Could Your 'Out of Control' Child Have a Disruptive Behavior Disorder?

I have been living the dream the last six weeks. My sister and her children ran away for the summer and joined me and my family upstate. (And yes, I am making a Hamilton reference. Though which of us is Angelica and which is Eliza has yet to be determined.) The last month and a half has been filled with day trips, late-night philosophical conversations, endless loads of laundry, and a unique opportunity to extensively compare and contrast our parenting styles. Especially when, between the two of us, we have seven children. Now, our parenting styles aren’t vastly different. We have the same set of core beliefs and very similar personalities. But our children? They are different. And because of that, they require diverse parenting. Over the six weeks we spent essentially co-parenting with each other, my sister and I learned how to talk to, discipline, and praise each child. But one of my nieces was an enigma and not a single one of the skills in my parenting toolbox seemed to fit.

If I had every single standard and metric socket wrench ever produced at my fingertips, my eight-year-old niece would require some sort of foreign hex wrench that needed to be specially ordered and would take eight weeks to arrive. Now normally, I would happily step aside and let a child like her be parented by her own, experienced mother. But even my sister—whom I admire for her love and patience with her children—doesn’t know what to do with my niece’s out of control behaviors. One night, after battling for two solid hours about bedtime, my sister pleaded with me. “Can you tell me what I’m doing wrong? Or what I could do differently? If I take her to the pediatrician, they ask what I’m concerned about and I can’t articulate it. She’s just out of control!” Another good friend of mine from high school also recently confided in me some of her frustrations concerning her child’s temper. At a breaking point and not knowing how to deal with the backtalk, hitting, and direct disobedience, she is at a loss for what to do and where to turn.

Comparing both my niece and my friend’s daughter, their life circumstances are wildly different. One comes from a single-parent home with a full-time working mother. The other has a stay-at-home mom and three siblings. One is incredibly gifted in school and is an angel to her teachers, the other has letters sent home regularly about disobedient behavior. The differences go on. But both have incredibly loyal, loving, dedicated parents concerned about them and their behaviors.

With two fellow mothers in the trenches of difficult parenting, I started doing some research. There are endless threads and parenting boards discussing and begging for advice about “out of control” children. Nearly all of them are filled with posts of related stories, but finding a solution—or even helpful suggestions—is next to impossible. Finally, I found a website that gave me some further ideas to explore. What I found at the end of the provided quiz was a list of disorders I had never heard of. If I’m being honest, my initial reaction was a massive eye-roll. Our society is over-diagnosed and over-medicated to a fault. And this was confirmation of just that. But I couldn’t help thinking about the disorders listed and wondering if they were, in fact, a clue as to what is going on with the two girls in my life that I care so deeply about.

In addition to the typical ADHD suggestion, two of the other disruptive behavior disorders listed were Conduct Disorder (CD) and Oppositional Defiance Disorder (ODD). As a parent of three and having worked with children in various professional capacities, I know that all children have occasional temper tantrums and emotional outbursts. And there are many, many schools of thought on the why and how to handle those situations. But when children are defiant, violent, constantly lash out, and can’t control their tempers, the behavior becomes more than what many attribute to “just being a kid.” When these behaviors impair learning in school, affect social interactions, or repeatedly cause family disruption and turmoil, it is a genuine problem.

So, what do you do about it? The first step after researching is expressing your concerns to your pediatrician. Be an advocate for your child and have prepared questions and examples when you go to your appointment. It never hurts to have a second opinion, either. If your concerns are shared by your pediatrician, he or she will likely refer you to a specialist that works with children and adolescents.

But this is where things get tricky. First, will your insurance cover mental health appointments? Do you choose a psychiatrist or a psychologist? What kind of therapy approach do you want to take with your child? And let’s not forget the social stigma attached to putting your child in therapy.

(Actually, we should forget that stigma. At the risk of sounding defiant toward the Mommy Wars prevalent in our country, I don’t care if the other moms of the cheer squad know my child sees a therapist. My child’s mental health is more important to me than whispers about me at the local PTA fundraisers. But I digress.)

Research has shown that one of the most effective treatment for symptoms of disruptive behavior disorders is a psychotherapy known as CBT—or Cognitive Behavioral Therapy. In a 2015 study comprised of nearly 2,000 participants, CBT not only significantly reduced ODD symptoms, but also lowered aggressive behaviors, parental stress, and maternal depressive symptoms. CBT was also credited with improving parenting skills and social competence. While it may sound like a specialized (i.e. expensive) type of therapy, it’s a very general term for a therapeutic technique that emphasizes the idea that our thoughts cause our feelings and behaviors, not external factors like other people or specific situations. Another draw to CBT is that it is generally considered the briefest kind of therapy, unlike other forms such as psychoanalysis which can take years. Trained Cognitive Behavioral Therapists typically have a specific agenda for each session because the approach to CBT is structured and directive. On average, successful CBT intervention happens in less than 16 sessions. If you’re paying out of pocket, that is good news.

Are our children “over-diagnosed” with all the disorders surrounding us today? Probably. But irrespective of where you stand regarding the vast autism spectrum, classifying different disorders, or simply just leaving children be to grow out of whatever phase they seem to be in, we are raising our kids in a different world than the one we grew up in. And if there is someone out there who can help us understand our children better, who can guide us in teaching them to be stable and contributing members of society, or someone who can simply empathize with us and encourage the parenting we are doing, I don’t see any shame in reaching out for assistance.