Oppositional Defiant Disorder Diagnosis

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am no expert but that seems OFF. ODD is very rarely diagnosed these days and it ALWAYS accompanies another diagnosis, which is part of the reason it is rarely diagnosed - ie., you want to see if remediating/understanding the ADHD, LD, anxiety or ASD helps. Also, clearly, something is goin on. That is some serious aggression and it is unlikely that it is "nothing", right? Did you do the ADOS? I am not sure what I would think. At the least, you have behavior issues, perhaps that do not fit into a diagnosis. And it sounds like the class switch has been great for him. Do you need an IEP? You may want one in case these issues appear in his next class.

OP Again:

We didn't do the ADOS, would that be part of the neuropsych testing we have upcoming or do I have to specifically request that? I'm thinking that I'll keep the KK appointment in March and have his new teacher do the evaluation portion. I'm interested in seeing if his behavior continues to improve in school as he didn't have any issues in K or 1st. I'm also not entirely convinced he doesn't have underlying anxiety issues.

OP, I'm guessing it's anxiety and impulse control/emotional regulation issues exacerbated by a bad teacher. I would not want to be going for an IEP or 504 plan with a diagnosis of ODD, because that's enormously stigmatizing and more importantly, likely incorrect. It could be that things are smooth sailing from here on out. If he's doing OK in the new classroom, I'd hold off for the rest of the year and work with private therapists.

I have a similar story but for a much younger kid. His anxiety and motor delays, coupled with terrible classroom management and aggressive teachers, resulted in awful behavioral issues. I have no doubt he would have gotten an ODD diagnosis if we'd sought it. (Luckily at 4 he qualified for an IEP under the more general developmental delay category, so we didn't have to go that route.) With time and more importantly MUCH BETTER teachers, his behavior has done a complete 180. He's still a sensitive, passionate, nervous, clumsy, kid! But he does not have ODD.

OP Here: Is this diagnosis any more stigmatizing than anything else? He definitely has ups and downs in terms of behavior and seems to go through phases or irritability. If it gets him some accommodations that would be the goal. This is all new to us as he hadn't had any issues in school prior to this year. When I look at the description of ODD he doesn't seem to fit everything.

Being easily aggravated and annoyed;
Irritating others intentionally;
Exhibiting sudden, unprovoked anger;
Blaming others for their mistakes or for their misbehavior;
Refusing to comply with adult requests;
Bragging about being mean and never truly being sorry;
Lying;
Being vengeful without provocation; and
Provoking conflict among peers, family members and other adult

He doesn't lie or provoke conflict among peers. He doesn't brag about being mean. He doesn't exhibit unprovoked anger. It's more like he has meltdowns when things he perceives as unfair happen to him and the tantrums just snowball into increasingly bad behavior. He is very sensitive and easily annoyed and sometimes doesn't comply with adult requests. He is well liked by his peers and has a lot of friends in school.

[Anonymous]

Who was he hitting/kicking/throwing stuff at? What was going on when he ran out of the room? If peers, I would t really say he is “well liked” right?

[Anonymous]

Intense melt downs can be part of asd. I would do the ados.

[Anonymous]

Oh and if you just want an iep to get ot, it’s very very hard for kids even those with ieps to get ot at school.

[Anonymous]

Anonymous wrote:Who was he hitting/kicking/throwing stuff at? What was going on when he ran out of the room? If peers, I would t really say he is “well liked” right?

OP Here: He wasn't throwing items at anyone he was throwing them on the ground from the desk when he was upset. He hit a child who got in front of him in line when they were coming in from recess. He would leave the classroom when he was upset, put on the spot, or it was too noisy and hide in the bathroom. The kids are 7 so he is well liked as this doesn't happen everyday and he has a pretty solid friends group, playdates every weekend etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am no expert but that seems OFF. ODD is very rarely diagnosed these days and it ALWAYS accompanies another diagnosis, which is part of the reason it is rarely diagnosed - ie., you want to see if remediating/understanding the ADHD, LD, anxiety or ASD helps. Also, clearly, something is goin on. That is some serious aggression and it is unlikely that it is "nothing", right? Did you do the ADOS? I am not sure what I would think. At the least, you have behavior issues, perhaps that do not fit into a diagnosis. And it sounds like the class switch has been great for him. Do you need an IEP? You may want one in case these issues appear in his next class.

