Sunday, February 6, 2011

Apart

I do a lot of reading on parenting kids with Oppositional Defiant Disorder and ADHD. Over his many years in foster care, T has received several different diagnoses, all of which basically come down to the same profile of a kid who is severely stressed and unable to calm himself. I am not sure I really place value on diagnoses; something about the medicalization and medication of traumatized kids makes me very uncomfortable. However, the writing on parenting kids with profiles like ODD is often very thoughtful and helps me devise new strategies.

Today I read a nugget of wisdom I've been searching for all along:

"In some teenagers, ODD may represent a remnant of separation anxiety disorder, in which oppositional defiance reflects a reaction to feelings of ambivalence and anxiety that arise from the developmental move toward inde­pendence."

It was like an equation suddenly adding up; that is exactly what my gut tells me is going on with T much of the time. Many things make sense from that point of view: his anxiety and frequent refusal to attend school, his difficulty falling asleep by himself, his inability to regulate his feelings when he is outside of our presence, his annoying, anxious behavior toward his friends, his tendency to sabotage opportunities that would take him away from home.

In some ways, I think settling into a permanent home at the ripe old age of fifteen has actually exacerbated his separation anxiety and thus his misbehavior at school. I wouldn't be surprised at all if, unconsciously, he is kind of bummed about impending adulthood and would prefer to hit the pause button so he can fulfill some unmet needs first.

Separation anxiety can't even begin to account for an early childhood like his, with social workers coming in the middle of the night to remove you from your family suddenly and without warning, separating you from your siblings, and moving you from caregiver to caregiver (16 homes in 15 years). If separation anxiety includes worrying about losing someone/something/someplace to which you are attached, he is worrying over that every day, all the time. I suspect that when he leaves home for school each day, some deep instinctive part of him does not trust that home will still be there when he returns. He is defiant at school because he is extremely agitated.

Kids like T receive so many messages of failure. He is disruptive and challenging in the classroom, forgetful and unfocused on academics. From the F on an assignment he neglected to complete to "cleanup in lieu of suspension" for repeatedly getting up out of his seat during history class, his typical school week is full of negative feedback. That feedback feeds into an already negative self-perception that comes from being severely abused as a young child. And so the cycle continues, and on top of his agitation at being away from home, he experiences anxiety about his ability to control his own impulses and the impending shame and guilt that follow on misbehavior--all of which only serves to produce more misbehavior.

To counterbalance those messages of failure, at home it works well to offer him choices and suggestions for resolving conflicts and then reward him when he tries out a new strategy even if it's an awkward attempt. By trial and error, we've identified a few other techniques that seem to help:

- Asking for eye contact, as in "show me some eyeballs please." Even a split second's glance seems to interrupt the circuits in his head, especially if we can meet him with a gentle face.

- Staying physically close to him. When he is in a tantrum, the thing that guarantees that he'll completely come unglued is me walking away from him.

- Having talks in our bed. When he had his wisdom teeth out, we let him recuperate in "the big bed" during the day. It was eye opening. If we need to really hash something out, we all lounge around on our bed while we talk. Particularly if the message is difficult (the consequences of cutting class, for example), the physical proximity is soothing and he listens better.

- Shutting off television and video games an hour before bed. Invariably he spends this hour hanging over us and chatting about his day and tickling us and pulling our hair and making plans and generally reconnecting before sleep.

- Text messaging when we're apart. One of our basic house rules is "keep in touch" and he excels at this one, sending texts like little sonar messages to make sure we're still out there paying attention.

- Talking about the future. He love stories about what we'll do when we're old, or how we'll visit him when he lives on his own.

- Using requests like "let's see if we can get back to working together" or "take a minute to think about what I've said and then let's come together with a compromise" that suggest neither "let's do this my way" or "I give up, you win".

- Vacations in small spaces where we all have to pile in together - a long car trip, camping in a tent, heaping together in a hotel room. The more cramped the quarters, the more relaxed is T!

In our parenting classes, they often said "Parent the need, not the behavior." Opposition and defiance seem to me to be mostly behaviors; it's somewhat counter-intuitive to think the driving need is connection and reassurance, but the more we stumble upon what works, the more obvious that link becomes.

6 comments:

motherissues said...

I love this. You've given me a lot to chew on here.

Erika said...

I don't like diagnoses either - except this one: Complex trauma. Have you heard of it? Check it out. It's basically like PTSD only within developmental, attachment framework. The tx is addressing trauma first, then emotion understanding/regulation in the context of parent-child relationship, then same with siblings, peers... See Arthur Becker-Weidman or Daniel Hughes if this interests you.

Erika said...

I don't like diagnoses either - except this one: Complex trauma. Have you heard of it? Check it out. It's basically like PTSD only within developmental, attachment framework. The tx is addressing trauma first, then emotion understanding/regulation in the context of parent-child relationship, then same with siblings, peers... See Arthur Becker-Weidman or Daniel Hughes if this interests you.

Lulu McCabe said...

Erika:
Thank you so much!
I googled, found this, and then nodded vigorously as I read it: http://www.aaets.org/article174.htm

I really appreciate the lead!

Lisa said...

My (transracially adopted through foster care at 8 months of age) 11 year old daughter was diagnosed with ODD, but that dx is not very helpful. It wasn't until we recognized the anxiety causing her to clam up, cry, refuse, be defiant, lash out, that we were able to make a dent in her misbehavior. The term "avoidant behavior" really helped me. So much of her tantrumming was to avoid something she was afraid of and once i recognized that, I could really help her manage her anxiety. And Prozac helped a whole bunch, too!

Heather said...

Wow, what a great post. Thank you so much for sharing your insights, and what works for you and your family. I will definitely be coming back to this in the months to come!

 
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