Defiant child, ADHD child: the PSYCHOTIP® parent programme

1. Before you start

Your child argues with every instruction. You have to repeat it five times, raise your voice, threaten — and sometimes give in. Meals, homework, getting dressed, bedtime and outings turn into exhausting negotiations. You feel you have become a parent you don't like: the one who shouts, who counts to three, who threatens things they will never carry out.

This programme is built for exactly that situation. It concerns children of roughly 2 to 12 years old who show oppositional behaviour: refusal, defiance, outsized anger, difficulty accepting a "no". It applies whether or not that behaviour comes with attention deficit hyperactivity disorder (ADHD).

It is written for parents. Not for specialists, not for teachers — for you, who live through the evening scene and do not have three hours to spend on a manual.

2. Understanding ADHD

What ADHD is not

It is not a failure of parenting. It is not a failure of willpower. It is not a recent invention: clinical descriptions of inattentive, restless children go back to the early twentieth century, and the disorder is one of the most studied in all of child psychopathology.

Nor is it simply an excess of energy. Many children with ADHD are not restless at all: they daydream, lose their belongings, forget instructions halfway through. They are often the least identified, because they disturb nobody.

Finally, it is not a matter of intelligence. ADHD occurs at every level of intellectual ability, and the gap between what a child is able to understand and what they manage to do is precisely what makes the disorder so baffling to those around them.

The real mechanism: a problem of execution, not of knowledge

A child with ADHD usually knows perfectly well what needs to be done. They can explain it to you. They do not do it.

That gap is called a deficit in executive functions: the set of mechanisms that let you hold an intention in mind, resist a distraction, start a boring task, stop in time, anticipate a distant consequence. Three practical consequences follow, and they govern this whole programme.

The future barely motivates. A reward announced for Saturday has almost no influence on Tuesday's behaviour. A punishment planned for "this weekend" has no effect on the action under way. This is not carelessness: it is a real difference in how the brain weighs a delayed consequence.

Inhibition is expensive. Where another child holds back an impulsive response without thinking, this one has to make a conscious effort — and that effort runs out. Hence the catastrophic ends of days, when the morning had gone well.

Working memory is short. "Go up, put your pyjamas on, brush your teeth and come back down with your school bag" contains four instructions. By the third step of the stairs, one is left, often the least important.

How the diagnosis is made

The reference manual clinicians use, the DSM-5-TR of the American Psychiatric Association, describes ADHD around two sets of symptoms. What follows is a restatement in everyday language, not the official list — that one is weighed in consultation, with concrete examples and a look back at the child's development since early childhood.

First set: inattention. This covers difficulty sustaining attention on a task or a game, careless mistakes, the impression of not listening when spoken to, instructions started and never finished, disorganisation of belongings and of time, avoidance of activities demanding sustained mental effort, objects lost in series, distractibility by whatever passes nearby, and forgetfulness in daily routines.

Second set: hyperactivity and impulsivity. This covers fidgeting or being unable to stay seated, getting up when one should stay put, running or climbing at inappropriate moments, an inability to play quietly, seeming "driven by a motor", a flood of talk, answers fired off before the question ends, difficulty waiting one's turn, and interruptions in other people's conversations or games.

To retain the diagnosis, the clinician checks several conditions, and this is where the whole difference from a simply lively temperament lies:

• A sufficient number of symptoms in at least one of the two sets: at least six for a child, at least five from seventeen years old.
• A duration of at least six months, at an intensity that does not match the developmental age.
• An onset before the age of twelve — several symptoms were already present in childhood, even if nobody named them.
• Presence in at least two different settings: home and school, or home and after-school activities. A child who is difficult only at home does not fall under this diagnosis; that would point instead to the family dynamic.
• A real impact on schooling, relationships or daily life.
• The absence of another explanation: anxiety, a sleep disorder, a learning disorder, difficult life circumstances or a mood disorder can produce very similar pictures.

Depending on how the symptoms are distributed, the DSM-5-TR distinguishes three presentations: combined (both sets), predominantly inattentive, or predominantly hyperactive-impulsive. The presentation can change with age: motor restlessness often fades in adolescence while inattention and disorganisation persist.

The point to hold on to about the two settings. If your child is unmanageable at home and perfectly adapted in class, this programme will be useful to you — but ADHD is unlikely, and it is worth looking for what, in family life, is sustaining the difficulty. Conversely, if the school reports exactly what you are living through, the hypothesis deserves an assessment.

The same disorder does not look the same at every age

One reason ADHD goes unnoticed for years is that it does not look like the same thing at three, at eight and at twelve.

Before school age, everything is in movement and intensity: the child climbs everywhere, cannot sit still for a story, moves from one activity to the next in seconds, gets hurt more often than others. At that age the difficulty is telling a lively temperament from a disorder — many three-year-olds tick almost every box without there being anything to diagnose. It is the intensity, the persistence and the impact that make the difference, never the mere presence of the behaviour.

At primary school, the demands shift. You are asked to stay seated, listen for a long time, organise yourself, finish. The difficulties become visible: unfinished work, lost equipment, an empty homework diary, comments in the school book, homework that drags on. This is the period when most diagnoses are made — often because the school raised the alarm.

At the end of primary and the start of adolescence, motor restlessness often eases: the child no longer runs around the classroom, they fidget on their chair or inside their head. What remains, and sometimes worsens, is disorganisation, procrastination, forgotten deadlines, verbal impulsivity. Because the most visible symptoms have gone, those around them readily conclude that "they grew out of it" and put the rest down to laziness. This is often when self-esteem deteriorates most.

What these children experience from the inside

It is worth picturing the day from the child's point of view, because it changes how you speak to them.

They hear, on average, far more negative remarks than other children: about their desk, their slowness, their noise, their forgetfulness, their school bag. Each one is justified taken alone. Added up over years, they build a conviction: I am someone who does things badly.

They also repeatedly experience the gap between their intention and their result. They meant to tidy up. They started. They stopped halfway without knowing why. When they are told they did not want to, they know it is untrue — but they cannot explain what happened, so they stay silent, or they argue.

A good part of the opposition comes from there. Not from a child who wants power, but from a child protecting themselves from a situation where they always lose. That does not make the behaviour acceptable; it tells you where to take hold of it.

What often comes with ADHD

ADHD rarely travels alone. In a majority of diagnosed children, at least one other difficulty is found: oppositional defiant disorder, an anxiety disorder, a learning disorder — dyslexia, dyscalculia —, a sleep disorder, tics, or low self-esteem built on years of reproach. This matters for two reasons. First because treating the ADHD without seeing the dyslexia behind it will not fix homework. Second because low self-esteem is often the most lasting consequence, and the most avoidable.

---