What Is Defiance and What Is Development? (ADHD Under-Fives)

Let's start by looking up what defiance actually means. And then we can look at what could be going on underneath the behaviour that can impact or influence a child so that defiance looks like the outcome.

Defiance means bold disobedience - when someone refuses to follow rules or shows a lack of respect for authority, like saying “no” to an adult or ignoring instructions.

• Defiance is when a child resists or refuses to do what an adult asks. This can be through words (talking back, arguing) or actions (walking away, ignoring instructions). dinosearch.com

• It often looks like not listening, saying “you can’t make me,” or doing the opposite of what was asked. dinosearch.com

• Some defiance is normal as kids learn independence, but strong or frequent defiance may need guidance. dinosearch.com

ADHD Under-Fives

The word defiant is used a lot when we talk about children's behaviour. A child is asked to put their shoes on and says no. They are told it is time to leave and refuse to move. They are asked to stop doing something and carry on. They become upset when an adult insists. From the outside, it can look very simple to a parent 'I ask them the question, they understood the question that they are refusing so they must be defiant.' But is it always that simple?

Before we decide that a young child is deliberately refusing to cooperate, perhaps we need to ask a different question:

Does this child understand what I have asked them, and can they interpret that question or instruction into an action?  

Is there something within this task that the child does not yet have the developmental capacity to complete?  

Is this defiance, or does this child need other abilities to do what I have just asked them to do?

What do we actually mean by defiance?

Defiance is not simply the act of saying no.

When we describe somebody as defiant, we are usually making an assumption about their intention. We are suggesting that they understand what is expected, have the ability to do it, and are choosing to resist. That distinction matters enormously with children under five.

A child may understand the words “put your shoes on”, but carrying out that instruction can require much more than understanding language. They may need to stop what they are already doing, shift their attention, hold the instruction in working memory, inhibit the urge to continue their current activity, tolerate the frustration of stopping, organise the steps required and then begin the new task. For a young child whose executive functions are still developing, that is quite a list.

Firstly, processing the question itself can take time. If it is a long question or instruction, your child may still be processing the beginning while your expectation is that they respond immediately. The emotion they have attached to what they are currently doing may also be substantial. Switching from something they really enjoy to something they haven't yet planned for in their head can lead to upset. Then take the seemingly simple instruction, “Put your shoes on.” They may need to remember where they last put their shoes, stop what they're currently doing, organise and plan what needs to happen next, and adapt to the new task ahead.

Suddenly, “put your shoes on” isn't quite as simple as it sounded. Then, if the task is to put their shoes on, they then have to remember when I last put them. After this, organising and planning their thought processes to be able to get dressed, understand what you're saying, and adapt to the new task ahead, which is really important. For some children with ADHD, knowing what is coming gives them time to picture it, prepare for it and emotionally adjust to the change. If they're suddenly expected to move into something they haven't anticipated, that uncertainty itself can feel almost like a shock to the system.

Many of the abilities needed here involve developing executive functions, such as inhibition, working memory, planning and shifting. But these abilities don't work in isolation. Other developing brain systems involved in attention, motivation, salience, emotion and arousal can also influence how a child responds to what is being asked of them. The prefrontal cortex is part of this developing picture, but it isn't the whole picture.

Research in preschool children with ADHD has found differences in some areas of executive functioning. In a 2012 study of 202 children aged 3.5–5.5 years, including 61 children diagnosed with ADHD, the ADHD group showed robust difficulties with inhibition. The researchers found few group differences in working memory in this particular study. PubMed

A separate study of 1,045 three-year-old children found that ADHD symptoms, both alone and alongside oppositional-defiant symptoms, were associated with poorer performance on inhibition tasks. The researchers also found associations between ADHD symptom levels and performance across inhibition and working-memory measures, although this was a non-clinical population study examining symptoms rather than a sample of children diagnosed with ADHD. PubMed

Importantly for very young children, executive functions are developing during this period. A longitudinal study following a predominantly clinically diagnosed preschool sample over 18 months found that inhibition and working-memory performance increased over time, particularly during the early preschool period.

What if the behaviour looks deliberate?

This is where it becomes uncomfortable because sometimes it really does look deliberate.

A child may negotiate, distract, run away, say no, suddenly need something else, become silly, get angry or appear perfectly capable of doing something one day and completely unable to do it the next.

This can look like defiance or demand avoidance. However, it could also be that the child knows what is coming, has experienced discomfort in this situation before, and is showing that discomfort through behaviour that looks like deliberate defiance.

