When child’s behavior crosses the line
Rita Watson
Many children go through stages of “No” or “I hate you” while parents shrug and hope they can get through those years between the terrible 2’s and the troublesome teens. Katherine Ellison, a Pulitzer prize-winning journalist and author, became so exasperated by one of her sons that she took him to the University of California at San Francisco for evaluation at age 9. She learned that he had both attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD).
Ellison, author of “Buzz: A Year of Paying Attention,” found in her research that 65 percent of children with an ADHD diagnosis are diagnosed with ODD. She said, “In most of the world, kids with ODD are still viewed as budding or blooming juvenile delinquents, more deserving of a locked prison cell than a doctor’s care.”
Dr. John Boekamp
John Boekamp, a doctor at Bradley Hospital, says that ODD is challenging for parents. He is clinical director of the hospital’s Pediatric Partial Hospital Program, a family-centered, intensive day treatment program for infants and children up to age 6, those with serious emotional, behavioral or relationship disturbances.
Boekamp said key differences between being oppositional and an ODD diagnosis are that at least four of eight symptoms must be shown over time, they must be more than one sees in average children, and must also interfere with daily activities. “Symptoms include losing one’s temper, arguing with adults, breaking the rules, deliberately annoying others, blaming others, being easily annoyed, becoming angry or resentful over minor things, and acting mean, spiteful, or vindictive. With symptoms in place over a six-month period, the diagnosis is likely to be ODD.
Some ODD symptoms
“An ODD diagnosis at an early age may develop into a conduct disorder. With adolescents, if 3 of 15 symptoms are exhibited during a six-month period, it is likely an ODD diagnosis,” he said.
“Parents might see serious rule violations such as bullying or threatening, initiating fights, using weapons to harm, physical cruelty to animals, stealing with confrontation, breaking and entering, forcing others into sexual activity, fire setting, destroying property, shoplifting, missing nighttime curfews, staying out late, being a con artist, running away from home overnight and skipping school. Three of these over a six-month period can be serious,” says Boekamp.
Preschool or young school-age children with ODD are three times more likely to develop a conduct disorder than children who develop ODD in middle or high school. Approximately 30 percent of children with ODD develop conduct disorder, and 10 percent ultimately develop antisocial personality disorder in adulthood, researchers say.
What can a parent do? He recommends that parents talk with their pediatrician or family practitioner before calling a mental-health specialist. He believes in the parent-physician partnership as a first step in helping families interact in a positive way.
Rita Watson, MPH, is a regular contributor to The Journal and a relationship columnist for the “All About You” section.