OP Again:

We didn't do the ADOS, would that be part of the neuropsych testing we have upcoming or do I have to specifically request that? I'm thinking that I'll keep the KK appointment in March and have his new teacher do the evaluation portion. I'm interested in seeing if his behavior continues to improve in school as he didn't have any issues in K or 1st. I'm also not entirely convinced he doesn't have underlying anxiety issues.

They should do an ADOS if, at the intake appointment, there is any question about Autism. You can specifically request it. With kids who are very verbal and don't exhibit classic stimming and avoidance of eye contact in the initial appointment, may have ASD dismissed out of hand without further testing. It would be appropriate to press on doing the ADOS if you have questions about autism, regardless of whether they "see" it at the intake appointment.

Can I ask what type of testing you did? Was it primarily questionnaires for the parents and teacher or did they do a full day of testing?

We did psycho educational testing. The ODD diagnosis was based on the questionnaires from us and his old teacher. The testing took about 3 hours and included the WISC-V and WIAT-III. The behavior info came from the BREIF2, BASC3, PBRS, RCMAS2, and ABAS3.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Who was he hitting/kicking/throwing stuff at? What was going on when he ran out of the room? If peers, I would t really say he is “well liked” right?

OP Here: He wasn't throwing items at anyone he was throwing them on the ground from the desk when he was upset. He hit a child who got in front of him in line when they were coming in from recess. He would leave the classroom when he was upset, put on the spot, or it was too noisy and hide in the bathroom. The kids are 7 so he is well liked as this doesn't happen everyday and he has a pretty solid friends group, playdates every weekend etc.

This sounds like ADHD or anxiety. Psychoeducational testing misses a lot of things that a neuropsych picks up. While ASD is a possibility you should discuss at the neuropsych exam, based on other information you've provided it doesn't sound like it. It sounds like he has some sensory issues, which is one diagnostic criteria for ASD, but also occurs with ADHD and anxiety.

Does your kid have any trouble on the playdates? Does he engage in joint play with the other kid, or is it parallel play? Does he have any particularly intense, narrow interests? Does he engage in any type of repetitive activity or motion. This is not just classic arm flapping, but any kind of repetitive motion of the body such as running, twirling, jumping or playing with a fidget? If it's no to all that, ASD is unlikely. Whether to do any specific testing for ASD is a matter of the neuropsychologist's professional judgement together with your own reports or concerns about his behavior.

[Anonymous]

Op, to give you an idea of what asd looks like in a "high functioning", socially motivated kid ... my DS enjoys playing with other kids and actively wants friends but has very rigid play. He tries to set the script and control the play. There are some kids that will play very well with him but most kids will play and kind of ignore him. He may or may not notice that they are actually ignoring him. He doesn't get reciprocity at all. If a neighborhood friend comes to the door and DS isn't interested in going out right then, he would just say no and shut the door. Similar with reciprocity in conversation.

I bring this up because rigidity, obsession with fairness, and blowing up when expectations are violated are kind of hallmarks of ASD but we had ASD dismissed out of hand when DS was younger because he was socially motivated and because friendships are almost always parent mediated in the younger years. And also DS'S stims were attributed to adhd hyperactivity. He's 10 now and it's become a lot clearer but it was pretty fuzzy at 6 and 7.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am no expert but that seems OFF. ODD is very rarely diagnosed these days and it ALWAYS accompanies another diagnosis, which is part of the reason it is rarely diagnosed - ie., you want to see if remediating/understanding the ADHD, LD, anxiety or ASD helps. Also, clearly, something is goin on. That is some serious aggression and it is unlikely that it is "nothing", right? Did you do the ADOS? I am not sure what I would think. At the least, you have behavior issues, perhaps that do not fit into a diagnosis. And it sounds like the class switch has been great for him. Do you need an IEP? You may want one in case these issues appear in his next class.

OP Again:

We didn't do the ADOS, would that be part of the neuropsych testing we have upcoming or do I have to specifically request that? I'm thinking that I'll keep the KK appointment in March and have his new teacher do the evaluation portion. I'm interested in seeing if his behavior continues to improve in school as he didn't have any issues in K or 1st. I'm also not entirely convinced he doesn't have underlying anxiety issues.

