Oppositional defiant disorder and bad behaviour in schools

Aggression, not listening, interruptions ... bad behaviour is on the rise in schools. What's causing this trend? Is it parenting styles or the pandemic? Nurse Erin has had plenty of challenges with her son, leaving her family at the end of their tether. But one therapy just clicked. Today, a family's story of oppositional defiant disorder and giving Parent-Child Interaction Therapy a go. Can coaching parents through one-way mirrors and ear pieces help build stronger relationships? And why is PCIT so effective for kids with ODD? Guests: ErinNurse and motherPCIT participant Professor Eva KimonisClinical PsychologistDirector of the UNSW Parent-Child Research Clinic Credits: Presenter/producer: Sana QadarProducer: Rose KerrSenior producer: James BullenSound engineer: Harvey O'SullivanMore information: Parent-Child Research Clinic at the University of New South Wales https://www.conductproblems.com/Partnering with schools to better deliver effective therapies https://www.unsw.edu.au/science/about-us/creating-impact/partnering-with-schools-to-better-deliver-effective-therapiesInvestigating Western Australian Teacher Perceptions of Young Children’s Challenging Behaviour in the Early Years (Kindergarten to Year 2): An Exploratory Analysis https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=6548&context=ajteLandmark report warns wellbeing of Australian children at a crossroads https://www.aracy.org.au/media-release/landmark-report-warns-wellbeing-of-australian-children-at-a-crossroads/Schools Plus https://www.schoolsplus.org.au/Soul Search The neuroscience of spirituality with Iain McGilchrist https://www.abc.net.au/listen/programs/soul-search/the-neuroscience-of-spirituality-with-iain-mcgilchrist/106829904To explore more great episodes from the award-winning psychology podcast All in the Mind with host Sana Qadar, download the ABC Listen app (Australia) or search 'ABC All in the Mind podcast' wherever you get your podcasts. There you'll find more episodes on mental health, trauma, attachment theory, wellness hacks, and family relationships. You'll also hear interviews with experts like Esther Perel, Billy Garvey and Ethan Kross. All in the Mind is created for ABC's Radio National by specialist journalists and reporters at the Australian Broadcasting Corporation.

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  Okay, while we check your audio, tell me what you had for breakfast.

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  I had some Just Right and I had some Jona yogurt because it was on special.

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  What's Just Right?

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  Just Right, like it's a cereal with

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  Oh, okay, yep, yep, yep.

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  Fruit and stuff, lazy.

• 0:52Speaker 04

  This is Erin. She's a mum of two kids aged 10 and 7.

• 0:56Speaker 03

  They both have ADHD. We live in the suburbs of Sydney with my partner, Lewis.

• 1:00Speaker 04

  She's a nurse working part-time.

• 1:02Speaker 03

  And the rest of the time I sew and I run the robot vacuum and try to keep the house clean-ish.

• 1:09Speaker 04

  Nice ish, being the operative suffix. Erin says their eldest child, Lily, is just starting to grow into her sense of humour.

• 1:16Speaker 03

  And she can get some really, really great burns in. It's really weird seeing your own jokes come back at you.

• 1:22Speaker 04

  And Micah recently discovered a love of magnet tiles.

• 1:25Speaker 03

  His absolute favourite.

• 1:26Speaker 04

  Now, both her kids really struggled at the start of their schooling. Lily got better after she got her ADHD diagnosis.

• 1:34Speaker 03

  Wasn't diagnosed till she was in year one and medicated.

• 1:37Speaker 04

  Micah's journey, though, has been far more complicated.

• 1:41Speaker 03

  Micah is finishing year one. He is going pretty okay, a very tumultuous start because he was born in 2018. So he went to preschool. During second wave of COVID and we noticed that he was different to Lily. He wasn't, Lily's very gregarious and outgoing, but Michael was quite withdrawn. His speech was not fantastic.

• 2:04Speaker 04

  Little Micah also struggled with big emotional meltdowns.

• 2:08Speaker 03

  When things didn't go the way he thought they would be. Like shoes is a constant problem. I would buy him shoes. He would hate how they felt. He would reject them, but he needs to wear shoes. So we'd have a huge fight and he'd get, you know, escalate, escalate, escalate. And eventually just explode. And sometimes we would have to like hold him physically because he'd hit us and be yelling his little head off.

