

When perfect is just no good!

It is great when we do a good job of something. There is a real sense of accomplishment when we set a goal and meet it. But…..there is a real difference between working hard to achieve a goal and perfectionism.

People who have a problem with perfectionism measure their self worth on their ability to achieve really high standards. If they do not meet these exceptional standards, then they berate themselves, feel unworthy and push themselves even harder to achieve further and higher goals. Perfectionism can drive people to a point where it is difficult for them to be happy and can be associated with excessive tension, stress, worry and depression.

For children, while they may not be aware that they are setting themselves goals or that they have a self worth, perfectionism can still strike. In children, perfectionism can be a big part of why some kids:

  • Procrastinate or put things off
  • Give up easily or refuse to try things they might get wrong
  • Don’t know when to stop on a project or homework
  • Too often check things to see if they are right or check with others who can give them reassurance
  • Become slow to make decisions or to speak

People (kids and grown ups) can be perfectionistic in different parts of their lives:

  • Work or school
  • Household cleaning or chores (I know it’s hard to believe that children can get perfectionistic about cleaning, but I’ve seen too many too-tidy sock drawers in my time)
  • Sport or fitness
  • Weight and body shape
  • Popularity

Perfectionism can be tricky to challenge alone. It’s easy for some people to get caught in a cycle of being told that they are great or achieving good things to the point where if they are not achieving, they feel inadequate or worthless. Failure and disappointment can become fears to be avoided at all cost rather than just another experience from which we can learn more about the world and ourselves..

Psychologists can help treat perfectionism that is causing unhappiness and tension by helping people to :

  • Look at their own cycles of perfectionism
  • Challenge and test their perfectionistic thinking and rules and to
  • Re-evaluating the importance of achieving.

At home or at school with children, its’ important to speak about perfectionism and it’s pros and cons as well as to speak about the pros and cons of disappointment and mistakes.

Where you can, be sure to monitor the emphasis that you put on winning and achievement.

Obviously, because little people are all wired differently by their biology and their day to day experiences, some kids can manage healthy competition and will strive to do their best without going over the top. However, if you see that your child is starting to become impaired (socially, emotionally or health-wise) by their relentless pursuit of getting something perfect, then it is time to step in.

In your household, try keeping your rules only for the dangerous things – like don’t pick up a red back spider, or always swim between the flags on patrolled beaches. Try to speak about the things you value in more general terms and with fewer absolutes, like “we will try our best to be kind” or “we prefer to eat healthy foods when we can”.

Perhaps you could try some family research about the great inventions and discoveries that humans have made because they made a mistake. (Hint – research the pace maker, the ink jet printer and the slinky!)

Try to model accepting your own mistakes, good sportsmanship when your team loses and celebrate your failures – turn epic cake failure into trifle, get some advice on your DIY project boo boos and stay for the end of the movie when they sometimes play the blooper reel.

I’d love to hear how you and your family deal with mistakes!



Why just Mothers’ Day? The importance of everyday self-care for Mums.

Yes – it’s on! Mother’s day is upon us and so, too, the carefully crafted junk mail and television commercials – Images of blow-waved children bouncing onto a perfectly ruffled bed on a sun-streamed morning bringing breakfast on a delicately manicured tray while a handsome man with the just right amount of five o’clock shadow smiles on from the bedroom door. Ahhh! Motherhood!

We all know that motherhood is rarely perfect. But – how much leeway is there from “perfect” before it starts to have a detrimental effect on families?

It is very clear that family violence is a toxic influence on the lives of little ones and that violence needs to be avoided at all costs. However, the other sometimes hidden, toxic, risk factor for eroding well being of children is maternal (and parental) mental health problems.

When you look into the literature on risk factors for child mental health, there is one factor that repeatedly screams out – parental depression. Depression is more than stress or fatigue. To some extent, some stress and fatigue are very much a part of parenting. Depression, however, is the big player in family wellbeing. Even when families are challenged by children with special needs or complex behaviours, it is the presence of absence of parental depression that often determines the outcome for the child’s mental wellbeing.

Parental mental health is critical to positive child well being. A parent with poor mental health can have a huge impact on the entire family – the other parent/s, the children, the ability to work and earn income and the ability to stay socially engaged with friends and extended family. A mother needs to be “fit enough” to be able to:

  • provide affection
  • be responsive to her child’s needs
  • be encouraging
  • teach every day lessons in moment by moment situations
  • engage with the child and the world
  • discipline positively when it is called for
  • support her partner in co-parenting and encourage the partners healthy relationship with the child.

If a mother’s ability to do these things is affected for any lengthy period of time, then that’s when a child’s well being may be affected unless support is rallied. Some mothers have difficulty relying on others or being relied upon themselves. Often, this difficulty can be a sign that something has gone on in the mother’s early years that interfered with the attachment between her and her own parents.

While some parents have clearly defined mental health problems, many parents may suffer from what we refer to as “subclinical” mental health disorders. A subclinical disorder is one where a mother can still soldier on and get to work, feed the family and attend all of the after school sport and activities, but underneath she is just not coping and may be leaning heavily on alcohol, other substances, or over working in order to get by.

Some mothers soldier on through their non-coping periods. Sometimes they do this because they don’t want to be a burden or a nuisance to others, because they are “so lucky” compared to some of the things they see people go through on the news and because they think they just need to “snap out of it”. Some get a bit of a Super Mum complex and then become resentful when their mood takes a hit.

Mothers need to prioritise self care. This doesn’t mean selfishness. It means genuinely looking after the person who, if not travelling well, has the ability to disrupt the whole family.

Just like we should check in and service our motor vehicles, Mum’s need time to reflect and take stock. A mum who is “firing” on all of her mental health “cylinders” uses healthy ways to regulate her emotions and manage her stresses and seeks and provides support from, and to, others. She watches the signs on her own emotional “dashboard” and refills when her “fuel levels” are low. Driving herself by being clear about her signs optimises her mental health, helps her make decisions, keeps her stable in her work and for her family and helps her exercise some sharp parenting skills.

Promoting self care for mums should be more than Mothers’ Day marketing madness. It’s imperative that mothers are supported to have, and maintain, good mental health that stays well clear of subclinical levels of concern.

So, what does a mother need this mother’s day?  Self-care!  She needs to do some basic stuff really well and really consistently and not just on Mothers’ Day.

A mother (or any parent or carer) needs to look after herself every day.  She needs to know how to ask for and accept support. She needs time to check in and make sure that she has balance and that her coping skills are healthy – more laughter, exercise, fun and sharing and less lonely, hard-working, stoic resentment.   She needs to be curious about life, be open to meeting new people and to trying new things. If there is something that is getting in the way, whether it is from the past or in the present, she needs to work on shifting it.

Banish stoic, perfect super mums and their bouncy, sun-filled mother’s day breakfast expectations and bring on healthy, open, warm, vulnerable, human mothers who can give and receive cuddles and have them gladden their hearts without fear that snot or crumbs will mean that there will be even more work to do before she can relax and genuinely “be” with her favourite people.

Mum, do right by yourself and your children and if you feel that your mental health could be wobbly, take time to check in on yourself. Your partner, best friend or even your GP may be great people to start a check in with. You might be surprised at how much they can tell you about yourself and what it is like when you may not be coping.