外文精讀｜對叛逆孩子的情感解釋

Emotional Explanations for The “Defiant” Child

對叛逆孩子的情感解釋

作者：Daniel Flint，博林格林州立大學臨床心理學博士研究生，主要研究兒童臨床心理學和宗教與精神心理學。在臨床方面，他與孩子和他們的父母合作，為各種各樣的行為問題設計可行的干預措施。

翻譯：羅紅黴素

Parents and clinicians alike may be tempted to label children who exhibit repeated acts of defiance or misbehavior as “oppositional/defiant。” Oppositional Defiant Disorder （ODD）， with an estimated adolescent prevalence of up to 12。6%， is a diagnosis that encompasses many behavioral symptoms relating to misbehavior， angry/irritable mood， argumentativeness/defiance， and vindictiveness。 This means that children who meet the criteria for ODD often lose their temper， get annoyed easily， argue， defy requests/rules， and act in a spiteful， aggressive manner towards others。 In short， children labeled with ODD are often seen as inherently oppositional and temperamentally difficult or vindictive。

父母和臨床醫生可能會試圖將表現出反覆違抗行為或不當行為的孩子貼上“對立/違抗”的標籤。對立違抗性障礙（ODD），估計青少年患病率高達12。6%，是一種包含許多與不當行為、憤怒/易怒情緒、爭論/違抗和報復有關的行為症狀的診斷。”這意味著，符合這標準的孩子經常發脾氣，很容易生氣，爭論，反抗要求/規則，並對他人表現出惡意和侵略性。簡而言之，被貼上對立違抗性障礙標籤的孩子通常被視為天生的對立者，在氣質上難以相處或懷有報復心理。

However， making these types of characterological attributions could do more harm than good—they don’t produce any workable solutions and may even distract from a real underlying psychological problem！ In fact， ODD itself is likely best understood as a label for a cluster of behavioral symptoms rather than an underlying cause of those behavioral symptoms。 While this blog post has no intention to delve into the moral implications of childhood misbehavior， it‘s worthwhile to explore other clinical explanations of childhood defiance that may help parents address the real root of the problem。

然而，把這些型別的性格歸因可能弊大於利——它們不會產生任何可行的解決方案，甚至可能轉移人們對真正的潛在心理問題的注意力！事實上，ODD本身最好被理解為一系列行為症狀的標籤，而不是這些行為症狀的根本原因。雖然這篇博文無意探究童年時期不當行為的道德含義，但值得探討的是，童年時期反抗行為的其他臨床解釋可能有助於父母解決問題的真正根源。

This article uses clinical and research evidence to suggest three possible causes for childhood misbehavior in an effort to defend the character of the so-called “defiant child” and help parents stay aware that acting out can be a symptom of an underlying clinically significant problem that might otherwise go unnoticed。

這篇文章利用臨床和研究證據，提出了導致兒童行為不端的三個可能原因，以努力捍衛所謂的“叛逆兒童”的性格，並幫助父母保持意識，行為不端可能是一個潛在的臨床重大問題的症狀，否則可能會被忽視。

1. Defiance may be a sign of anxious distress

1. 反抗可能是一種焦慮不安的跡象

General emotional distress （e。g。， anxiety， sadness） was mentioned as a potential root cause of defiance and misbehavior。 Below， we take a more nuanced approach and discuss the link between disruptive behavior and disorders of anxiety specifically。 About 40% of children who meet the criteria for ODD also meet the criteria for an anxiety disorder。 This means that almost half of all children who exhibit clinically significant behavior problems also experience a clinically significant amount of anxiety—that’s an astonishing comorbidity rate！ Researchers have sought to untangle the direction of effects regarding the two types of disorders， and like many things in life， it‘s a complicated matter that depends on the myriad individual and environmental factors。 However， what is clear is that at times， oppositional and defiant behavior can be rooted in intense feelings of anxiety。

一般的情緒困擾（如焦慮、悲傷）被認為是反抗和不當行為的潛在根源。下面，我們將採用更細緻入微的方法，具體討論破壞性行為和焦慮症之間的聯絡。大約40%符合ODD標準的兒童也符合焦慮症的標準。這意味著幾乎一半的表現出臨床意義重大的行為問題的兒童同時也經歷了臨床意義重大的焦慮——這是一個驚人的共病率！研究人員試圖理清這兩種疾病的影響方向，就像生活中的許多事情一樣，這是一個複雜的問題，取決於無數的個人因素和環境因素。然而，有一點是清楚的，有時候反抗的行為可能根植於強烈的焦慮感。

