ODD (Oppositional Defiant Disorder) and a Big WTF?!?

Great Debates
21

California’s still ahead of the rest of us, apparently, as I’ve never seen a single definitive test for ADHD in almost 11 years of parenting an ADHD child. He was recently diagnosed with Asperger’s syndrome, and that wasn’t a single simple test, either.

Perhaps Zenster you could flip your outrage around? What about all those generations of bullies who went undiagnosed and wound up self-medicating with drugs and alcohol, uneducated, wound up in jail, etc? I’m not claiming it’s an either/or situation, obviously, but you seem to be quite comfortable asserting that it is. I’m trying very hard to overcome my affront at my parenting efforts being so casually dismissed as hopelessly inadequate because my child has an acronym written in his school file, so bear with me.

Greck was dead on with the qualifying that proper diagnosis can only be made after looking at how much and how often the symptoms interfere with day to day life. I personally struggled for years with my son, refusing to medicate him on the premise that whether his brain chemistry is normal or not, it’s his for life and to medicate while he’s young would be denying him the opportunity to learn good coping mechanisms. We had hours of homework nightly from the first grade on, we had behavioural charts with clearly marked rewards and consequences, we had established routine’s more anal than anything I thought I’d ever experience, there was discipline galore and the grand total of all that was simply years of misery.

Until I accepted the basic idea that this wasn’t something we could overcome by sheer will, nothing was effective. Meanwhile, my son was ostracized at school and even within his extended family, he fell further and further behind in school, daily life became drudgery to be endured. The light finally dawned upon me, would I withhold insulin if my child were diabetic? Of course not, so why not try what’s available if it can help?

I had and still have huge concerns about what this is doing to him, growing up pumped full of chemicals, but the alternative just didn’t work at all. Accepting the diagnosis and medicating my child didn’t signal the end of my parenting efforts, if anything we have years to make up for. The difference being, now we have a fighting chance.

Sure, there are a lot of kids being diagnosed with trendy acronyms, and no I don’t agree with it. I think it trivializes the student’s who truly are affected and, yes, a lot of parents are simply looking for a big rationalization tied with a bow that let’s them feel better about why johnny can’t behave. Is it just the specific ODD and CD labels that bother you, or are you ready to throw out pediatric depression, schizophrenia, ADHD, Autism and OCD too? I think it’s better to have stricter diagnostic tools pointing toward a specific problem rather than lumping distinctly different needs under one ineffective umbrella, but obviously YMMV.

22

This thread makes me sad.

Ya know, I fought for YEARS to keep my kids off the drugs. I denied there was anything wrong for the longest time. Then I tried EVERYTHING and I do mean EVERYTHING to not medicate them.

I had taught preschool for years and seen kids put on Ritilan that didn’t need it. My brothers were both on it growing up. I did not want that for my kids, even though I had FOUR doctors tell me Josh was in need of a medication of some kind for his ADHD.

When I was growing up, we just had to ‘suck it up and get over it’ when we felt like we wanted to world to just end. That everything would be better of we could just die and get ot over with. That’s what I grew up with. Even with all the additional training I had as a caregive for school age children, I still expected Shannara to suck it up and deal.

And then Josh, at the age of FIVE was spending more time in the office than in class. Shannara was getting suspended. You have no idea how much of a shock that was. MY DAUGHTER, who had been the sweetest of children, was getting suspended for fighting, cutting class. I finally had to drop out of college because I spent more time dealing with the kids’ schools than my own, even though I was always home by the time they got home it wasn’t enough. But what was the clencher for Shannara was when I got a call from the school telling me she was in the ER because she was talking about killing herself to her friends and it scared them.

The psychologist told us to hide every sharp object in the house. I had a sword and dagger collection that was the envy of many a collector. I sold them all.

But she still found something to cut herself with and I didn’t notice because it was winter and she was wearing long sleeves all the time. Her arms will be forever scared from wrist to elbow. I yanked her out of school and started home schooling.

The last day of school for Josh’s teacher, a rep from the freaking school board, two psychologist that had been observing him in class, the principle and a special ed teacher were waiting for me to discuss Josh. I had to either pput him on Adderall or he couldn’t attend school. He was having violent outbursts in the classrom, throwing FURNITURE. He was a danger to others. He never acted like this at home. Large groups=stress. He can’t deal with that still. My son has ODD and ADHD with a little of OCD thrown in just for fun. My daughter suffers from Depression and Anxiety Disorder. And so do I.

Josh is on his Aderall and in a special class for children like him, though he spends a couple hours a day in a regular classroom. Shannara is on Lexapro and wants to go back to public school next year and we think she will be able to handle it now and they both take Risperdal.

