Oppositional Defiant Disorder or Trauma?

Children with a history of traumatic experiences exhibit greater oppositional defiant behaviors than children without exposure to trauma. This is most likely the result of the negative physiological impact trauma has on core regulatory systems, compromising a child’s ability to regulate and process sensory inputs. Changes in the body’s critical stress response system prevent the modulation of sensory deregulation, making the child incapable of self-regulating their emotions and behavior. The experience of trauma increases vulnerability to stressors, even mild stressors that healthy individuals are able to handle. For example, simple problem solving becomes difficult, causing anger and confusion in a child that simply “does not know what to do” about a situation, ultimately resulting in rage, aggression and other oppositional defiant-like disorders.

Under stress, traumatized children’s analytical capacities are limited and behaviorally react with confusion, withdrawal and/or rage. Rather than making a gradual shift from right brain hemisphere dominance (feeling and sensory) to dominance of the left hemisphere (language, reasoning, problem solving) resulting in an integration of neural communication between hemispheres, they react only from their “sensory” or right brain often lacking the “thought” or planning before action is taken.

Interestingly, many of the symptoms and reactions present in Oppositional Defiant Disorder (ODD) are parallel to the symptoms and reactions in children post-trauma. More than 800,000 children are exposed to trauma annually from abuse and neglect alone. Twenty percent of those children are observed to have dramatic changes in behavior consistent with ODD following a traumatic event. It would be beneficial to develop guidelines helping pediatricians and other early childhood professionals routinely screen for the presence of trauma-related symptoms and impairments even in very young children. This would prevent the mislabeling of ODD in later years. As one of the top diagnoses given to children today, it is certainly important to understand both the etiology and intervention options proposed for ODD. When ODD is viewed from a biological and trauma-informed perspective, compassion from parents, caregivers, and teachers often follows.

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