OP, I'm guessing it's anxiety and impulse control/emotional regulation issues exacerbated by a bad teacher. I would not want to be going for an IEP or 504 plan with a diagnosis of ODD, because that's enormously stigmatizing and more importantly, likely incorrect. It could be that things are smooth sailing from here on out. If he's doing OK in the new classroom, I'd hold off for the rest of the year and work with private therapists.

I have a similar story but for a much younger kid. His anxiety and motor delays, coupled with terrible classroom management and aggressive teachers, resulted in awful behavioral issues. I have no doubt he would have gotten an ODD diagnosis if we'd sought it. (Luckily at 4 he qualified for an IEP under the more general developmental delay category, so we didn't have to go that route.) With time and more importantly MUCH BETTER teachers, his behavior has done a complete 180. He's still a sensitive, passionate, nervous, clumsy, kid! But he does not have ODD.

OP Here: Is this diagnosis any more stigmatizing than anything else? He definitely has ups and downs in terms of behavior and seems to go through phases or irritability. If it gets him some accommodations that would be the goal. This is all new to us as he hadn't had any issues in school prior to this year. When I look at the description of ODD he doesn't seem to fit everything.

Being easily aggravated and annoyed;
Irritating others intentionally;
Exhibiting sudden, unprovoked anger;
Blaming others for their mistakes or for their misbehavior;
Refusing to comply with adult requests;
Bragging about being mean and never truly being sorry;
Lying;
Being vengeful without provocation; and
Provoking conflict among peers, family members and other adult

He doesn't lie or provoke conflict among peers. He doesn't brag about being mean. He doesn't exhibit unprovoked anger. It's more like he has meltdowns when things he perceives as unfair happen to him and the tantrums just snowball into increasingly bad behavior. He is very sensitive and easily annoyed and sometimes doesn't comply with adult requests. He is well liked by his peers and has a lot of friends in school.

Well, if you don't feel it's stigmatizing and it will get you what you need, then I don't at ALL mean to discourage you. But based on my experience, I wouldn't want that diagnosis because it would not have seemed fair or accurate for our simliar-sounding kid. His bad behavior was caused at least in equal parts (if not more) by the school's failures to accommodate his *other* needs (and just their failures all around in that particular classroom -- my DS just happened to be the lucky one who "externalized" his reactions!) I do get the position you're in, though. When, for whatever reason, behavioral issues result in the child being excluded from the classroom or are otherwise very disruptive, it's obvious that there is a failure to provide FAPE and access the curriculum. Then you have to find the disability to go with it. ODD basically just seems like the easiest way to describe the symptoms of "disruptive behaviors." My son was younger so we could just call it "developmental delay."

[Anonymous]

I think there's a reaction by some that ODD is willful behavior (hence all the corporal punishment people) where if there is a diagnosis of anxiety, adhd, and or asd, they view the behavior as a function of the disability. Unfortunately you can't really control who is involved in your DC education in public school.

[Anonymous]

"He doesn't lie or provoke conflict among peers. He doesn't brag about being mean. He doesn't exhibit unprovoked anger. It's more like he has meltdowns when things he perceives as unfair happen to him and the tantrums just snowball into increasingly bad behavior. He is very sensitive and easily annoyed and sometimes doesn't comply with adult requests. He is well liked by his peers and has a lot of friends in school."

To me, the screams NOT ODD. My bet is ADHD, anxiety and/or ASD.

-Mom of child who's meltdowns much improved when put in a more appropriate educational setting and medicated for ADHD

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I am no expert but that seems OFF. ODD is very rarely diagnosed these days and it ALWAYS accompanies another diagnosis, which is part of the reason it is rarely diagnosed - ie., you want to see if remediating/understanding the ADHD, LD, anxiety or ASD helps. Also, clearly, something is goin on. That is some serious aggression and it is unlikely that it is "nothing", right? Did you do the ADOS? I am not sure what I would think. At the least, you have behavior issues, perhaps that do not fit into a diagnosis. And it sounds like the class switch has been great for him. Do you need an IEP? You may want one in case these issues appear in his next class.