• 2:33Speaker 04

  How old was he when this was happening?

• 2:35Speaker 03

  Must be, must have started like two or three, definitely by three.

• 2:39Speaker 04

  Okay. And then by the time he was at school, Micah was getting into other kids' personal spaces and generally disrupting class.

• 2:47Speaker 03

  He'd be all wiggly and like poke them and annoy them and, you know, sing silly songs right next to them and just give everyone the poops.

• 2:55Speaker 04

  Hmm.

• 2:56Speaker 03

  And his teacher, like he doesn't respond well to normal discipline or anything. It's like, Micah, stop it. So she was really, he was having a really hard time every day. When I'd pick him up from school, she'd come out and talk to us about, you know, the conflict of the day.

• 3:10Speaker 04

  And this is kindergarten, is it?

• 3:11Speaker 03

  Yes, this is kindy. Just soaked up.

• 3:14Speaker 04

  Yeah.

• 3:16Speaker 04

  The thing is, Micah isn't a total outlier. You might have clocked the steady stream of headlines over the last few years, reporting that behavioural issues are on the rise in schools. And it turns out Australia has some of the most disruptive classrooms in the world. A 2024 Senate Committee report found teachers on average spend about 15% of class time managing student behaviour rather than actually teaching.

• 3:42Speaker 05

  They're seeing kids entering school with more difficult behaviours. They're seeing kids that were already in school showing an increase in problematic behaviours.

• 3:51Speaker 04

  It all begs the question, why is this happening?

• 3:56Speaker 04

  From ABC Radio National, I'm Sana Qadar. This is All in the Mind. Today, from parenting to the pandemic, why behavioural issues are on the rise, and one programme that's going directly into schools with highly specialised psychologists and trying to help right at the source. It made a huge difference for Micah and his family. That's in today's episode.

• 4:26Speaker 04

  For Erin and her husband Lewis, things got especially hard the year before Micah started school. They were going through some big changes. They'd moved out of their family home and they were building a new one. And so they were paying rent and a mortgage. And for their little boy, it was all a lot.

• 4:43Speaker 03

  He was stressed because of all the change. I'm quite an optimistic person, but it was the only time I've been genuinely unhappy because his behaviour was just so out there. Like, he'd take forever to go to bed. He wouldn't eat anything that you would want him to. It was just, everything was hard. He wouldn't get dressed. He wouldn't come out to the car. He wouldn't put his seatbelt on. And Lewis and I had to dedicate a lot of energy to Micah, to calm him, to get him to comply with family routines. And Lily was feeling left out, like she wasn't getting the attention she needed. And that felt terrible as well. It was a sad time.

• 5:22Speaker 03

  I know control is an illusion, but you sort of feel like you have control over your kids a bit. And he has just proved over and over and over again, I do not. And also, I do not have control of my emotional regulation, an important lesson. I've been working on that.

• 5:40Speaker 05

  So we're hearing from schools that they're really seeing a rise in disruptive types of behaviours in their students.

• 5:47Speaker 04

  This is Eva Kemonis.

• 5:49Speaker 05

  And I'm a professor in the School of Psychology at the University of New South Wales.

• 5:53Speaker 04

  Eva works with kids and families and teachers through a type of treatment programme called parent-child interaction therapy, which we'll talk about in more detail soon. But for now, you just need to know that her team works on that. On behavioural issues in young kids, up to around the ages of seven or eight. And to paint you a bit of a picture of what these behaviours can look like, Eva says it's often stuff like tantrums.

• 6:18Speaker 05

  Big emotions that are very difficult to calm down. Impulsive types of behaviours, engaging in aggressive behaviour, destructive behaviour, bullying other children.

• 6:28Speaker 04

  There's also a lot of not listening.

• 6:30Speaker 05

  Kind of chronic not listening, which can be really a big strain for teachers when they're trying to manage a whole classroom. We've had children where they're just not participating at all in classroom activities. Maybe they're hiding under the desk. And we've got a lot of cases where children are requiring one-on-one management from a student learning support officer just to engage in standard school activities.