Children with anxiety disorders exhibit excessive worries， fears， and anxiety that may be general and span different domains of life （as with Generalized Anxiety Disorder） or specific to a particular type of situation （as with Social Anxiety or Separation Anxiety Disorder）。 One of the key features of all anxiety disorders is that the person finds it difficult to control his or her worrying。 This means that when children suffer from untreated anxiety disorders， they may have an exceptionally hard time coping or regulating their emotions when placed in anxiety-inducing situations—at times becoming defiant or oppositional as a result。 In part one， we discussed childhood defiance as a form of control-seeking in uncertain， anxiety-provoking situations or a form of （faulty or misleading） self-expression when unable to articulate an intense emotional experience in a more socially acceptable way。 Both explanations remain likely scenarios for children with anxiety disorders。

患有焦慮症的兒童表現出過度的擔憂、恐懼和焦慮，這些焦慮可能是普遍的，跨越了生活的不同領域（如廣泛性焦慮症），也可能只針對特定型別的情況（如社交焦慮症或分離焦慮症）。所有焦慮症的關鍵特徵之一就是患者發現很難控制自己的焦慮。這意味著，當兒童患有未經治療的焦慮症時，他們可能會有一段非常艱難的時間來應對或調節他們的情緒，當處於焦慮誘導的情況下，有時會變得叛逆或對立。在第一部分中，我們討論了在不確定的、引起焦慮的情況下，童年反抗作為一種尋求控制的形式，或者在無法以更能為社會接受的方式表達強烈的情感體驗時，作為一種（錯誤或誤導的）自我表達的形式。這兩種解釋都可能適用於患有焦慮症的兒童。

Additionally， when fear and anxiety are more acute， children may become oppositional simply in an effort to escape the situation that makes them feel such emotional distress。 This is called “avoidance，” and children and adults alike go to great lengths to steer clear of the things that they fear the most in life。 For example， a child that meets the criteria for Separation Anxiety Disorder may exhibit persistent reluctance， and even downright refusal， to go to school because of an intense fear about leaving loved ones。 While this behavior could easily be construed as opposition and defiance， a further assessment of the child’s internal states would reveal the true cause of the disruptive behavior。

此外，當恐懼和焦慮更加強烈時，孩子們可能會變得對立，只是為了逃避讓他們感到情緒壓抑的情境。這就是所謂的“逃避”，孩子和成年人一樣會竭盡全力地避開他們生活中最害怕的事情。例如，符合分離焦慮障礙標準的孩子可能會表現出持續的不情願，甚至完全拒絕去上學，因為他們非常害怕離開所愛的人。雖然這種行為很容易被理解為反對和蔑視，但對孩子的內在狀態的進一步評估將揭示破壞性行為的真正原因。

2. Defiance may be a sign of depression symptoms

2. 反抗可能是抑鬱症狀的標誌

Of these three types of disorders， depression is the least common， however， among older children， depression has an occurrence rate of greater than one-in-twenty。 And， although this prevalence rate is fairly low， individuals can have symptoms of depression without exceeding the threshold necessary for a diagnosis of depression。 With this in mind， it’s worth considering the possibility that older childhood misbehavior may be a sign of depression symptoms。

在這三種疾病中，抑鬱是最不常見的，然而在年齡較大的兒童中，抑鬱的發生率大於二十分之一。而且，儘管這一患病率相當低，但個體可以在不超過診斷抑鬱症所需的閾值的情況下出現抑鬱症狀。考慮到這一點，值得考慮的是，童年時期的不良行為可能是抑鬱症狀的一種跡象。