OP Again:

We didn't do the ADOS, would that be part of the neuropsych testing we have upcoming or do I have to specifically request that? I'm thinking that I'll keep the KK appointment in March and have his new teacher do the evaluation portion. I'm interested in seeing if his behavior continues to improve in school as he didn't have any issues in K or 1st. I'm also not entirely convinced he doesn't have underlying anxiety issues.

OP, I'm guessing it's anxiety and impulse control/emotional regulation issues exacerbated by a bad teacher. I would not want to be going for an IEP or 504 plan with a diagnosis of ODD, because that's enormously stigmatizing and more importantly, likely incorrect. It could be that things are smooth sailing from here on out. If he's doing OK in the new classroom, I'd hold off for the rest of the year and work with private therapists.

I have a similar story but for a much younger kid. His anxiety and motor delays, coupled with terrible classroom management and aggressive teachers, resulted in awful behavioral issues. I have no doubt he would have gotten an ODD diagnosis if we'd sought it. (Luckily at 4 he qualified for an IEP under the more general developmental delay category, so we didn't have to go that route.) With time and more importantly MUCH BETTER teachers, his behavior has done a complete 180. He's still a sensitive, passionate, nervous, clumsy, kid! But he does not have ODD.

OP Here: Is this diagnosis any more stigmatizing than anything else? He definitely has ups and downs in terms of behavior and seems to go through phases or irritability. If it gets him some accommodations that would be the goal. This is all new to us as he hadn't had any issues in school prior to this year. When I look at the description of ODD he doesn't seem to fit everything.

Being easily aggravated and annoyed;
Irritating others intentionally;
Exhibiting sudden, unprovoked anger;
Blaming others for their mistakes or for their misbehavior;
Refusing to comply with adult requests;
Bragging about being mean and never truly being sorry;
Lying;
Being vengeful without provocation; and
Provoking conflict among peers, family members and other adult

He doesn't lie or provoke conflict among peers. He doesn't brag about being mean. He doesn't exhibit unprovoked anger. It's more like he has meltdowns when things he perceives as unfair happen to him and the tantrums just snowball into increasingly bad behavior. He is very sensitive and easily annoyed and sometimes doesn't comply with adult requests. He is well liked by his peers and has a lot of friends in school.

Well, if you don't feel it's stigmatizing and it will get you what you need, then I don't at ALL mean to discourage you. But based on my experience, I wouldn't want that diagnosis because it would not have seemed fair or accurate for our simliar-sounding kid. His bad behavior was caused at least in equal parts (if not more) by the school's failures to accommodate his *other* needs (and just their failures all around in that particular classroom -- my DS just happened to be the lucky one who "externalized" his reactions!) I do get the position you're in, though. When, for whatever reason, behavioral issues result in the child being excluded from the classroom or are otherwise very disruptive, it's obvious that there is a failure to provide FAPE and access the curriculum. Then you have to find the disability to go with it. ODD basically just seems like the easiest way to describe the symptoms of "disruptive behaviors." My son was younger so we could just call it "developmental delay."

OP here: I definitely agree with you. I don't think the diagnosis fits really and what you're describing about the school really rings true in his situation. I'm definitely going to keep the KK neuropsych appointment. We got tested at Mt Washington and the psychologist said our DS didn't have enough markers based on the parent and teacher surveys for ADHD or Anxiety. They were pretty focused on how high his IQ was and that he could be "manipulating situations to get what he wants".

I'm just worried if we don't go with the diagnosis and something else happens before we get another one we will be caught in the lurch if something should pop up again at school. He is doing amazingly well in his new class and his teacher sends me daily emails about how there aren't any issues at all. He normally doesn't do well with transitions at all so I'm just concerned that next year when he switches teachers a similar thing could happen where he behaves badly.

[Anonymous]

Anonymous wrote:Op, to give you an idea of what asd looks like in a "high functioning", socially motivated kid ... my DS enjoys playing with other kids and actively wants friends but has very rigid play. He tries to set the script and control the play. There are some kids that will play very well with him but most kids will play and kind of ignore him. He may or may not notice that they are actually ignoring him. He doesn't get reciprocity at all. If a neighborhood friend comes to the door and DS isn't interested in going out right then, he would just say no and shut the door. Similar with reciprocity in conversation.