• 6:55Speaker 04

  There can be a lot of different drivers for this kind of behaviour, but Eva says many of the children that she works with meet the criteria for ODD, Opposition Defiant Disorder.

• 7:06Speaker 05

  Not everyone has a diagnosis, but when a child is showing disruptive, destructive, aggressive, hyperactive, impulsive type behaviours at a high frequency, then they are more likely to meet diagnostic criteria for Opposition Defiant Disorder, which can progress on to the more severe Conduct Disorder. Many of them also have Attention Deficit Hyperactivity Disorder as well, which co-occurs at a high rate with Opposition Defiant Disorder and Conduct Disorder.

• 7:36Speaker 04

  And so does their behaviour look like the chronic not listening? Or is it like more getting into fights?

• 7:41Speaker 05

  So again, it's a mix. So they tend to kind of build on their behavioural repertoire. So as you develop, you develop new skills. So they often start looking or engaging in the same types of problematic behaviours as typical kids. So they're not listening, they're throwing tantrums when they're told to do something or told they can't get something that they want. They're hitting when they want something for some kids. And what we know is they show the same types of behaviours that young, healthier, typically developing kids show, but at a much greater frequency. And so the problem becomes that. Makes it really difficult for parents to consistently respond in a positive way. And they tend to then move towards more of a negative response where these kids are getting

• 8:24Speaker 05

  lots and lots of attention for the bad behaviors and not a lot of attention for the good behaviors because most of their behaviors are bad behaviors. And so part of what we try to do is tip the scales and give them more attention for the positive behaviors so we can increase those positive behaviors and trying to reduce the attention that they're getting for the negative behaviors.

• 8:46Speaker 04

  So, as Eva mentioned, challenging behaviors in schools have become more common, more frequent. The question is, why? The pandemic and the associated increase in screen time for a lot of kids, the break in routine, the hit to mental health during that time, all of those issues have definitely played a role. But she says that changes in parenting styles have also contributed.

• 9:13Speaker 05

  We know from data that there have been increases in problems post pandemic. We've also seen a rise in different interpretations of, say, gentle parenting styles through social media and less of an emphasis on limit setting than maybe we've seen in past generations.

• 9:31Speaker 04

  Yeah, can you tell me a bit more about that? Because, yeah, I think we hear a lot about how the pandemic had an impact, how screens are having an impact. I'm curious to know what the other cultural, social factors are that you think might be contributing to this problem of problem behavior in schools.

• 9:46Speaker 05

  Yeah, I did. They definitely, through our clinic and through the clients that we work with, we do much more commonly in recent years compared to previous years, hear parents not wanting to put in discipline strategies, not aligning with that approach to parenting. And that's very difficult because we know that the science of parenting tells us that the optimal type of parenting is really a combination of sensitivity and responsiveness, but also limit setting. And this is what we call an authoritative parenting style. And this is the type of parenting style that's been shown to be related to. To better long term outcomes for kids.

• 10:28Speaker 05

  But when we don't have limits and boundaries and we have more of a permissive style of parenting, children don't learn those limits like they need to early on in life. So it makes it so much harder when they enter school years. And they have, they must have limits and boundaries for school to function in a healthy way. But they've not really learned that. So that's certainly another factor that's adding to the mix.

• 10:50Speaker 04

  Right. And a 2024 Senate inquiry found that Australian schools are ranked among the worst in the world for managing behavioural issues in the classroom. Why are we so particularly bad here? Do you have any thoughts?

• 11:03Speaker 05

  I'm not sure. I don't, I don't know why here. Certainly if you're in more disadvantaged areas, then there are more sort of complex factors that are contributing. One of the big problems is that children that have disruptive behaviour problems, only about 25% of those children are actually getting the treatments that they need.

• 11:23Speaker 04

  Right.

• 11:23Speaker 05

  And that could be part of the issue.

• 11:26Speaker 04

  And so what typically happens with these kids who are really disruptive in class? If they don't get help, like, do they end up just getting kicked out of school at a certain point? Or do they, you know, drop off on their own? What happens?