Say what you want about the medications, the over diaginosis, but those things and the therapy that goes with them gave me my children back.

23

Y’know, since this isn’t in the pit, and I don’t feel like dragging it there, I’m going to completely ignore the insinuations about my parents that I see in this paragraph. Maybe you didn’t mean it like that, but it sure comes across that way.

You want to know what my problem is? I can’t focus when I want to. Maintaining attention on all but the most interesting things is difficult at best, and oftentimes next to impossible. That’s pretty much it.

24

Y’know, there was a period through the 1950s and 1960s (with some doctors not getting the word until the 1980s) when parents of schozophrenic kids were solemnly assured that it was simply their failure as parents that had disrupted their childrens’ lives. I am so glad that that fine spirit has moved on to other illnesses now that we can’t use it for schizophrenia.

And, of course, alcoholism is nothing more than a failure to apply will to a desire–as is the invented “addiction” to nicotine.

Interestingly, I have never met a physician, psychiatrist, or psychologist who, when discussing ADHD or ODD did not note that the drugs were only to help the child get some control, but that actually overcoming the problem equired that the parents and the schools work with the child to establish specific boundaries of behavior and specific strategies to stay inside the boundaries. Since the medical and psychological communities agree that treatment requires boundaries, protocols, and sanctions, I always find it interesting when people who are standing outside the situation leap to the conclusion that the problems could be solved simply by setting the rules and holding the child to them.

25

Please try not to be too defensive. No one has dismissed your parenting skills nor have I said that poor parenting is the sole reason. Based on my own observations, children that are exposed to incoherent personal philosophies tend to exhibit irrational behavior.

[sup]ITALICS ADDED[/sup]

I’ve already recognized ADHD and schizophrenia in previous posts and have no argument with the importance of accurate diagnoses being made. Everything preceding the italics in your second paragraph is an excellent summary of my own concerns in this case. Maureen, has splendidly summed up some of my other issues as well.

I will put before you the simple fact that many parents who represent the most direct cause of their child’s problems will also be among the first to sign off on a diagnosis of ODD or CD. By this, I mean to highlight a horrific conflict of interest on the parent’s part. There exists a definite segment of really lousy parents who are sufficiently lax or too lazy to implement positive behavior reinforcement. Their children are often social trainwrecks. Yet, these crappy parents will probably be the first to leap at a chance to have their child’s misconduct attributed to anything else but themselves.

All of this needs to be coupled with some really important consideration of psychiatry’s true goals. Right now, there exist no drugs that I know of treat ODD or CD. I will bet my bottom dollar the pharmaceutical giants are working to change that. There also seems to be a propensity for many psychiatrist’s to “prescribe away” a patient’s problems. It is an intensely sad and ironic thing that regular interactive therapy sessions provide the most effective treatment for many low level mental disorders. Therapy is appallingly expensive and drugs which suppress the most flagrant symptoms are prescribed instead. I remain exceptionally concerned that there will not be another massive push to medicate this new set of disorder categories.

As someone who deeply admires the advances of modern medicine, no one should ever think that I am against medical drug therapy. The last 50 years have seen stunning progress in every field of medical science. I am not able to be so rosy about psychiatry. The operant components of the personality are elusive at best. Statistical and behavioral analysis give us some of the only qualitative and quantitative tools. Too often the methods are qualitative and that is where my trouble with this begins.

Once again, crappy parents dragging their kids in for limited medical treatment instead of the therapy they desperately need is one more possible outcome of this. I am not calling anyone in this thread or their own parents inadequate. In your case, ultrafilter, I was curious as to whether your were over-disciplined or if it was balanced with sufficient love as well. Please know that you have not the least obligation to answer any of this. However, unless your own depression or ADD were strictly chemical in nature, there most likely would have been other contributing factors within your home as well. That is all I am referring to.

Again, Queen Tonya, you and Maureen have capably managed to sum up some of my greatest concerns. Please remember that I do not attempt to tar all parents with my brush. I’ve already mentioned, “thuglife peers and ineffectual school counselors” as well. I just see a terrible conflict of interest looming and remained profoundly disturbed at the large scale overmedication going on in America today.

26

Well, that quote of mine was originally supposed to say, I have never denied that ADHD and ADD exist. Cursed double negative.

