And so, to meet the criteria, the child must be displaying these behaviors more frequently (and with more intensity) than their peers, and it must create significant problems. Has been spiteful or vindictive at least twice in the past six monthsĪll children experience temper tantrums, can be irritable, or refuse to comply with directions. Often blames others for their mistakes or misbehavior Often actively defies or refuses to comply with requests from authority figures or with rules Often argues with authority figures or, for children and adolescents, with adults Although ODD is often thought of as a precursor diagnosis to CD, many children who receive a diagnosis of ODD do not go on to subsequently develop CD" How is ODD Diagnosed?įor a child to meet the diagnostic criteria for ODD, 4 of the following behaviors must be present for at least the last six months. A diagnosis of CD is assigned when behaviors violate the rights of others and major societal norms, including bullying, threatening others, initiating physical fights, sexual assault, and stealing. Children and adolescents with ODD frequently lose their temper, are easily annoyed with others, and will often argue with authority figures or refuse to comply with rules. "ODD is characterized by a pervasive pattern of angry and irritable mood, argumentative tendencies, defiant behavior, and vindictiveness. Fadus et al., 2020 provide a helpful summary of these two diagnoses and their distinctions: Both of these behavioral disorders co-occur with ADHD at a high frequency. While ODD is often diagnosed among younger children, CD is often not diagnosed until the teenage years. Children diagnosed with ODD are often described as "uncooperative, defiant, and hostile toward peers, parents, teachers, and other authority figures" ( Hopkins Medicine). Both capture a clustering of behavioral patterns. The two major disruptive behavior disorders include Oppositional Defiant Disorder and Conduct disorder (CD). While ADHD is a neurodevelopmental condition, ODD is classified as a disruptive behavioral disorder. There may be situations where such a diagnosis can be useful. While I would be extremely cautious diagnosing this myself and particularly cautious before diagnosing a BIPOC child with ODD, I am also hesitant to make umbrella statements. Some families may find it helpful to have a name for the pattern of behavior they are working with. ![]() With that said, there may be some cases where the diagnosis may open up necessary supports such as: parenting training/support and additional emotional-regulation resources. The overdiagnosis also perpetuates harmful stereotypes about Black boys and Black men (To learn more about ADHD, ODD and racial bias see my infographic about it here). A diagnosis of ODD in a Black or brown child can set them down a systemic trajectory that leads to devasting consequences. A white child with a similar presentation is more likely to be diagnosed with an adjustment disorder or with ADHD. To really support these children, we need to understand what is happening beneath the surface that makes this behavior make sense.Įmerging research suggests ODD is likely overly diagnosed in Black and non-white Hispanic children, particularly Black boys ( Ballentine, 2019). ![]() My fear is that the diagnosis of ODD stops curiosity, and the kid's behavior becomes the focus of treatment. It can be sensory-driven and related to underlying neurological differences (i.e., ADHD and autism). It's also common among anxious children it can also be a response to trauma or race-based discrimination. For example, defiant and angry outbursts are common among depressed children, especially boys. It is often used as a catch-all diagnosis that captures a kid's behavior but misses the underlying reason for the behavior. It is a behavioral disorder, meaning it captures the child's pattern of behavior but fails to capture the "why" behind the behavior. I won't make this article a stump speech on ODD, but I want to highlight my concerns with the diagnosis itself. ![]() What is Wrong with the ODD Diagnosis?Īs I dove into the research, the more problematic the ODD diagnosis felt to me. However, I didn't want to let my bias influence my process, and the reality is that up to 40% of ADHD children are also diagnosed with ODD ( Miller), so it felt like an important topic to speak to. I have been hesitant because I don't particularly like the diagnosis of ODD. I have been hesitant to create this Venn diagram as part of my #ADHD misdiagnosis series.
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