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What Is ODD?
Q: From the time he was a toddler, my son has been a discipline problem. He has been thrown out of four day cares and two private homes because they could not handle him. He's seven-years-old now. I've been called to the school numerous times because of his behavior. The principal suggested I have him evaluated for ODD (Oppositional Defiant Disorder) and ADD(Attention Deficit Disorder). I am familiar with ADD, but not ODD. Can you tell me about it?
A: Oppositional Defiant Disorder is a syndrome where children have hostile, negative, and defiant behaviors. While all children can have some of these behaviors at various times during their early years, they generally develop self-control and restraint, accepting the normal rules of society that eliminate those behaviors. In children with ODD, their behavior causes significant impairments in their social, academic, or occupational functioning.
In a child, the specific criteria for diagnosing ODD include having the behaviors for at least six months, with at least four of the following patterns:
- Often loses temper
- Often argues with adults
- Often defies or refuses to comply with adults' requests or rules
- Often annoys people deliberately
- Often blames others for his or her own mistakes or misbehavior
- Often is touchy or easily annoyed by others
- Often is angry or resentful
- Often is spiteful or vindictive
These criteria come from the Diagnostic and Statistical Manual of the American Psychiatric Association.
It's also important to note that in answering yes to these criteria, you have to compare the behaviors to other children of the same age and developmental level. Thus, for a three-year-old who loses his temper and defies adults, I wouldn't answer yes because many three-year-olds have that behavior -- it's relatively typical. In a seven-year-old, those are not typical behaviors.
The cause of ODD is not completely understood, but is felt to be related to both genetic and environmental factors. While ODD is different from ADD, it does appear that some children who have ADD also have this type of disruptive behavior when they are younger. It's important to have a child evaluated when there are significant concerns, because both ADD and ODD can be managed effectively with early intervention. You can ask your pediatrician for a referral to a child psychologist or child psychiatrist to help evaluate your son.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.