27

Not at all. The test to which I refer is sent to pediatricians all over the country, and was put forth by an east coast pharmaceutical company beginning with the letter Pf. There are approximately 40 questions along the lines of “does your child sometimes have difficulty focusing on the task at hand?” Well, who the hell doesn’t?
I suppose I would not be so vehemently opposed to the knee jerk reaction of medicating children had I not been misdiagnosed with ADD myself. My mother fought tooth and nail for further tests, and it turned out, after the doctor noticed I could not tell my left from my right, and tended to transpose numbers, that I am dyslexic. She worked with me long hours to help correct the problem. I can usually tell when it’s time to put the book down and go to bed…the paragraph I’ve read 3 times is gobbledygook. Unfortunately, it appears to be genetic; my daughter shows the same traits. I will NOT medicate her, and am working with her just as my mother worked with me. I don’t deny that AD/HD exists. I simply feel it is too easy a diagnosis, and the children who truly NEED help are getting medication instead. While these meds can be and are a boon to child development, they were intended to be a tool, not a fix-all, and it is difficult to ignore the fact that prescriptions for AD/HD have increased over 300% in the past 20 years.

28

Let me tell you about a sixth grader I had to deal with last year who was diagnosed with ODD.

R would throw furniture when the teacher would ask him to do things like take out his paper and pen. Desks. Chairs. His backpack. Whatever was handy. Not shove them. Not tip them over, but pick them up and throw them. He did usually refrain from throwing them at people, but that was about the best that could be said.

R would start fights with kids twice his size - he was a small kid, so that was most of the other boys at school. He fought like a rabid terrier, using teeth, nails, and often going for the throat and facial features. The fights usually started over a relatively innocuous comment, but he would completely blow his top, and the nearest adult would have to pick him up and pry his hands off the other kid’s neck.

R came to my Art Club meeting once (once). While we were discussing possible projects, he suggested that we adopt stray animals, nail them to boards, cut them open, take out their insides, and spread them around on the board. When we talked about charitable activities, he said that we should go find people with cancer and kill them to put them out of their misery.

He drew a picture of his Social Studies/English teacher lying on the ground in a pool of blood with several knives sticking out of her. On several occasions, he said that he wished he were dead and would talk about ways he wanted to kill himself.

At first, his parens were not very open to the school’s suggestion that they seek psychiatric care for him. It pretty much came down to the middle school faculty (all six of us) refusing to have him in our classes. R was spending more time in isolation in the office than he was in a classroom, because it was the only way we could ensure our safety and others’.

When his parents finally agreed to take him to a psychiatrist and a counselor - because the school’s next step was a formal expulsion - his father mentioned that when R was conceived, in utero, and for the first two years of his life, both his parents were heavy drug users. R had been given to fits of rage even before he could walk. Now, recovering drug addicts don’t usually make the best of parents, and their lack of skills certainly contributed to R’s inability to control his behavior or connect that behavior to the consequences that followed. R was almost always shocked that he would be removed from the situations where he lost his temper or given suspensions for trying to beat up other kids. When I kicked him out of the Art Club meeting, he sat outside my door and cried loudly until the end of the meeting.

R was out of school for nearly two months while the school Medicare/psychology contact, Child Protective Services, the psychiatrist, his counselor, and his parents had him tested and began treatment. The diagnosis of Oppositional Defiance Disorder was not lightly made, but R’s behavior and his own descriptions of his feelings and reactions pegged him. Had he gone untreated, I have no doubt that he would have been thrown in juvenile hall within six months, and eventually have killed himself, killed someone else, or gotten himself killed. R simply could NOT socialize in a healthy, acceptable manner.

Now, after six months of intensive therapy, he can manage himself in a classroom environment, though he has the teachers’ permission to go outside where he will stomp his feet, scream, and beat his hands against the concrete sidewalk when his rage overwhelms him. Believe me, it’s a lot better than the throwing of furniture.

His parents still refuse to consider medication, which is their legal option. Perhaps after their storied history with self-medication, they’re leery of giving their son anything, but I think it’s a shame. R is now in seventh grade, and his hormones will start to catch up with him any day now. I can’t see that helping him at all.

Those of you who think psychiatric diagnoses of conditions like ODD are psychobabble catch-alls to manufacture profits for drug companies or convince the population that we’re all sick one way or another need to consider that these diagnoses are not intended for the idiosyncratic, quirky behavior of a well-adjusted person or the unethical, immoral choices of the average kid. ANY kid can be a bully. R was something else.

R’s behavior - whether the root lies in his parents’ teratogen consumption, poor parenting skills, or a decision on R’s behalf to become a small town’s answer to Damien - was all too real. It was entirely outside the scope of what we anticipate as the behavior of a normal, healthy pre-adolescent. While it was untreated, it had a profound affect on R and everyone around him.

