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

Great Debates
41

Er, and why does the need for drugs to help contain the problem actually invalidate the problem? That seems to be what you’re implying. If a disorder becomes more widespread*, why not try to fight it with drugs?

*On widespread… These disorders may seem to pop up out of nowhere, and that their is some sort of epidemic of people getting this disorder, and it becomes ‘trendy’ to diagnose someone with it. However, it is merely science and the better understanding of the mind’s problems. A disease pops up that wasn’t there 20 years ago, and when people start diagnosing it now, with something like 400 cases, it seems like an epidemic when really the same number had it happen years ago.

Say 1/20 people had Asperger’s (number made up) 20 years ago, and that number is still the same. Were 20 people diagnosed with Asperger’s diagnosed 20 years ago? No. With a better understanding of the disorder, we are able to diagnose it, and put them on medication or some form of therapy. Sometimes, drugs can help, sometimes not. It’s the doofus doctors who go all diagnosing crazy and say, “Your son seems to have trouble reading, dyslexia. Next patient.” Some doofus parents and doofus kids tend to use it as a license for their kid to get away with murder, which casts an unfair light to those of us who struggle to keep our problems in check.

People with ODD are what we imagine when we see bullies. They are parasites, the jerks, the guys who are doing life at 20. To imply that it’s not their complete fault for some people raises people’s ire because what they diagnose by is bullish type behavior. The disorder is that behavior taken to the extreme, though. That is something you must remember. Most schoolyard bullies aren’t going to throw peoples desks around and attempt to physically hurt anyone, regardless of how big or small they are a lot of the time. I am not saying kids can get away with big time things, I am saying that if a consistent pattern occurs, to a point where no normal kid would continue to do something like that, it is an indication their might be something wrong.

It is silly to say that a disorder doesn’t exist because it sounds too implausible to you or something that is common to everybody. A symptom of ADD is not being able to concentrate on one subject. That makes people think that little Johnny is doing his math, and perhaps looking out the window for a few minutes and going back to work. Where as Little Johnny is jumping around, playing with a ruler, talking to everybody in class, performing macbeth with shadow puppets, knocking over chairs, etc.
In conclusion, just because a disorder seems to be silly or implasuible doesn’t mean that it does not exist, and is the product of parents coddling their children.

42

I’m a bit puzzled on where you draw the line and call a problem a “disorder”. What’s the difference between bullying and ODD? What’s the difference between a short attention span and ADD?

It seems that we have arbitrarily decided that certain conditions are “disorders”, which conveniently makes all other conditions “normal”. However, there are plenty of “normal” children who have attitudes and behaviors that must be corrected. What difference does diagnosis make?

Based on my limited experience, I’d say that diagnosis usually just means that drugs are okay and the kid has an excuse for bad behavior. I would like to be corrected, though; could someone explain to me what positive effects diagnosis can have?

43

The difference is the level at which it occurs. Some people have short attention spans, but with ADD, it is sometimes to the extent where they cannot function properly. Same with ODD, it’s the level at which it occurs. Now, people aroudn here are required to match a certain number of criteria, at least over here. Thus, if the short attention span is included with enough of the other symptoms, it is ADD. Simply having a short attention span is not.

Diagnosis helps you to understand the problem better. Normal behaviours can be controlled by such things as behaviour modification, where as drugs can help people with disorders in conjunction with behaviour modification. It can vary amongst people, and people that have ‘normal’ type problems might need drugs.

Might plays a big part into it. Everybody is different. Some methos work more effectively with certain problems than others.

It can help boost the self esteem. When I was diagnosed with AS, I didn’t feel like an outcast. I had a problem that made me different from others, and I could work at it. Before, I had felt that me being odd was permeanent thing, it was not something I could change. When I learned it was a disorder that could be helped, I felt great.

I don’t let AS run as my excuse to run wild. I try to keep my behaviour in check, and apologize if I do something bad as a result of AS. Some people use it as a get-away-with-murder card, but that is not a fair assumption.

Drugs CAN be ok. The thing is, the common theme is it can or might. I am not advocating everyone dope their kids up and not do anything else. Try all the methods, see whch one is best for you.