Especially given that irritability is a key diagnostic feature of depression in children and adolescents， one can quickly make the logical jump to understand that a depressed child might be predisposed towards acting out。 Imagine if 14-year-old Jess， who lives a fairly average daily life， experiences none of the normative daily highs that her peers do。 She doesn‘t enjoy her elective art class， she doesn’t feel excited when her team wins in gym class， she doesn‘t grow eager to get home at the end of the day。 Instead， her mood exists somewhere between flat emptiness and mild grumpiness。 How much more likely is Jess to react unpleasantly in response to her parent’s request to take out the trash than her peers might be？ For the adolescent who experiences more-than-average symptoms of depression （regardless of qualifying for clinical diagnosis）， simple inconveniences and tasks are not buffered by the daily highs experienced by most children。 As a result， Jess may react to her parent in a defiant manner – or even break down into tears of frustration。 Signs like this suggest that the child may be experiencing some emotional turmoil rather than that they are a defiant child。

特別是考慮到易怒是兒童和青少年抑鬱的一個關鍵診斷特徵，我們可以很快做出合乎邏輯的跳躍來理解一個抑鬱的孩子可能傾向於表現出來。想象一下，如果14歲的傑西過著相當普通的日常生活，卻沒有經歷過同齡人所經歷的正常的日常高潮。她不喜歡自己選修的藝術課，當她的團隊在體育課上獲勝時，她不會感到興奮，她也不會變得急於在一天結束後回家。相反，她的情緒介於空虛和溫和的暴躁之間。傑茜比她的同齡人會不會更可能對父母倒垃圾的要求做出不愉快的反應？對於青少年誰經歷超過平均水平的抑鬱症症狀（無論資格的臨床診斷），簡單的不便和任務不會被日常高潮緩衝。結果，傑西可能會以一種挑釁的方式對她的父母做出反應——甚至會因為沮喪而大哭。像這樣的跡象表明，孩子可能正在經歷一些情感上的混亂，倒不是因為她是一個反抗的孩子。

3. Defiance may be a symptom of traumatic stress

3.反抗可能是創傷壓力的一種症狀

Finally， childhood defiance may be rooted in previous exposure to a traumatic event。 The way children react to trauma can often look a lot like oppositional defiance， and indeed， a large percentage of children who are exposed to trauma subsequently exhibit dramatic changes in behavior that map quite well onto the symptoms described by ODD。

最後，童年時期的反抗可能源於之前的創傷事件。孩子們對創傷的反應通常看起來很像反抗，事實上，很大一部分暴露於創傷的孩子隨後表現出行為上的巨大變化，這些變化很好地反映了對立違抗性障礙的症狀。

Childhood traumatic experiences take many forms—exposure to violence， medical trauma， and natural disasters。 These are events that pose serious emotional or physical injury or even threaten death to the child。 To be clear， these events threaten a child’s sense of physical or emotional safety in a way that major life stressors （e。g。， parental separation/divorce， parental remarriage， moving） do not。 Most children who are exposed to traumatic events experience initial high levels of distress that diminish over time—it is well established that most individuals naturally recover from traumatic stress。 However， there is a subset of children who do continue to experience long-term effects of trauma， such as behavioral problems， poor emotion regulation， physical health problems， and academic struggles。 Indeed， like many things in life， reactions to trauma exist on a spectrum—child reactions to trauma vary widely， and at times， defiance， temper loss， and other disruptive or destructive behaviors may occur。

童年創傷經歷有多種形式——接觸暴力、醫療創傷和自然災害。這些事件造成嚴重的情感或身體傷害，甚至威脅到孩子的生命。需要明確的是，這些事件以一種主要的生活壓力因素（如父母分居/離婚、父母再婚、搬家）無法消除的方式威脅著孩子的身體或情感安全感。大多數暴露於創傷性事件的兒童最初會經歷高度的痛苦，隨著時間的推移，這種痛苦會逐漸減輕。然而，仍有一部分兒童繼續遭受創傷的長期影響，如行為問題、情緒調節不良、身體健康問題和學習困難等。事實上，就像生活中的許多事情一樣，對創傷的反應存在於一個譜系——孩子對創傷的反應差異很大，有時反抗、發脾氣和其他破壞性的行為可能會發生。

So how exactly can trauma lead to childhood defiance？ To quote researchers Perry and Pollard， “All experiences change the brain， but not all experiences affect the brain equally。“ Traumatic events are uniquely threatening and may cause impairments in the function of several brain areas responsible for emotional and behavioral regulation。 These impaired neurophysiological processes often render a child more likely to be reactive to everyday stressors， leaving him or her feeling unsettled and leading to emotional and behavioral outbursts ［10］。 In other words， children whose brains have been deeply affected by a traumatic event are more likely to “overreact” or become defiant， especially in situations that threaten the child’s sense of safety or well-being。