• 11:37Speaker 05

  So many of the kids that we've worked with, you know, they're facing partial enrolments. They're facing having to, to spend several days at a behaviour school. Eventually, they may not be able to attend the mainstream school at all. As they get older, they may, we know they're more likely to drop out of a school, to fail academically. Then they're on a pathway to a host of problematic outcomes later in life, which involve poor occupational achievement, poor financial achievement. So we do know that, you know, roughly 10% of a society are at risk for these kind of life course persistent antisocial behaviours.

• 12:18Speaker 04

  Right.

• 12:19Speaker 05

  Which lead them on that pathway.

• 12:22Speaker 04

  That is a really scary set of outcomes to think about. And obviously, it's not what happens with every child who's struggling in school. Luckily for Erin, she was able to get help from Mica very early on.

• 12:34Speaker 03

  When I went to the kindergarten orientation, there was a speech by one of the PCIT coordinators, because it's a study run by the UNSW. And I saw it, I was like, ding ding, sounds fantastic.

• 12:46Speaker 04

  This is how Erin came into Eva's orbit. Eva and our team at UNSW were running this study at a few select schools around New South Wales, where they would go into these schools and run PCIT programs, parent-child interaction therapy.

• 13:01Speaker 05

  And the reason that I chose to work with this particular type of treatment is because it's been found to be one of the most effective treatments for these disruptive behaviour disorders like ODD and conduct disorder and ADHD.

• 13:13Speaker 04

  But one of the drawbacks about PCIT, which Eva wanted to address, was that generally, it's not run in schools. Families do it outside of school. And so, any behaviour changes they see at home don't necessarily transfer over to the classroom.

• 13:28Speaker 05

  It can, but you don't consistently work with teachers as part of programs like this, even though this is the gold standard treatment for ODD and conduct disorder. So what we were interested in doing was saying, could we take this gold standard treatment for ODD, conduct disorder, these very disruptive, aggressive behaviours? And could we put that into schools? Because by doing that, we would break down a lot of those access barriers, because they're already going to school every day. Transportation barriers, childcare barriers in some cases. So it was a way to get this very effective treatment to a place where more people would be able to get it.

• 14:07Speaker 04

  So Eva teamed up with a few schools in southwestern Sydney and developed a version of PCIT that could be delivered on-site.

• 14:15Speaker 05

  What we did was we built clinics on the grounds of schools. And we had the teachers come in and watch the parents. And the parents watched the teachers, and we coached both of them.

• 14:24Speaker 04

  And the thing that makes PCIT quite different to other forms of therapy is that it involves one-way mirrors and wireless ear devices. I'll let Eva explain.

• 14:36Speaker 05

  It involves live coaching of the parent while they're interacting with their child.

• 14:43Speaker 05

  And while the parent is interacting with their child, you have a therapist who's behind a one-way mirror. And they are talking to the parent from behind that one-way mirror through a wireless bug in ear device.

• 14:55Speaker 03

  We were in a little room with a two-way mirror. So every session would be using next door.

• 15:00Speaker 04

  That's the name of the therapist that Erin had.

• 15:03Speaker 03

  I put on an earpiece so she could give me instructions. And we would play. So part of PCIT, a big part of PCIT is special time. It's like at least five minutes, like dedicated child-led play where you practise everything that you're learning.

• 15:18Speaker 05

  It's a progressive program where the first thing that we're doing, the first phase of treatment, it's all about following the child's lead and using skills that are known to build the relationship.

• 15:30Speaker 04

  Skills like labelled praise.

• 15:32Speaker 05

  So if you have a child that is usually running around the room, they're extremely hyperactive, but now they're sitting down and concentrating and engaging, that's when we want parents to be saying, "Great job focusing so hard on the activity."

• 15:46Speaker 04

  Other skills include reflecting and repeating what the child is saying and imitating the child.

• 15:52Speaker 05

  Often, you know, some of the parents that we work with, they just don't, they tell us, "I don't play with my child. I don't know how to play with my child." Imitation is great because it teaches a parent how to play at the child's level.

• 16:04Speaker 04

  And then the parent or caregiver is encouraged to up the joy factor in the relationship.

• 16:09Speaker 05

  Because again, this is a dyad where a lot of conflict, a lot of negativity, and we're trying to make this a really positive experience.

• 16:16Speaker 04

  So getting the parent to act and feel happy around the kid?