44

Oh please. What a f-ing pat answer. It doesn’t exactly help when the kid who is ‘being 13’ is SIX. I invite you to go to a locked inpatient unit for children and adolescents, if you think this is true. Come and see what cihldren with these problems are REALLY like. I WORK on one of these units. We have kids that can’t focus on you when you are saying their name, in a loud voice, from TWO FEET AWAY (often we have to clap our hands in front of their faces to get their attention). We have kids who deliberately shit their pants when they don’t get their way. We have kids that bite, kick, scream and destroy property because they don’t like what is being served for dinner. We have kids who twitch so much that that they can’t sleep, or that have such a nervous, scratching tic that they have scratched themselves raw. And when you look at the charts on these kids, many times they have come to us AFTER a parent has tried the 'spank ‘em till they behave’ route, or the ‘Oh, if they’d only find Jesus’ route, or the, ‘If only they’d stop eating sweet cereal’ route.

They have REAL diseases, and I get to work with the worst of them everyday. Sure, some of the parents are a nightmare - but many of them are also some of the nicest people you’d ever want to meet.

I don’t argue that there are too many cases diagnosed - often we get THOSE kids, too - and after we wean them off the drugs and see their true behaviors, we will work with the parents on THEIR skills, and send the kids home, and OFF the meds.

45

I’ll only speak on my own experience, so that will be limited to ADD and not ODD. This is based on my husband’s diagnosis, not my own. Having a short attention span is not necessarily an indicator of ADD. ADD has a specific set of criteria that any good health care provider will test for before prescribing anything. My husband was diagnosed at 18 (IIRC), after undergoing a series of tests with his doctor, who then referred him to a psychiatrist, where he went through another series of tests. These took several hours to complete and were administered by a psychiatrist who also heard about his life conditions and was able to see how he reacted in person. I would not trust a doctor or a diagnosis based on completing a questionaire. I have no doubt that this does happen on occasion, but I don’t think it is as often as people think.

The process of naming a disorder and coming up with a treatment may seem arbitrary, but it takes lots of research for a disorder to be recognized by the medical community the way that ADD is. Normal children misbehave, but normal children are also in control of their actions to some extent ( more so as they age). A child with ADD cannot force himself to focus. He is not misbehaving when his mind wanders and stops processing information any more than someone who is bipolar is misbehaving when they are experiencing a manic phase.

Diagnosis can have an immediate effect by letting the child know that help is available and he is not a bad child for experiencing what he does. If medication is needed, it can help the child (or adult) get through the day without frustration. It can help the child’s relationship with his family and friends when every day is no longer a struggle to get the child to cooperate. The child can feel pride as they learn to overcome potential barriers and see the difference in their schoolwork and home life. This is not all due to medication, it also takes education on the part of the child and the parent as to how to make things easier.

My husband still has ADD but chooses not to take medication right now. He knows what the difference is and can choose to go back on it if he wants (he is in school again so he might want to.) The difference is that now that he is diagnosed, he knows what to look out for and also what his options are. Before he was diagnosed he often wondered what was wrong with him, and why he couldn’t make himself do what he wanted to do.

Contrary to excusing his ‘behavior’, being diagnosed actually made him more in control and able to take responsibility for it.

46

…so you mean that if I’m so badly behaved and out of control that I don’t function properly, I have a “disorder” and deserve special attention. Cool! Sign me up!

Are you saying that no diagnosed disorder can be controlled without drugs? If so, you’re proving my point.

If someone truly has a disorder, there is no reason society should encourage them to feel good about that particular aspect of themselves. A disorder is something to be disliked, something to be fought. It’s not something that should be accepted by anyone involved; rather, parents, children, teachers, and yes, perhaps even psychologists, should work together to try to bring the child’s behavior back to normal.

In my limited experience, any self-esteem boost that comes as a result of diagnosis is generally short-lived or fragile, because it is not caused by any improvement in the child; rather, it is caused by a lowering of the expectations of the parents and teachers.

47

Er, no dude. Behaving badly is not gonna get you diagnosed with some form of disorder. For example, I doubt someone could manage to pretend to exhibit ADD qualities all the time. You can’t really emulate the way it is. And, Ritalin, one of the most widely used drugs to treat ADD, causes hyperactivity in non-ADD people, so it makes it even more unlikely that you could pretend.

