Issue 20: Oppositional Behavior Patterns in Children: What Are They and How Can We Help? Melissa Packwood

Parents and teachers regularly deal with children's behaviors. Oftentimes, these behaviors are widely experienced and thought of as typical and are easily worked through. But what happens when behaviors form an ongoing pattern, and the strategies parents and teachers are using don't work? That's one of the most common questions parents and professionals ask.

What is Oppositional Behavior?

Oppositional behavior is when one refuses to comply with the direction of someone who is in a position of authority or power. For example, when Ms Rudd reminds Jasper to complete his math test, he yells at her and then rips up the paper; he is showing oppositional behavior. Alternatively, when Coach Jennings tells Julie to be safe with the PE equipment, and she responds by ignoring him and walking away, she is showing oppositional behavior. When oppositional behavior becomes repetitive over time and begins to interrupt regular life on a regular basis, it may fit the diagnostic criteria for a diagnosis of Oppositional Defiant Disorder.

Oppositional Defiant Disorder is diagnosed by a professional, such as a psychologist or psychiatrist, using specific diagnostic criteria recognized in a particular country or territory. However, there are other reasons why a child may exhibit oppositional behavior patterns. For example, anxiety can cause anyone, child, or adult, to find tasks stressful, especially when these tasks feel as if they are a demand. In addition to demands placed by an authority figure, tasks or demands someone has for themselves may also cause stress. Consider Jordan's predicament. He wants to attend a birthday party for his friend but refuses to leave the house when it's time to go because he feels anxious about who will be there and the possibility of being late. He struggles to motivate himself to move beyond his stress to attend the party.

In 2003, the first academic article about Pathological Demand Avoidance, which Elizabeth Newson first identified, was published. Pathological Demand Avoidance can also result in oppositional behavior patterns and is included under the Autism umbrella as an ASD profile, which includes a large amount of anxiety. This type of neurodiversity is not yet included in all diagnostic manuals and may be diagnosed as Autism and a separate anxiety disorder in some countries. Additional reasons why oppositional behavior may occur include prior trauma, sensory processing challenges, language processing challenges, illnesses in general, and executive functioning challenges. Sometimes oppositional behavior is simply a difference in priorities, a slow processing time, or difficulty in understanding what is being communicated rather than purposeful opposition to a direction.

Fight, Flight, Freeze, Fawn

It's important not to take a child's behavior personally. As adults, we must stay calm and de-escalated to help children learn to de-escalate and make decisions in a rational manner. This can be easier said than done, so I try to remember that when children are making oppositional decisions, they may be operating within their primal survival instincts. Their brains are telling them to survive because of a perceived threat to themselves. Though this threat may not be rational, their brains are sensitive to stimuli and react with responses such as fight, flight, freeze, and fawn. Fight simply means one fights back against someone or something and may look like a student throwing a chair or a book. A flight response is more likely to cause a student to elope or hide. Sometimes, people under stress will freeze and be unable to make a decision or move from a place. This may mean a child cannot make themselves speak or go to a different place in a room. The last potential response to anxiety is discussed less often but is quite important. Fawn means that someone does what is asked of them without issue, even if they don't want to, and then they may have a large meltdown afterwards. An example of fawning would be going to art class when asked to, though it is over-stimulating and causes a negative stress reaction due to sensory challenges. The student may hold it together until arriving home or may fall apart later in the school day. Understanding these four possible responses can help us prepare for potential behavior challenges and strategize ways to assist children in de-escalating.

How Can We Help?

The most common question I hear in practice is, "How can we help?" Consider each situation and remember that behavior is communication. Behavior choices are meant to deal with stress or get your attention to receive help to manage stress. This doesn't mean the behavior is meant to cause stress or drama. Two important keys to a positive mindset during an oppositional behavior are to start fresh after a situation occurs while giving chances to try again and don't hold grudges. Children need a safe place to share emotions and make wise decisions, but this takes time and practice. We are their safe place and their guides. It's up to us to be 'the calm and reason' when they find themselves in the midst of an emotional storm.

Before behavior challenges occur, be proactive. Establish rapport through common interests, parallel play, or cooperative play. Practicing the use of strategies to calm anxiety before it becomes a panic attack or meltdown is extremely important and can help over time. Help the child to make a list of things they can do to calm down when upset. Some examples may include reading a book, a hug from a parent, time with a sensory fidget, drawing, exercise, or a more personalized option. Use pictures and words for children who may not read fluently yet so they can identify each action quickly when needed. Also, being an active listener and being open to facilitating a positive relationship so the child trusts you in times of stress can be a large advantage.