I just can’t condone leaving R and kids like him untreated because some people think psychiatry is pulling diagnoses out of their asses in an effort to spawn more profits for drug companies. Just because the diagnosis is new, doesn’t mean the illness has been created out of thin air. It’s just that we finally have a label to identify the traits of an illness.

Are their people who are improperly diagnosed with psychiatric conditions? Absolutely. Are their conditions that become “fashionable” and easy targets for some irresponsible parents to blame for their kids’ behavior? Certainly. But that does not negate the kids like R who are profoundly ill and need the services of our medical resources.

29

Maureen what don’t you understand about medication and behaviour modification working hand in hand? If a parent uses meds, then they still do what you are doing with your kid. We trialled meds after being very dubious about it and one of the big changes was that once he was medicated, the interventions worked.

I think you’re referring to the Connor scales BTW. I’m not a huge fan, they’re not a particularly wonderful screening tool IME.

I don’t come across many people I’d consider to be crappy parents on the mailing lists and support groups I belong to. I guess it’s easier to demonise parents though.

30

Which we have NOT done. And, for the third time, I RECOGNIZE THE NECESSITY FOR THESE MEDICATIONS. But for each of the people mentioned here who have serious medical problems, there are several children who DO NOT. Saying “but it helped so and so” does not negate the fact that the drugs are abused. I’m sorry, there is no other word for it. This is not a fantasy. I am speaking from firsthand knowledge and 17 years of experience in my profession, 5 of those years in a pediatric office.

I am in no way, shape or form denying the usefulness of the early diagnosis and treatment of AD/HD. What I, and I think Zenster if I may speak for you sir are decrying is the overuse of that diagnosis. It is not acceptable to simply lump a child into a category, label that child, and then move on without even attempting to correct the problem. Phouka, I am not your enemy on this, and I do agree that the child you spoke of had what sounds like several serious problems. But not ALL children exhibit those symptoms. In fact, many, many children have much milder forms of AD/HD, and are prescribed with exactly the same dosages of exactly the same medication. When a lower dosage or even diet changes may have helped. I firmly believe in treating the person, not just the disease. And in order to do that, I think we need to take a serious look at the way these childhood diseases are treated. Ritalin is an addictive, mind controlling substance. It should not be prescribed lightly, as if it were simply something to help you relax, no big deal. It is a big deal.
And while I respect the profession of the people prescribing these medications to children, I have worked with too many of them for far too long to believe they are infallible. Or that they are not susceptible to the merits of, for example, having a paper published in a medical journal. Or a grant subsidized. While their motives are usually good, can you truly say the same of the drug company backing that grant? Does any major corporation exist to do anything but make money? No matter what their advertisements say, at the end of the day, that corporation is beholden to its shareholders. And this is where we cross the line into medicine without conscience, where the line of “first, do no harm,” blurs into “the ends justify the means.”

31

BTW, what’s the possibility of getting this moved to Great Debates? It’s a very hotly contested subject, not just among parents, but also healthcare professionals of every stripe.

32

Before you try moving this to GD, would you like to support this assertion with evidence? I would assert the opposite. In my experience, for every child who has been doped up and turned loose, there are several more who have been actually treated. (Actually, my experience has been that far more parents take a “it can’t be my child” approach and resist any intervention than go seeking quick fixes.)

[quote]
What I, and I think Zenster . . . are decrying is the overuse of that diagnosis.

[quote]
Really? This is an example of simply decrying overuse?

33

What, supply you with a list of names to which you have no medical or legal right? Certainly, what do I need to keep working for? Idealism is a fine thing. And I try to keep an open mind. But not so open that my brain falls out of my head. And to assert that children are not misdiagnosed and prescribed a mind controlling substance simply because you haven’t seen it happen is not only idealistic, it’s arrogant. Yes, I’m cynical. So stipulated. In this particular case, I’ve actually got experience to back that cynicism up.

34

I know a 35 year old adult male with all of the OP symptoms.

35

Of course not. However, an actual study by professionals reviewing multiple cases in peer-reviewed journals investigating the issue would make a better case than you and I exchanging personal anecdotes–and would make this a Great Debate rather than an exchange of Not So Humble Opinions.
Specifically, I find your assertion that children, once diagnosed, are simply assigned a drug and ignored on a regular basis to need better support than your personal impressions. I, too, would agree that some overprescribing occurs, however, that has not been the position you have presented.

You are asserting that the majority of diagnoses are wrong, not that some overprescribing occurs.

(And your claim that any child over 2 could be diagnosed as ADHD, is utter nonsense, so your other anecdotal evidence is now suspect.)

