COULD IT BE ...
Why I Never Diagnose Oppositional Defiant Disorder
When your kid's behavior is out of control, you're desperate for help. A diagnosis like Oppositional Defiant Disorder (ODD) can make you feel vindicated -- like "Ohh, he has that" or "That's why she's so tough."
If you know me, you've heard this rant. Here are 3 reasons why I consider ODD a useless diagnosis that's unfair to kids, especially my under-7 crowd.
The Diagnosis: Oppositional Defiant Disorder
These are the DSM-5 criteria. Check off at least 4, present over a 6-month period, and a child is eligible for this diagnosis [note: even kids under 5.]
- Often loses temper
- Is often touchy or easily annoyed
- Is often angry and resentful
- Often argues with adults
- Often actively defies or refuses to comply with requests
- Often deliberately annoys others.
- Often blames others for his or her mistakes or misbehavior.
- Has been spiteful or vindictive at least twice within the past 6 months.
Oppositional Defiant Disorder isn't a thing that kids "have." It's just a list of visible symptoms.
Here are my 3 big objections.
The ODD diagnosis doesn't point to any cause.
To me, ODD is useless because it's so nonspecific.
It doesn't point to any biological or environmental cause.
Imagine bringing your child to the pediatrician with cough, sneezing and congestion. What if your doc said, "She has "Cough/Sneeze Disorder." (I made that up.)
You'd want to know WHY! Due to allergies, COVID, valley fever (an Arizona specialty), pneumonia, the flu?
When kids come to me with symptoms of ODD, I want to know WHY. It is, in fact, the heart of my JOB to find out. I'm not content to call it ODD and blame a developing child.
The ODD diagnosis is developmentally insensitive.
We adults often can't explain our emotions and choices. We're short with a co-worker or spouse ... something rubs us the wrong way and we react.
Kids, especially my under-7 crowd, are still learning how to put words onto feelings. How do you say,
- I think they love my brother more than me.
- I feel unsmart and embarrassed to ask for help.
- I am being maltreated and it's unsafe to tell.
This diagnosis presumes kids are just being bad if they can't explain their actions. That's not how I see it.
The ODD diagnosis may point simply to behavior management.
I believe the ODD conclusion can lead clinicians in solely behavioral direction. Fix the kid. Make them stop. Consequence this.
Just try to "behavior manage" a kid's feelings without understanding them. That's the recipe for TGWF (Things Getting Worse Fast).
The ODD conclusion may also stop the search for other reasons for oppositional behavior. Here's my short list:
- Nutrition out of whack (my #1 rule-out)
- Home stress
- Parent-child strained relationship
- Separation and divorce
- Being bullied
- Poor fit between child/teacher, child/school
- Learning problems
There are many behavioral tools in my bag. They're all paired with parent insight, attachment and executive function. That combo is ChildSightTools®.
Cool the Tantrums was built to help kids who "look ODD" but have much buried in their hearts. See how my course can help you in privacy, right now.
Thanks and see you next week!
And remember ... Looking through your child's eyes changes everything.
What are your thoughts? Hit reply or email Beth@DrBethKids.com.
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