Does My Child Really Have Bipolar Disorder? Oppositional Defiant Disorder?
I wish I had a nickel for every time I’ve had a distraught parent ask me one of these questions. I also wish that mental health professionals would become more trauma informed and knowledgeable about what attachment deficits and early neglect do to a young child’s developing brain, so they wouldn’t misdiagnose and medicate. But let me answer the questions. Not necessarily.
Parents give me their child’s name followed by a long letter salad. “Sarah has ADHD, RAD, and BD. Oh! I forgot she also has generalized anxiety disorder and a mood disorder, otherwise unspecified.” “Ryan has ADHD, ODD, and maybe CD. Is he headed for jail?” No wonder parents want to head for the hills. They’re terrified!
Let’s break this down. Mental health professionals who are unfamiliar with the Adverse Childhood Experiences Study and are unschooled in the effects of disorganized attachment and neglect on a little child’s developing brain (and far too many are), have only their observations of behavior to guide them in making a diagnosis. Take ADHD, attention deficit hyperactivity disorder. The criteria used would be an inability to focus and pay attention, and the inability to tolerate being still and calm within one’s own body, as well as problems filtering out distracting stimuli. Note these are all observable behaviors.
Another example is ODD, oppositional defiant disorder. Again they observe behavior to make a diagnosis. Do we see a child ho chronically argues over unimportant issues, even to his own disadvantage? Does this child have a need to control? Is he often defiant and disrespectful regardless of the consequences, violating the norms of acceptable behavior? Again they look for observable behaviors to make a diagnosis.
But what if they’re barking up the wrong tree? What if behaviors aren’t the main issue at all? What is they’re only symptoms of something that we aren’t digging deep enough to find? Your pediatrician may tell you to use aspirin to take down your child’s fever if she has the flu, but what if she really has scarlet fever? At the beginning, the symptoms look much the same. When we have a chronically traumatized child with an early history of neglect and abuse, we’re looking at a child with serious attachment issues. And a child who didn’t have a secure attachment is a child who will not be able to cope with stress, setbacks, or rejection. To fail to look deeper into the child’s history, put our own feelings aside, and make every effort to see the world as a child sees it, is to fail that child.
When we focus on behaviors alone, we are missing the big picture. For example, when we see behavior problems, we use behavioral techniques in an attempt to correct them; behavior modification charts, rewards and punishments, loss of privileges, sending them to time-out. These may be successful for typical children, but for children who’ve suffered early chronic neglect, these strategies are actually harmful. Time-out, for example, is a bad idea. To send a child away will feel like she’s being abandoned all over again. Punishments will be interpreted as a lack of love and rejection.
Let’s go back to ADHD and ODD and reinterpret what we see. Children who lacked an early attachment figure, which is neglect---the very worst trauma a child will ever experience---had no one to comfort and regulate him as an infant when he was distressed. One of the outcomes of this early attachment trauma will be that he’s never been able to self-regulate and calm himself down. If no one co-regulates with him and calms him when he’s an infant, he never learns to do it for himself. If there is abuse and screaming going on in his family, he’ll be terrified. Even though he’s just a baby, he must learn that others will hurt him, so he can trust no one but himself. He must lookout for Number 1. No one else will. Maybe if he stays very hypervigilant, being constantly on the lookout for danger, he can keep out of danger and do what he can to protect himself. Baby will do anything in his limited power to control his environment for sake of his own survival. This instills the need to control at all costs.
When we reframe ADHD in light of attachment trauma, we see that the inability to pay attention and focus can be a luxury a child does not have if he constantly feels unsafe, and what looks like hyperactivity, is actually hypervigilance. The inability to filter out distractions is actually an important safety mechanism for a child who must assess every new sight and sound to see if it represents danger. Attachment trauma with it’s focus on staying alive, will also rob a child of his normal curiosity and exploration, so he misses so many experiences and opportunities that a safe secure child will have available to him. Therefore, he will not have learned nearly as much from experience as a secure child will have. He’ll have trouble assessing risk and has delayed cause and effect thinking. He reacts emotionally and for safety sake before he can utilize his thinking brain. Therefore he acts impulsively. All of which looks like ADHD.
Oppositional Defiant Disorder is all about the need to control. When a child needs to be in control, literally as if his life depends on it, we cannot reasonably expect him to give that up. Defiance comes from a horror of giving up control---of not being able to defend himself from serious, perhaps, life-threatening danger. Our priority must not be on changing the behavior first. He cannot reasonably do that until he is convinced that he is free from harm, safe in a forever family, and that he’s not going anywhere no matter what. This child will repeatedly test for commitment. Let him vent his feelings and put your need for respect on the back burner for now. Your task as a parent is to demonstrate your willingness to accept him for where he is on his healing journey now, and that his behavior is only a manifestation of his inner agony. This child needs empathy, understanding, and playfulness from you in order to feel safe.
I hope you’re beginning to understand how early childhood attachment trauma is not really about the behavior at all. If we don’t pay attention to the despair behind the behaviors, we are only adding more damage to a child who is already intolerably overloaded. We need to meet these kids at their true emotional age, which is much younger than their chronological age, and return to them their birthright; love, safety, acceptance, and nurture. Many of these children love being treated like a cherished baby. Though they behave as though they want to be left alone, in reality, they want to be wanted, but are afraid. Our priority is to convince them of their true value.