• 16:20Speaker 05

  Act and feel, and sometimes it is a matter of, you know, fake it till you make it. For some parents, that's what we're going for, is this really, we almost call it like a sync, like a dance.

• 16:29Speaker 04

  And during this first phase of the program, parents or caregivers are also coached on what not to do.

• 16:35Speaker 05

  We tell them not to give commands just during this therapeutic time. Of course, it's important to give commands at other times. We don't ask questions because, and that's quite unnatural, right? Especially if we think about in educational contexts, how important questions are. And we tend to say with teachers, "Don't ask unnecessary questions." But with parents, we say, "Don't ask questions during this special, what we call special time."

• 16:58Speaker 04

  Why?

• 16:59Speaker 05

  Because bottom line is child's in the lead.

• 17:01Speaker 04

  Okay.

• 17:02Speaker 05

  And when you've got a parent who's asking a lot of questions, that's taking away from the lead of the child. And oftentimes, questions are hidden commands.

• 17:10Speaker 03

  So you'd reflect everything, you'd show interest in what they're doing. And when I would do something wrong, she'd be like, no, let's reframe that. And if Lewis was there, we would swap.

• 17:20Speaker 04

  And what was it like to have someone coaching you on how to interact with your kid?

• 17:24Speaker 03

  It was interesting, like sometimes it wouldn't feel like it was a natural part of what we were currently doing with Micah. So she'd say, now insert a label praise, or say, you know, reflect back at him, but he was talking, so I'd have to wait. But you get used to it. And also, Micah got used to it because he can sort of hear a bit of it here. And as he got used to the routine, he'd be like, time to swap. But yes, he loved it though. And we got to take Lily for a bit too, like we'd do it all together. And she loved it. So we've integrated that into our lives.

• 18:02Speaker 04

  So that is phase one. Once these relationship building skills are down pat, it's on to the trickier phase two,

• 18:09Speaker 05

  which is where we introduce strategies to manage the bigger behaviours, like chronic non-compliance, aggression, destruction. And this is where we are teaching parents how to give a command in a way that the child is most likely to listen. Things like, you know, being very direct with your command. So telling the child exactly what you want them to do as opposed to what not to do. So instead of saying, don't run, please walk. So it has to be very clear to these young children exactly what it is that you want them to be doing.

• 18:43Speaker 04

  And so were there any sessions or elements of the training that had a like especially big impact on you?

• 18:48Speaker 03

  There was this one scene after we'd done that basic skill where we were working on having him do what I say. It wasn't child-led, it was parent-led. And it was supposed to be very, you have to be very specific. You have to be positive, only one command at a time. And we were playing with magnet tiles, which was Micah's absolute favourite by the time we'd been at PCIT for a while. And he would make these big things on the floor, like a big monster that would slide around on the floor. A scorpion, he called it. And he'd just built this incredible scorpion. And Yutang said, Erin, I need you to tell him to clean it up. It's time to move on to a new activity.

• 19:27Speaker 04

  Oh, wow.

• 19:27Speaker 03

  And I was like. I was like, are you sure? She's like, yeah, we have to do it. And I was like, okay. And I said, Micah, it's time to clean up the magnet tiles. We're gonna go and play with the Lego now. And he was like, really? But I've just made this scorpion. And I was like, yes, baby. It's time to clean it up. We're going to go and play with Lego now. And he was devastated.

• 19:52Speaker 05

  Hmm.

• 19:53Speaker 03

  He cried, I cried.

• 19:54Speaker 05

  Hmm.

• 19:55Speaker 03

  I was, you know, just when you say, you say clean up and you don't harp on it, you just let them do it. And so I just sat and watched him put away all his magnet tiles, this amazing creation he just made. And he was like, so sad, but he did it.

• 20:12Speaker 05

  Wow.

• 20:12Speaker 03

  Cause he trusted me.

• 20:13Speaker 05

  Yeah.

• 20:14Speaker 03

  And when he'd finally put away the magnet tiles, I was like, okay, come here, baby. We had a beautiful hug. And I said, you did so well. I know that you didn't want to put away those magnet tiles, but you knew that it was time to, and I'm so proud of you. It was, sorry.