In this situation parents and adults try to explain why. 'There must be a reason that my child is behaving this way.' Much of our parenting skills come from our own knowledge of how we were parented along with other experiences or environment and what we see or perceive on social media.

Many adults and parents look at the child and think the following:-

They want control.

They're testing boundaries.

They're attention seeking.

They're being oppositional.

They're avoiding a demand.

They're anxious.

But how much can we actually know about the mechanism underneath a behaviour simply by watching the behaviour? Two children can do exactly the same thing for completely different reasons. And the same child may refuse the same request for different reasons on different days.

That is particularly important when we start giving patterns of behaviour names.

The ability to be deliberately defiant

There is also something we need to consider before deciding that a young child is being deliberately defiant. To interpret a behaviour as deliberate defiance, we are assuming that a sequence of abilities has taken place. The child needs to understand what has been asked, hold that information in mind, recognise what is expected of them, consider their own response and then act on that response. Depending on the situation, this can involve attention, working memory, inhibition, planning, emotional processing and other developing systems working together. These abilities are still developing throughout the preschool years, and some are areas in which preschool children with ADHD can experience particular difficulty. So although an under-five can of course deliberately say “no”, seeing refusal does not automatically tell us that the child has stepped back, considered the expectation and made a deliberate decision to oppose it. We still need to ask what happened developmentally between the instruction and the behaviour we eventually saw.

The behaviour is real. The difficulty is real.

The question is whether observing the behaviour automatically tells us why it is happening.

And what about children under five?

This is perhaps the part I am most interested in. The early years are an enormous period of development; executive functions develop, emotional understanding develops, language develops, self-awareness develops, the ability to tolerate frustration develops. Children gradually become better able to stop, wait, shift, remember, communicate and understand what is happening inside themselves.

For a young child with ADHD, however, some of the abilities involved in this development may be more difficult or may develop differently. Preschool research has identified difficulties across areas including executive functioning, delay-related behaviour, emotion recognition and emotion regulation in children with ADHD. PubMed

Emotion itself is important here too. Across the wider child and adolescent ADHD literature, a large meta-analysis found differences not only in emotion regulation, but also in emotional reactivity and in recognising or understanding emotions. PubMed Research into recognising emotion from facial expressions has also often found children with ADHD to be less accurate than comparison groups, particularly for some negative emotions, although findings across individual studies are not completely consistent. PubMed

Self-awareness and the ability to understand another person's perspective are also developing during these early years. These abilities cannot simply be assumed to be consistently available to every young child. Barkley's model of ADHD places self-awareness within executive functioning and describes ADHD-related executive difficulties primarily as developmental delays. Research in typically developing preschool children has also found a relationship between executive functioning and the developing ability to understand another person's perspective. Therefore, if some executive abilities are developing differently or more slowly in a child with ADHD, it is reasonable to consider whether this may also influence how easily that child can reflect on their own response or step outside it to consider somebody else's point of view.

So imagine what this can mean when we look only at the behaviour. A child may have difficulty stopping their immediate response, tolerating frustration, shifting away from what they are doing, understanding their own emotional response, or correctly interpreting the expression and response of the adult in front of them. Yet what we eventually see may simply be a child saying “NO”, walking away, arguing or becoming upset.

That development does not finish at five, and ADHD does not mean development stops.

One longitudinal study of a predominantly clinically diagnosed preschool sample measured inhibition and working memory three times over 18 months. Both abilities improved over time, particularly during the early preschool period. Poorer inhibition was associated with ADHD and disruptive behaviour disorders, while poorer working memory was associated with ADHD. PubMed

“How do we stop this behaviour?”

I want to know:

What is this situation asking this child's developing brain to do?

Can they stop?

Can they shift?

Can they remember?

Can they understand?

Can they communicate what is difficult?

Can they tolerate the feeling produced when something doesn't go their way?

And, importantly, which bit are they struggling with?

Perhaps “no” is where the investigation begins

I don't think every refusal is ADHD, I don't think every refusal is developmental, and I certainly don't think adults should ignore behaviour that is making life extremely difficult for a child or family. But I also don't think that seeing a child refuse tells us enough to decide immediately what is happening underneath.

There is an enormous difference between:

won't

can't

can't yet

doesn't understand

can't shift

can't regulate

and

can do it, understands it, has the capacity right now, and is choosing not to.

From the outside, several of those can look exactly the same.

And perhaps that is why, particularly with children under five, we need to be curious before we are certain.

Because behaviour is the part we can see.

Development is the part we have to look for.