Conduct Disorder (CD) is defined in the DSM-IV-TR (American Psychiatric Association, 2000) as a “repetitive and persistent pattern of behavior in which the basic rights of others or major-age inappropriate societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months with at least one criterion present in the past 6 months. . .” The criteria comes from different categories, including aggression to people and animals, destruction of property, theft, and serious rules and violations.
Oppositional Defiant Disorder (ODD) is defined as a pattern of angry and irritable behavior or vindictiveness that persists for at least six months. At least one of these interactions needs to be exhibited with a non-sibling. The person with ODD also needs to display four or more symptoms in the following categories: vindictiveness, angry/irritable mood, and argumentative/defiant behavior (American Psychiatric Association, 2013).
In the documentary “Hold Me Tight, Let Me Go,” children and adolescents with ODD and CD are being treated at Mulberry Bush school. The opening scene features Alex, a child who has just kicked an adult, Julie, in the vagina. Another adult is asking Alex what he did, why he what did, and to name three things about Julie that he likes.
While watching the film, I noticed that certain events seemed to trigger acting out behaviors in the kids with ODD and CD, such as transitioning to different activities, not getting one’s own way, being restrained, feelings of sadness when a child’s family visit ended, and accepting responsibilities for their actions and behaviors that hurt other people. I also noticed that when the kids were asked to express their feelings about their behaviors, especially feelings regarding how they had hurt somebody else physically or emotionally or pertaining to sadness, they tended to act out physically, yell, and say mean, rude remarks to adults, such as the words “nigger” or “fatso.”
Talking about vulnerable feelings, such as anger, sadness, and disappointment, seemed to be difficult for the kids in the film. After one of the kids had apologized to an adult named Lisa for hurting her, he started to yell, cry, and tried to break the physical restraint. A Mulberry School worker pointed out that the child seemed to be acting out because Lisa did not accept his apology in the way that the child wanted her to accept it.
Difficulty in expressing feelings properly also showed up later on in the documentary. A boy named Michael kept spitting at the workers, swearing, hitting, and refusing to do any homework. He had to be restrained and then later taken out of the room. When a worker asked him why he keeps spitting at people, Michael said that he was angry about his father getting married to an ex-girlfriend and that had been bothering him for most of the day.
Some typical OCC and CD symptoms that were displayed by the children at Mulberry throughout the film included biting, hitting, and kicking adults; swearing at workers; urinating on the floor; picking up a weapon, such as a knife; physically assaulting others, spitting at people; and saying mean and hurtful comments to adults and other peers.
One risk factor that seemed to be apparent was problems and issues at home, such as the break-up of parents (i.e. Michael’s father getting married to an ex-girlfriend) and a history of OCC and CD like behaviors in parents. Michael’s mother expressed a history of having similar issues as her child, feeling heartbroken when she sees her younger self in Michael’s current behavior, to a worker on the film.
The treatments that the workers used seemed to coincide with a combination of physical restraint first and later, Cognitive Behavioral Therapy (CBT) orientation. The adults would set up a small meeting between the youth acting out and the workers involved in the acting out behavior, both on the receiving end of the acting out behavior and ones who witnessed it. First, the workers would point out the child’s inappropriate or bad behavior, ask them why they did it, and the eventually get down to the root of the problem. This diverted the kids to focusing on their thoughts and how these thoughts can lead to inappropriate actions. The real reason usually centered on a child’s angry feelings about something, as was the case in Michael’s aggressive behavior. His acting out was really a symptom and signal of his inability to cope with his uncomfortable angry feelings triggered by his father marrying his ex-girlfriend.
The treatment continued with the workers expressing how the youth’s behaviors made them feel and them asking the child to name a better way to deal with their feelings and an alternative to acting out through physical and verbal aggression. In the case of Michael, the worker asked how he can talk to his father about his getting upcoming marriage. In some instances, the workers asked what they can do to help the child act more appropriately. The treatments seemed to work with many of the kids expressing their true feelings, some of them admitting that they really did want to stop their acting out behaviors.
Other secondary parts of treatments including distracting the kids with physical activities, such as playing the recorder, singing, reading, coloring, and focusing on children’s strengths. With Ben, the worker asked Ben to describe his feelings in a color and to say what his anger feels like. This led to Ben expressing feelings of loneliness and how he hates his life. Part of the treatment also focused on praising kids for the right and appropriate behaviors, which Ben’s mother and workers did when Ben behaved during his mother’s visit.
Enrolling children in the Mulberry Bush School can be difficult for parents. Upon admitting Charlie to the Mulberry School, his mother appeared sad and conflicted about her decision. I also noticed that some of children’s families had issues of dysfunction, such as alcoholism and divorce. However, the parents that did show up to support their kids at Mulberry Bush seemed involved and committed to their children getting better and eventually going home.
I liked how patient the Mulberry School workers were with the children with ODD and CD. I do not feel that physical restraint worked as well as using CBT and talking therapy with the children. I liked how the children’s family was involved with treatment, which I feel helps the child feel supported emotionally, their behavior improving more rapidly.