What would you gain by acting like that? Some people paying a little bit of extra attention, perhaps some medicine with side-effects but no good effects because you don’t really have a problem?

No.

It doesn’t make me feel good about my disorder. It gives me hope. A disorder is something that I can work on, it’s not something that is ingrained into me, which would not be as easy to treat as an identifiable problem. If you can identify the problem, you can deal with it, or attempt to.

It is an improvement. Otherwise I would’ve sunk further and further, and had I not been diagnosed, I might’ve fallen thru the cracks of the education system. You don’t lower your expectations, you realize that their are some areas where you might not be able to achieve well at, such as math or social communication. The challenge is to overcome and prove them wrong by working harder, and becoming a better person.

I feel that since it is something that I can try to achieve, something tht can be conquered, my chances are much more improved then before when I just thought I was a terrible person.

48

By diagnosing a child with ADD, you are telling him that it impossible for him to make himself focus. Are you sure that’s true? My first guess would be that many children who have been diagnosed with ADD have simply never been taught how to pay attention properly.

Why was ADD not a significant issue until the last few decades? It’s difficult for me to believe that it has simply gone undiagnosed for hundreds of years or more. I would think that if undiagnosed cases of ADD has always been a problem, many classrooms and homes in the late 1800s should have been absolute chaos, since they lacked both modern psychology and modern pharmaceuticals. Was that the case?

Conversely, if actual cases (diagnosed and undiagnosed) of ADD have risen dramatically since the late 1800s, modern methods be damned, let’s deal with children the old way.

Why not?

49

All (I think) diagnoses in the DSM have as one of their diagnostic criteria: " the disturbance must cause clinically significant impairment in social, emotional, or occupational functioning" -something like that anyway, I wrote the exact quote in an earlier post. That means that the kid has to be suffering to an extent that he is unable to function at a level even near that of his peers, or what might be expected of a child his age.

Take depression for example, we all feel depressed from time to time, sit up in our room with our headphones on listening to music, crying at odd parts of movies, feel worthless and helpless. It’s a depressive episode when it occurs all day every day for two weeks, you can’t sleep or sleep way too much, your body weight changes by more than about 5% in a month, you feel inapropriate or excessive guilt, can’t concentrate all day every day,
-suicidal thoughts or preocupation with death are a pretty big indicator. Don’t really enjoy things that you normally enjoy even if you want to.
That kind of stuff. All of the above of course have to be because of the depression, not because of some medical condition, or bereavement or some other life change.
Two of these episodes and it’s Major depressive disorder.
Why diagnose?

This is kind of a controversial topic even within the profession. Whether or not it is beneficial to the client to label them with diagnoses.

My answer to it is: As a therapist, I use a diagnosis when it makes sense to do so. It depends on the client, the diagnosis, and the context.

If I think it will help the client to have a definitive disorder; to help them organize their thinking and they will be able to use the definition to help themselves, then I use one. If an insurance company requires a diagnosis, I’ll use one. If I need to speak with another clinician about a case, I use the diagnosis as a means of speeding up communication.

In the case of Oppositional Defiant disorder, I rarely use it in therapy with the client as part of treatment. It’s rarely, in my experience, useful to do so. Maybe it might help the parent understand that they’re not alone in this thing, and help them understand that they’re going to need to employ some special strategies that they wouldn’t need for other kids.

Diagnosis is a tool, it is useful in some situations, not in others. Some professionals are better with this tool, others not as much.

I’m a pretty good diagnostician, but I’m not that good at using diagnosis as part of treatment; so I don’t very much. But that’s just how I work. Others use the tool for more applications than I do, and it varies widely throughout the profession.

50

Quite simply, if you’re diagnosed, you’re not responsible for your behavior. At least, that’s what parents and children seem to think. Once again, this is from my own personal observation; I have not been diagnosed with any kind of psych disorder, but I have several friends who have been diagnosed and treated for ADHD.

That makes sense. Unfortunately, most of the children I know who have ADHD don’t view it that way, and their parents don’t, either.

51

You keep talking about your limited experience, and it shows, but you don’t seem like you are trying to understand more about it. Clearly, the self-esteem boost is not from society making them feel good about having a disorder. It is from being able to do something about it.

