In the 1960’s, the renowned psychologist, Bruno Bettelheim, popularized the theory that autism is caused by “refrigerator mothers,” women who failed to bond with their children in such a profound way as to render their offspring mentally incapacitated. Bettelheim’s reputation has collapsed in the wake of revelations that he faked his credentials and allegations of child abuse in his treatment facility. Today, most people with at least a passing acquaintance with autism would consider his theories bizarre, not unlike medieval explanations for infectious diseases. Autism is widely understood to be a disease of neurological origin, at least in the U.S.,* among the general public, and researchers strive to understand the nature of the pathology that causes it.
For parents of children with Oppositional Defiant Disorder, however, the past, as Faulkner says, is not past. Medical sites frequently place parenting issues and environment as equal or even primary factors to genetic influence or neurological problems when listing the causes of ODD. This is so, even though ODD is frequently, perhaps usually, co-morbid with other neurobehavioral disorders such as ADHD and Asperger’s Syndrome. This is so, even though siblings within the same family do not exhibit the same behaviors. These authorities conflate the apparent efficacy of behavioral therapies for treating ODD with parenting technique and environment being the cause of ODD. It’s as though a hospital published an information page for Celiac Sprue and listed “wheat” as a cause of the disease. Adding to the confusion is that there are some childhood professionals who apparently believe that “bad parenting” causes ODD, not to mention a whole school of thought that all the behavioral disorders receiving increasing attention in recent years have their roots in family environment.
Of course, any child’s disruptive behavior can be exacerbated by unstable conditions, inconsistent discipline, inappropriate harshness, bad diet, and lack of routine, and therein lies part of the problem. Many laypeople and some childhood professionals are skeptical of the alphabet soup of diagnoses handed out to children who don’t conform to societal expectations today, and ODD fits easily into their bias, because all children display defiant or oppositional behavior at some time. Neurotypical children, in contrast, rarely exhibit the kinds of overt self-stimulation that mark autism: hand-flapping, incessant rocking or spinning, or echolalia. Furthermore, systematic sensory deprivation and neglect can cause autism-like behaviors in children, as the horrifying conditions found in Romanian orphanages after the fall of the Ceausescu regime made public knowlege, yet parents of autistic children are not routinely suspected of severe abuse or neglect. So, why do ODD parents search for help for their kids’ behavior in a cloud of shame and suspicion, often brushed off and dismissed by medical professionals and the educational system?
One reason may be that many ODD children act out primarily around their parents, and this makes care takers and medical professionals suspicious that there’s just something not right about the home or the family. Some mistake the instability that results from having a chronically defiant child in a household for the cause of the child’s problems. The fatigue and irritability that parents of ODD children may display under such constant stress makes it easy to think the worst of them. Other ODD children act out primarily at school, making teachers and administrators wonder whether the children are spoiled and not given proper discipline at home, making them unwilling to respond to other authority figures. Regardless where the disruptive behavior is occurring, however, ODD makes people uncomfortable. The oppression of dealing with such a disturbed youngster can be painful to witness, and acquaintances, even professionals who are supposed to be helping the family, may find it more palatable to believe that these parents are responsible for their children’s behavior than they are the victims of a random neurological train wreck.
Although “bad parenting” may not cause ODD, experts such as Ross Greene, author of The Explosive Child, believe that addressing the disorder lies in fundamental change in the disciplinary paradigm that can only occur through the parents (or schools, if applicable). Greene’s Collaborative Problem Solving model is based on the observation that the unilateral authoritarianism in mainstream parenting techniques seems to trigger and fuel chronically defiant behavior in susceptible children. Other experts have offered what Greene calls non-adversarial parenting techniques working from similar premises. Note that adopting these techniques requires a fundamental re-wiring of what we think we know — and most of our culture knows — about the correct way to deal with children, though, and is very different from doubling down on mainstream parenting prescriptions, the want of which is often presumed to be the source of oppositional and defiant behavior.
Adding to ODD’s invisibility and image problem is that there is no drug treatment specifically for it, though many children with the disorder take drugs for ADHD or psychiatric drugs for anxiety and depression. Social critics may shake their fists at the perceived over-medication of young people for ADHD, but surely the existence of a drug therapy to treat it has helped reify it in the public eye. To the extent that behavioral therapies may benefit ODD, parents are typically stuck with paying for them out-of-pocket unless their child is also autistic or has developmental disabilities (bearing in mind that Greene, mentioned above, argues that chronic oppositional behavior is a developmental disability, a view that most early intervention services and insurance companies do not share).
Parents on the ODD parent support forum I frequent sometimes comfort themselves with the thought that we are living in a moment in time, our turn in the Refrigerator Mother Barrel, so to speak. We thank heaven that we aren’t subject to the isolation and lack of information that mothers of autistic children experienced in the pre-Internet age. We pray that our children, if they are younger, will outgrow the oppositional behavior, as it does for a substantial percentage of ODD children, and that it will not turn into Conduct Disorder or bipolar disorder as it does for others when they grow older. And we pray that we have the strength and patience to help our kids turn into the most balanced and happy adults they can become, despite the internal turmoil they must overcome.
*There are still hold-outs to the belief that even autism is a developmental or neurobehavioral disorder: the BBC reported in 2012 that France was still treating autistic children with psychoanalysis (http://www.bbc.com/news/magazine-17583123).