那麼，創傷究竟是如何導致兒童反抗的呢？引用研究人員Perry和Pollard的話，“所有的經歷都會改變大腦，但並不是所有的經歷對大腦的影響都是一樣的”。創傷事件具有獨特的威脅性，可能導致負責情緒和行為調節的幾個大腦區域的功能受損。這些受損的神經生理過程往往使孩子更容易對日常壓力做出反應，使他或她感到不安，並導致情緒和行為的爆發。換句話說，那些大腦受到創傷事件嚴重影響的孩子更有可能“反應過度”或變得目中無人，尤其是在威脅到孩子的安全感或幸福感的情況下。

Take， for example， an all-too-common form of childhood trauma： repeated and incessant bullying。 Imagine Johnny， who is in 3rd grade， goes to school every day where his peers laugh at his clothes， push him into the walls when the teacher isn‘t looking， and even spit on him。 Like many children who are survivors of bullying， he feels powerless and defenseless while this is happening。 Soon， Johnny starts to hate going to school。 Even the thought of going to school triggers a physical reaction—blood rushes to his face， his stomach gets all knotted up， he loses his appetite。 He starts to refuse to get on the bus in the morning， throwing tantrums or running away from his parents。 He might even refuse to do his homework in the evenings because it reminds him of his experiences that day at school。 Surely， these acts of outward defiance are not rooted in an oppositional temperament or a flaw in his parents’ parenting skills—they are an entirely reasonable reaction to an extreme situation in which Johnny’s very well-being is threatened！

舉個例子，一個非常常見的童年創傷的形式：反覆不斷的欺凌。想象一下，三年級的約翰尼每天去學校，同學們嘲笑他的衣服，趁老師不注意把他推倒在牆上，甚至朝他吐唾沫。像許多受欺凌的倖存者一樣，當這種事情發生時，他感到無能為力、毫無防備。不久，強尼開始討厭上學。甚至一想到要去上學就會引起身體的反應——血液湧上他的臉，他的胃都打結了，他失去了食慾。他開始拒絕在早上上車，發脾氣或從父母身邊跑開。他甚至可能拒絕在晚上做作業，因為這會讓他想起那天在學校的經歷。當然，這些公然反抗的行為並不是植根於對立的性格或他父母的育兒技巧的缺陷——它們是一個完全合理的反應，在一個極端的情況下，約翰尼的健康受到了威脅！

Why is labeling accurately—or， just as importantly， choosing not to label—so meaningful？ The defiant label stigmatizes the child as inherently “bad” or comparatively worse than other children。 This has implications relating to self-esteem， self-fulfilling prophecy， and parental interventions。 Additionally， viewing defiance as a fundamental personality flaw could lead to two equally dangerous outcomes： 1） it could absolve parents and child of the responsibility to be agents of change， since personality is often viewed as relatively stable， or 2） it could lead to parents feeling hopeless about ever-improving their child’s behavior and perhaps even giving up trying。 It should be noted that our hope is not to discourage parents from seeking treatment for their child’s misbehavior， but rather to empower parents with knowledge about defiant behavior so that they are better equipped to tackle their child‘s behavior problems。

為什麼準確的標記——或者同樣重要的是，選擇不標記——如此有意義？反抗性的標籤侮辱孩子天生“壞”或相對比其他孩子更壞。這與自尊、自我實現預言和父母干預有關。此外，視挑戰為一個基本人格缺陷可能導致兩個同樣危險的結果：1） 它免除家長和孩子作為變革動力的責任，因為人格通常被視為相對穩定，2） 可能導致父母對改善孩子行為感到絕望，甚至放棄嘗試。值得注意的是，我們的希望不是阻止父母為孩子的不端行為尋求治療，而是讓父母掌握反抗行為的知識，這樣他們就能更好地應對孩子的行為問題。

原文載於 Psychology Today， https：//www。psychologytoday。com/us/blog/behavior-problems-behavior-solutions/202005/3-emotional-explanations-the-defiant-child