During oppositional behavior challenges, there are many things you can do to help someone de-escalate enough to problem-solve. If the child is able to communicate, ask the person what may help them. Make sure that alternative forms of communication are available in addition to a verbal response. Be open to reframe the issue and be open to the child's perspective. Perhaps the child wasn't quite finished with what they were doing but was being told to immediately stop and move on to something else. This is tough for adults in many cases, so it's reasonable for children to find this difficult as well.

Consider self-advocacy a positive endeavor even when it isn't done in the nicest way.

Consider self-advocacy a positive endeavor even when it isn't done in the nicest way. We can always work on self-advocacy skills, but it's important to encourage speaking up for yourself because children will need to do this in order to receive helpful accommodations and explain their needs throughout life. Leaving room for self-advocacy helps children feel heard and supported. When we listen, even if we may need to tell a child "no", children will know that we value their opinions. This also gives adults the opportunity to explain their thinking and decision-making processes. In doing so, adults can take the opportunity to exercise proper language and tone of voice to explain big emotions, wants, and needs. Self-advocacy also provides the opportunity to continue establishing rapport and a chance to bounce ideas off an older, wiser support person in their lives.

Limit miscommunication by being an active listener. When actively listening, repeat what you hear to verify that the child's meaning matches what you heard. Then, listen and accept more information as needed. Do not interrupt unless safety is an issue. Don't get into an argument or power struggle over who gets to talk first or last. Understand that it's okay to have different goals and priorities than a child. (We don't have to come to their conclusion; just listen and hear them out.) When possible, give space and time for the child to synthesize the information discussed regarding decision-making after listening to their concerns.

Work together to find alternative options which fulfill the same goals when possible.

Another strong option to help children with oppositional behavior patterns is to use teamwork and collaboration to solve problems. Work together to find alternative options which fulfill the same goals when possible. Be flexible and build extra time into your day to allow for the time needed to de-escalate and problem-solve. Leave as much control as is safe in the hands of the child because having some power over a situation helps alleviate some of the stress felt and can help de-escalate a charged situation.

Positive Traits of Children with Oppositional Behavior Patterns

It is important to consider the whole person when considering how best to help someone find strategies for success. One way to do this is to remember their positive attributes. Taking a holistic approach helps me to relate to my clients and students better. There are some common traits of children with oppositional behavior patterns that may help parents and professionals to view children as more than their behavior patterns, even in the toughest of times. Some of the traits that may be seen in those who have challenging behaviors include:

• Human rights activist
• Animal rights activist
• Self-advocate
• Enjoys leading
• Confident in own path
• Detail-oriented
• Persistent
• Excellent memory
• And many more!

We Can Make a Difference

One of the biggest issues parents and professionals face is behavior challenges. These situations can feel isolating and frustrating. The good news is that we can teach and model strategies to assist children as they work through stress. We can help children find strategies that empower them to de-escalate their behavior and regulate their moods and responses to stress. Once de-escalated, children can work on decision-making strategies over time to help them learn how to navigate challenging situations on their own one day.

It's important to recognize that learning challenges can cause anxiety, which, in turn, can cause demand avoidance. When we view behavior through the lens of an emotional response to a worry or a challenge rather than as "naughty" or "bad", we can better understand how to support a student as they work through that challenge.

We Can Make a Difference

• Dulcan MK, ed. Oppositional defiant disorder and conduct disorder. In: Dulcan's Textbook of Child and Adolescent Psychiatry. 2nd ed. Arlington, Va.: American Psychiatric Association; 2016. [psychiatryonline.org]
• Facts for families: Children with oppositional defiant disorder. American Academy of Child and Adolescent Psychiatry. Accessed January 3, 2024. [aacap.org]
• Newson E, Le Maréchal K, David C. Pathological demand avoidance syndrome: A necessary distinction within the pervasive developmental disorders Archives of Disease in Childhood 2003;88:595-600.
• Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013.
• O'Nions, E., Christie, P., Gould, J., Viding, E. and Happé, F. (2014), Development of the 'Extreme Demand Avoidance Questionnaire' (EDA‐Q): preliminary observations on a trait measure for Pathological Demand Avoidance. J Child Psychol Psychiatr, 55: 758-768. [dsm.psychiatryonline.org]
• World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (Vol. 2). World Health Organization. [wiley.com]

Melissa Packwood

Melissa is a certified teacher with decades of combined experience in public schools and private practice. She has earned a master's degree in reading and literacy as well as a graduate certificate in ESE. She plans to complete her psychology doctoral dissertation by the end of 2024. Melissa works with professionals, parents, and students of all ages to achieve their education and executive functioning goals. She enjoys presenting at conferences and contributing articles for publications to further advocacy for and understanding of neurodiverse students' needs. Melissa lives in Florida with her three neurodiverse children, two cats, and a treeing walker hound dog. She enjoys reading, visiting the beach, hiking, and attending ballet classes in her free time.

Extracts from Dystinct Magazine