I bring this up because rigidity, obsession with fairness, and blowing up when expectations are violated are kind of hallmarks of ASD but we had ASD dismissed out of hand when DS was younger because he was socially motivated and because friendships are almost always parent mediated in the younger years. And also DS'S stims were attributed to adhd hyperactivity. He's 10 now and it's become a lot clearer but it was pretty fuzzy at 6 and 7.

OP here: This really sounds like him. He plays with friends but he often says "I made up all the games," or "They are in my club." He is very concerned with things being fair and equitable which is the cause of many meltdowns. He also needs advanced warning and doesn't do well with sudden changes of plans. I think I will ask for him to be tested when we do the neuropsych at KK if that's not already included. I don't think they think to test him for this initially because he has no issues with eye contact and is a very clever engaging kid with adults. He is very fidgety and has some sensory issues with loud noises, tags, socks, etc.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op, to give you an idea of what asd looks like in a "high functioning", socially motivated kid ... my DS enjoys playing with other kids and actively wants friends but has very rigid play. He tries to set the script and control the play. There are some kids that will play very well with him but most kids will play and kind of ignore him. He may or may not notice that they are actually ignoring him. He doesn't get reciprocity at all. If a neighborhood friend comes to the door and DS isn't interested in going out right then, he would just say no and shut the door. Similar with reciprocity in conversation.

I bring this up because rigidity, obsession with fairness, and blowing up when expectations are violated are kind of hallmarks of ASD but we had ASD dismissed out of hand when DS was younger because he was socially motivated and because friendships are almost always parent mediated in the younger years. And also DS'S stims were attributed to adhd hyperactivity. He's 10 now and it's become a lot clearer but it was pretty fuzzy at 6 and 7.

OP here: This really sounds like him. He plays with friends but he often says "I made up all the games," or "They are in my club." He is very concerned with things being fair and equitable which is the cause of many meltdowns. He also needs advanced warning and doesn't do well with sudden changes of plans. I think I will ask for him to be tested when we do the neuropsych at KK if that's not already included. I don't think they think to test him for this initially because he has no issues with eye contact and is a very clever engaging kid with adults. He is very fidgety and has some sensory issues with loud noises, tags, socks, etc.

Hi OP, when we were going through diagnostic hell when our kid was about 5, a well-regarded pediatric neurologist told us she wasn't fond of ODD diagnoses for kids his age -- she said, (paraphrasing) "When you look at the situation, you usually find they actually have something to be oppositional about." Meaning that finding the underlying cause for his unhappiness and acting out was the important thing. I know your child is a bit older, and I don't know much about ODD, but I'm hoping you get good advice with your followup evaluations, and that your doctors keep an open mind about what's going on. It's a tough situation -- good luck to all of you.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op, to give you an idea of what asd looks like in a "high functioning", socially motivated kid ... my DS enjoys playing with other kids and actively wants friends but has very rigid play. He tries to set the script and control the play. There are some kids that will play very well with him but most kids will play and kind of ignore him. He may or may not notice that they are actually ignoring him. He doesn't get reciprocity at all. If a neighborhood friend comes to the door and DS isn't interested in going out right then, he would just say no and shut the door. Similar with reciprocity in conversation.

I bring this up because rigidity, obsession with fairness, and blowing up when expectations are violated are kind of hallmarks of ASD but we had ASD dismissed out of hand when DS was younger because he was socially motivated and because friendships are almost always parent mediated in the younger years. And also DS'S stims were attributed to adhd hyperactivity. He's 10 now and it's become a lot clearer but it was pretty fuzzy at 6 and 7.

OP here: This really sounds like him. He plays with friends but he often says "I made up all the games," or "They are in my club." He is very concerned with things being fair and equitable which is the cause of many meltdowns. He also needs advanced warning and doesn't do well with sudden changes of plans. I think I will ask for him to be tested when we do the neuropsych at KK if that's not already included. I don't think they think to test him for this initially because he has no issues with eye contact and is a very clever engaging kid with adults. He is very fidgety and has some sensory issues with loud noises, tags, socks, etc.

This sounds so much like my ADHD/anxiety/ASD kid at that age.