• 20:27Speaker 05

  No, don't apologize.

• 20:30Speaker 03

  Like when I was reflecting on that today, I was just like, oh my God, it was a big, like Yutang was crying professionally in the room, in her little room. And it was a big thing.

• 20:42Speaker 05

  Yeah.

• 20:43Speaker 03

  Usually he would have, you know, freaked out, probably chucked the tiles around the room, kicked the Lego.

• 20:48Speaker 05

  Right.

• 20:49Speaker 03

  But he just cleaned it up and trusted me and did what I said. And we moved on and played with the Lego and we had a good time. That was the, my standout memory.

• 21:02Speaker 05

  And in a third phase, which we give to some of our kids when they are having difficulty developing empathy or remorse, we're then teaching emotional literacy skills. So how can they recognize when people are feeling distress, fear, sadness, helping them to understand how to respond appropriately?

• 21:23Speaker 04

  And so is this still, are you still running this program in schools? Or?

• 21:27Speaker 05

  So we started the program in 2019 and that's when we first wanted to ask the question of could we implement this program in schools? And since 2019, we've worked with 20 public primary schools in southwest Sydney and most recently in Albury. So we're now in a regional area of New South Wales, which is very exciting that we can get this out to a community that don't really have access to this type of treatment. The project is still going on and of the kids that complete the program, we're seeing that over 90%, so 91% are no longer showing these ODD, Conduct Disorder, symptoms in a clinically significant range.

• 22:10Speaker 05

  So their level of behavior is comparable to any other child. And so it's very exciting that we're seeing such big shifts for those families that complete treatment. So that was about 57% of the families who engaged completed treatment and an additional 10% ended because the child's behavior was so improved. So we're seeing really big gains by implementing this program that involves both parent and teacher.

• 22:36Speaker 04

  And is that behavior change permanent or are you seeing it up to six months out? Or like what is the measure?

• 22:41Speaker 05

  So we've measured out to three months and what we're seeing is that, so that statistic at the end of treatment, 91%, it was 89% at three months after treatment ended.

• 22:52Speaker 04

  Okay.

• 22:53Speaker 05

  When we look at the broader PCIT literature, we do see that the gains maintained long term. So there have been studies up to six years after treatment ends. And studies of similar types of parenting programs that are delivered as an early intervention actually see long-term gains in terms of reduced contact with justice system or reduced violent acts in the future. So by delivering this early intervention, we are able, we believe, to prevent lots of really negative long-term outcomes for these kids.

• 23:24Speaker 04

  So oppositional defiance disorder is treatable then?

• 23:28Speaker 05

  Absolutely.

• 23:30Speaker 03

  When Yutang first said, "Oh, Micah meets the clinical definition for oppositional defiance disorder and ADHD," we got, you know, we were doing our little things every week. And she shows the graph at the end and said, "He no longer meets the clinical definition of oppositional defiance disorder."

• 23:46Speaker 04

  That's incredible.

• 23:47Speaker 03

  Which is really cool, very cool.

• 23:49Speaker 04

  So at the beginning, you were saying he used to struggle with all kinds of things, like for example, you know, when you'd buy him shoes, he'd hate the shoes, it would be a huge massive thing.

• 23:57Speaker 03

  Still a problem.

• 23:58Speaker 04

  Is that still a problem?

• 23:59Speaker 03

  Yeah.

• 24:00Speaker 04

  Does it cause as big an outbreak now?

• 24:01Speaker 03

  Uh, no, now we just try to move on. I try to just give up, like, it doesn't matter, I guess. I've given away, lucky my friend has two kids who are smaller feet than him because they have received so many brand new shoes from me. I have another pair to give them because I bought us a new pair. Yeah, it's an ongoing issue, but now it isn't the cause of an enormous meltdown. Now he will say, "I'm not wearing that." And I say, "Okay."

• 24:26Speaker 04

  Right.

• 24:27Speaker 03

  And I just leave it. Or if he has to wear it, I'm saying, "You will be wearing those shoes. Those are the only options you have." And then he will try, he loves arguing. I don't opt in anymore. I just say, "I'll give you time to get used to the idea and we'll come back to it." And usually he will come around, in best situations, put them on himself, no arguing. If you drop the rope, it works.