If you are unable to function properly and are diagnosed as having a disorder, yes, you do need special attention. If you truly think children who have ADD are better off for having it because of any “special attention” they may get as a result, then I don’t know what to tell you. Well I do, but I can’t say it here.

May I ask what you are basing your ‘guesses’ on? I challenge you to volunteer with ADD children and teach them to pay attention properly. Please report back on how that goes.

Are you serious? Why was any modern disease not a significant issue until the last few decades? Why didn’t we diagnose schitzophrenia correctly 100 years ago? Why don’t we treat all disorders and diseases the same way we did in the 1800’s?

With this suggestion to treat children with psychological disorders the same way we did in the 1800’s I can only hope that you are completely ignorant of how it was done even 50 years ago. I also hope that you never have to experience a disorder that other people tell you you are making up. Are you saying that any psychological discovery and research in the past decade is false?

52

  1. no, no, no, you NEVER tell a child that he has no choice/control. The medicine helps, but only if he’s trying and learning to control himself. Your first guess would be incorrect. There is something chemically different about the ADD child, and he wouldn’t be able to focus long enough for you to teach him how to pay attention.

  2. Some theories on that one: the demands of modern society are ever more demanding of a child’s ability to filter information, so we’ve raised the bar for what’s a necessary amount of attention to task.

The pieces weren’t together enough to understand children to the extent necessary to diagnose this condition until the last few decades.

Many children in the late 1800’s weren’t educated, many were deemed “uneducable.” I’d say it’s more likely these kids didn’t go to school/were kicked out early.

Maybe many classrooms in the 1800’s WERE absolute chaos and we’re falling victim to what Stephanie Coonts calls “the nostalgia trap” believing that the good ol’ days were good.

I don’t think there’s a definitive answer, and there’s probably more than one.

53

No, no, no. I am responsible for my actions, but my actions may be affected by my disorder. I am not saying it is not my fault, it is. Me having AS results in my actions, and since it is a part of me just as your ears are a part of me, thus it affects me. Some of the things that are caused by disorders should be discounted.

A correct example: Not punishing a kid with ADD for fidgeting in his seat.

A incorrect example: Not punishing a kid for puching someone because he was feeling antsy.

Well, that is too bad. I realized that a long time ago. I wish I could tell them that the disorder isn’t some sort of write off so that they can slack off because they have a disorder. Sorry if that phrasing offends you, but I cannot think of any other way to phrase it.

54

greck, thank you for your explanation. That makes a good deal of sense, but also gave me the distinct impression that psychological diagnosis is a glorified crapshoot. How can a psychologist determine that it is impossible for a child to make himself focus? I would think that the behavior of a child who has never been taught to pay attention would be very similar if not identical to the behavior of a child who cannot force himself to focus.

55

Other than drugs, what can a child who has been diagnosed with ADD do about her problem that an undiagnosed child can’t do? I guess that’s my main question. Zenster started this thread with a rant about the APA’s acknowledgement of Oppositional Defiant Disorder as a “disorder”. What does that recognition do? It seems to me that it should be instantly obvious to any ADD child that he struggles with paying attention, sitting still, etc. Does he really need a shrink to tell him that?

Velma, I’m sorry, my comments about the recent rise of ADD were very rude and poorly thought-out. (no, that is not sarcasm.)