36

If I may be so bold, you may certainly be decrying the fact that the overdiagnosis of certain conditions occurs and occurs often, but Zenster does not seem to be averring just this.

From the OP:

This is not a rant about moronic doctors following prescription fads, but a fairly vehement assertion that no such condition can possibly exist.
Posters before me (Phouka, greck et al) have done an admirable job of showing that such a condition can and does exist. I have nothing to add to what they say.
Thank you.

37

I am troubled that so many people seem so eager to bring ADD, ADHD, and a host of other diagnosable conditions into a thread specifically about ODD.

To whatever extent ODD actually is a legitimate diagnosis, in my experience practicing disability law for the past 17 years, I can assure you that I have encountered numerous instances where mental health professionals were very willing to diagnose such condition on the basis of a single interview, perhaps only based upon a parent’s representations. Which, in my non-medical opinion, I consider absolute bullshit.

I believe ODD exists in an area of psychology where the line blurs between diagnosable underlying conditions inherent in an individual over which he has limited control, as opposed to personality tendencies exacerbated by undesirable environments and other factors. And I believe it is legitimate for an observer who is not invested in the mental health community to be more sympathetic to the former than the latter.

Even if someone just has a personality defect instead of a diagnosable mental or emotional impairment, that personality defect can be “treated” and influenced by a variety of methods both formal and informal. There is a fine line between an individual who is diagnosed with a personality disorder DSM 301 et. seq., and someone who is just a run of the mill asshole.

IMO the APA’s acceptance of a label as a legitimate diagnosis does not magically elevate a symptom-complex to some unquestionable pedestal, where individuals bearing such label are automatically and universally considered deserving or entitled to support, sympathy, additional resources, etc.

38

Are you sure you are not simply seeing the typical situation for a “hired gun” testimony in a lawsuit that corrupts a lot of other medical testimony, as well?

39

Tom - never meant to suggest that my experiences were anything like an adequate unbiased sample. Simply stating that I have observed such behavior. Thank you for clarifying that.

Of course, those “hired guns” are acting on behalf of individuals who are pursuing benefits based in large part on these diagnoses. So the cynical lawyer in me concludes that there are at least some instances in which ostensibly qualified mental health professionals are willing to diagnose conditions such as ODD based on what this layman considers woefully inadequate evidence.

Gets to a basic debate concerning mental health. For example, one could propose that the very act of an individual pursuing disability benefits, rather than being gainfully employed, is indicative of their experiencing a mental disorder. I believe there have been historical swings where popluar opinion has vacillated between considering specific behavior controllable or not, or whether it is organic in nature or not. Substance abuse and homosexuality are easy examples, as is the whole somatization, fibromyalgia, CFS, psychogenic overlay, hysteria area. Moreover, a diagnosis alone says nothing about the severity of symptoms and functional limitations imposed by that condition.

Psychology is not alone in providing instances where they act as tho “labelling” something is a significant achievement. Reminds me of my speech comm classes, or much management and employment counselling, where “consultants” simply label common sense and market it. But I was questioning the ADD folk for getting off-topic… :wink:

40

  1. lemmie get this straight- you’ve known enough of “these types of unruly kids” to have a whole “too many times” yet the existence of the diagnosis ODD was a newsflash to you? I’m gonna need exact numbers in order for your ancecdotes to go unchallenged; especially if you’re going to claim to have intimate knowledge of the disciplinary scheme of all their homes. Certainly with that much data on your hands you’ve written volumes about different disciplinary strategies.:dubious: What, do you have hidden cameras in all these kids’ homes to observe how they’re disciplined? Or are you just going on what you observed at the neighbor’s barbecue last saturday?

  2. “coherently explain why misconduct is not acceptable” OOOOOOOOH! NOW I get it! 'cause if kids understand why they shouldn’t misbehave, then they won’t. uh-huh, can I use that when I work with parents and their kids? You got a patent on that one? There’s no need for you to write a book now, it’s all neatly encapsulated in that one gem. The answer to all parental discipline.
    How many parents DO you know? Of those parents, how many have children with Oppositional Defiant Disorder? And when some of those parents have “taken the time” to explain it all to their kids, did the kids miraculously do a 180 degree turnaround, or did it take a while to sink in?

  3. you’ll forgive me if I don’t lend much reverence to your observations about trends in the mental health field given your shock about a diagnosis that has been in the DSM for several years. But if you’ve got hidden cameras in therapists’ offices, I’d love to hear about that too. :dubious:

It would be nice if you would just admit you don’t understand and ask for help, I could avoid the sarcasm toxicity from which I now suffer.