After the terrible twos...


Wednesday, April 17, 2019

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CHILDREN, even those who are usually very well-behaved, can get a little sassy sometimes, even going as far as to defy authority especially as they traverse the infamous terrible twos and pre-teens. However, if this behaviour goes beyond the terrible twos, becomes consistent, excessive, and lasts more than six months, clinical psychologist Dr Pearnel Bell said that it is quite likely that you may be dealing with a behavioural disorder.

“It is often said that the developmental milestone at age two is the terrible twos. This is when a child throws tantrums and is quite oppositional, saying no to everything. If a child passes the age of two and this behaviour persists, and is exacerbated, this could be a disorder known as Oppositional Defiant Disorder (ODD),” Dr Bell explained.

She pointed out that it can be quite difficult to differentiate the disorder, which is seen in a greater number of boys than girls, from behaviours seen in an ordinary but strong-willed or emotional child. However, she notes that a child with ODD is characterised by often losing temper, arguing with adults, actively defying adult instructions or rules, and being vindictive towards authority figures.

“Some children with ODD may also be annoying to others, they blame others for their mistakes, they never seem to follow established rules, and also always tend to argue with adults. This may also manifest in the child being hostile towards peers, bullying classmates, and somehow always finding themselves at the centre of conflict situations,” Dr Bell outlined.

She said that mild symptoms may occur only in one setting; for example, this may play out at school or just at home. When the case is moderate some symptoms occur in at least two settings, and when severe, it occurs in three or more settings.

“Depending on the severity of the condition, excessive bad behaviour may or may not persist. If it does parents need to get the child psychologically assessed by a psychiatrist or psychologist. If the child is found to have ODD, they need to begin some behaviour modification with parents learning how to manage the behaviour. There are some instances where psychiatric evaluation may indicate the need for medication.

“Behavioural treatment of ODD involves learning skills to help build positive family interactions and to manage problematic behaviours. Additional therapy, and possibly medication, may be needed to treat the disorder,” Dr Bell advised.

One hallmark of ODD, according to Dr Bell, is the catastrophic consequences it has on a parent-child relationship and the family unit in general. To ensure that you don't fall into this trap, Dr Bell said that seeking professional guidance is your best option because trying to manage the condition at home could result in violent or unhealthy confrontations.

“An ODD child can wear a parent down. A therapist will tell you that as a parent it is important that you always aim to be clear and consistent with directives and follow through on consequences for the child. This is because failure to be consistent could lead to the exacerbation of the behaviour,” Dr Bell advised.

In addition to this, Dr Bell said that you must always bear in mind that the ODD child is experiencing a mental illness and you must ensure that all interaction comes from a place of empathy. So rather than focusing on the effect the child's behaviour is having, do not take it personally. You must remain the parent and never assume the role of a friend because this would set a bad precedent. Also, always respond and remain calm even if you are angry because this will only exacerbate the behaviour. What might also be helpful is if you offer praise when the child conforms to the required behaviour.

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