56

How can a diagnosis help? So many ways…for starters, to add to the self-esteem boost idea, kids don’t particularly need a psychiatrist’s label to tell them they’re different. They’re more than aware of that and are excellent at the self-hatred thing, one of the reasons kids with ADHD, ODD and CD are at a higher risk for depression. Rather than simply a fuzzynice feel good boost, the diagnosis gives them a knowable goal, a target to work toward instead of a generic “just act right!” directive from frazzled parents and teachers.
A diagnosis is often of more benefit to the frazzled teachers and parents than the child. A ‘traditional’ parent who firmly believes that a child should be able to suck it up and that firm discipline and explaining what’s acceptable will fail. If those types of solutions worked for ADHD kids, for example, we wouldn’t be having this discussion. Generally speaking, it’s after all traditional methods of child-rearing have failed that a diagnosis is sought. Sure, there are crap parents who’ll see it as an excuse, a validation of their worth that’s largely unearned, one can only hope in those cases that at least the child benefits from directed assistance at school.
Pre-diagnosis for my son meant discipline hell at school, normal (for an ADHD kid) fidgeting annoyed the teacher, who’d isolate or belittle him, he’d react right back even worse rather than being able to control his impulses, it was an ever-escalating cycle of negative reinforcement. He wasn’t learning at school, he was disruptive to the class, etc.
Post-diagnosis meant a lot of changes. Teachers go out of their way to make eye contact during teaching to ensure his attention snaps back to the lesson at hand, or touch him on the shoulder as they move about the classroom. Simple things like having a page he can look at on his desk given to him for copying, as opposed to copying from a chalkboard that’s 15 feet away at the front of the room, for my son that’s the difference between a doable assignment and one that’s not. Prior to the teachers having that diagnosis, little stuff like this was never introduced.
As a parent, the diagnosis gave me direction. It was like, ok I’ve been trying everything that I know should work, and it isn’t working. Now that there’s a working label, let me read up on what’s worked for others with the same diagnosis and see what I can learn and apply.

Seeing as Ritalin and Adderall were, until a few months ago, considered controlled substances where I live, subject to the same rigorous procedures as prescribing/filling a morphine script, the idea that a parent can casually get drugs for their child and not be seeking psychiatric or theraputic care kinda boggles me. My pediatrician won’t even write a script for these types of medications, they’ll just write a referall to a psychiatrist. My obligation as a parent to ensure that I can even get the pills to my child include taking him to see a psychiatrist every couple of months, therapy weekly, ensuring that the communication paths between the school authorities and the doctors stay open and making sure he has liver checks twice a year. Granted, I’m sure there are script mills somewhere that will sell paper to parents that choose to not seek therapy for their kids, but I’ve never heard of one.

57

Thanks, I admit to overreacting a little as well. I see now that you are more sincere than I first thought. I know people who use their own diagnosis as an excuse to slack off as well, so it’s not like I don’t think it never happens. It does make it more frustrating for people who genuinely have a disorder and try to work with it. I feel sorry for kids who have ADD and never have the chance to learn to deal with it. They will find out someday it is not a valid excuse to anyone but themselves. I see it as similar to a learning disability - it cannot be ‘fixed’ but it can be overcome. People who have it must actually work harder.

Queen Tonya has given good examples of how diagnosis can help even without medication so I won’t bother adding much more. Medication is appropriate for some, others not. My husband didn’t like being on Ritalin and so he’s not on it anymore. He has another medication he can take now but does not feel he needs it for everyday life. Now that he is in school again he might feel it would be beneficial. He hasn’t completely outgrown his symptoms, but with maturity comes a better capability to cope.

58

Again, it’s not IMPOSSIBLE, any more than it’s impossible for a depressed person to cheer up.

Try this: turn on the radio and the tv at a party and try to watch your favorite show while in the midst of a conversation.

another illustration: You know how in a large gathering you don’t hear what the conversation at the far end of the table is, but when someone over there says your name you hear it? That’s your brain filtering out what’s irrelevant, your name is meaningful and therefore didn’t get filtered out. For the ADD kid, most of it sounds as relevant as his name. So imagine yourself trying to hold a conversation at one end of the table when your name is repeated about every 10 seconds at the other end of the table.

Imagine you have the attention span and maturity of a 7 year old while doing this. Imagine you’re so wired on coffee you can’t sit still too. And imagine the conversation to which you’re trying to pay attention is about math.

maybe a bit dramatic, but does that help?

It’s not impossible, but maybe you can see where you might need to learn manually to do something that other people do automatically.
That’s why it takes drugs to help sometimes.

59

Any numbers on how many of these ODD or CD kids come from dysfunctional homes versus satisfactory nuclear families?

60

There’s no such thing as a satisfactory nuclear family. That’s why we move out. We all come from disfunctional homes (to some degree). Some of them are more functional than others, but nobody’s perfect, few are even within about 100 points of perfect.

But to answer your question; we’re most likely talking about an interaction between parenting style and temprament of the child. So abuse and neglect, attachment disruptions, trauma, these things will more likely lead to a child developing a disorder of some sort. Some kids are more prone than others and it will take much less, some kids are naturally less sensitive and these circumstances don’t affect them in the same way.