• 24:52Speaker 04

  I feel like I'm learning parenting lessons from you right now. I will take some of this away. Erin says Micah's behaviour at school is totally different as well.

• 25:01Speaker 03

  Like, Kindy was a tumultuous year. He had constant behavioural problems and it kind of sucked. But year one, he was, he started medication and a completely different experience. Like, his teacher didn't know him in Kindy. So she was like, "Oh, Micah," our first interview, she was like, "Oh, Micah's really great. I really like him. He's very friendly, good with the other kids, pays attention in class." And I was like, are you having any troubles with him? And she said, no. And I told her about last year where he was in everybody else's personal space, constantly annoying everyone. And she was surprised.

• 25:38Speaker 04

  Hmm.

• 25:38Speaker 03

  Like, you know, as a nurse, we're taught to give as little medication as possible. And the idea of medicating my kids, I was a bit, and you know, some of our family members were very

• 25:51Speaker 04

  Right.

• 25:52Speaker 03

  Very disapproving, but it's a game changer.

• 25:56Speaker 04

  Hmm.

• 25:56Speaker 03

  Like, my older daughter, she started taking Ritalin halfway through year one. And overnight, she stopped biting her nails. Her performance academically improved. Everything just turned around really quickly. So it has been an incredible tool for us.

• 26:09Speaker 04

  How much of Micah's behaviour change do you chalk up to medication versus PCIT?

• 26:14Speaker 03

  I think the medication just helps him focus and not wriggle.

• 26:18Speaker 04

  Hmm.

• 26:19Speaker 03

  I think the PCIT tools that he has learnt, I think they have been more effective. Or the drug has enabled him to have the clarity to use those tools without getting overwhelmed by what's going on in his head.

• 26:32Speaker 04

  Right.

• 26:33Speaker 03

  The language he uses for his own emotions, he's like, I feel, I'm feeling a bit angry. I'm going to go and play by myself in my room for a little while.

• 26:41Speaker 04

  Hmm.

• 26:42Speaker 03

  And I'm like, well done, little man.

• 26:44Speaker 04

  Yeah.

• 26:44Speaker 03

  It's really great to see that. So his emotional intelligence has improved a lot.

• 26:51Speaker 03

  Our life now is so, like, apart from the kids fighting, it's pretty chill. You know, last night I was putting Micah to bed, because Lewis and I take turns putting each kid to bed still. We were snuggled up and he said, I love being part of this family.

• 27:04Speaker 04

  Oh.

• 27:05Speaker 03

  And I was like, I love being part of this family too, Micah. I think we're all really great people. And we had a kiss and a hug and he was like, it was really good.

• 27:12Speaker 04

  That is so beautiful. I'm tearing up. That's gorgeous.

• 27:15Speaker 03

  It's quite, like, our family is, that's one thing my family did. We told each other we loved each other a lot. You know, your beautiful hugs, kisses, blah, blah, blah. And I've carried that forward with my babies and our household is really warm and affectionate, which I love.

• 27:29Speaker 04

  Beautiful. Oh, I'm so thrilled for you. Thank you so much for sharing that.

• 27:33Speaker 03

  Thank you.

• 27:35Speaker 04

  That is Erin, a nurse and mum living in the suburbs of Sydney. You also heard from Eva Kimonas, a professor in the School of Psychology at the University of New South Wales. And if you're interested in learning more about PCIT, parent-child interaction therapy, we'll link to some resources in our show notes. Thanks to producer Rose Kerr and senior producer James Bullen and sound engineer Harvey O'Sullivan. I'm Sana Qadar, and just before I go, if you're after more on the brain and psychology, I would recommend Soul Search with Dr. Meredith Lake. This week, they're looking at how our internal and spiritual lives are shaped by the physical structure of the brain.

• 28:19Speaker 04

  Fascinating. That is with Dr. Ian McGilchrist, who is a British psychiatrist, neuroscientist and philosopher. We'll link to that episode in our show notes, but you can find it on ABC Listen as well. Look for Soul Search. Okay, that is it for All in the Mind this week. Thanks for listening. I'll catch you next time.

• 28:47Speaker 00

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