Where to go for ODD dx (or find out what else it is)

[erikdeb]

My 8yo ds I highly suspect would classify as ODD. I'm not sure if there are underlying things there as well. What kind of place do I seek a dx? Neuropsych? Normal child psych? The autism center place? His ped? Developmental ped? Behavioral person? What?

 

(We took older ds to the autism place where he also recieves therapy. He was dx with PDD-NOS and ADHD-combined.  8yo is starting OT in a couple weeks without a dx, but we'd like to know what to really study up on. His anger is really concerning me.)

[OneStepAtATime]

You might want to post on the Special Needs Board sub-board. There are parents there that have dealt with this issue.  I wish I could help but I can't.  Hopefully someone over in SN will assist you....

[Tiramisu]

So, your 8 yo ds as no dx at all, but your older ds has PDD-NOS? 

 

I'm very much NOT an expert on this stuff, but I've been reading an older book about parenting kids with Aspergers and high-functioning autism. It mentions that if there is one child in the family with a spectrum dx, it's likely that a mix of similar traits exist in the other family members. It also mentioned that ODD can be an inaccurate dx for kids who are later dx'd on the spectrum. I'm just throwing that out to think about. Perhaps he's not ODD but on the spectrum himself, or dealing with SPD as a trait that could appear to be ODD. Also, depression in children often appears as anger. Depression also is often co-morbid with spectrum disorders, according to the book. Depression and anxiety is also supposed to be more common in families where there's been a spectrum dx.

 

Since you are familiar with the autism place, I'd consider going there. There may be an np or someone else on staff or they could recommend someone who would be able to look at the whole picture and give you an accurate answer. I'd be disinclined to go to a psych without spectrum experience in case it turns out to be something like that. Even if it's not that, they will be familiar with the traits and might be able to give you good advice for helping with them. They may also be familiar with the emotional issues that come up in families like yours. 

 

Sorry to jump in when I really don't know what I'm talking about, but I've been thinking about the same sort of thing lately and thought I'd share what I've learned. 

[Tokyomarie]

I can't point you to an exact reference right now to substantiate this, but ODD is a label that often gets applied to children who also have other labels. It is not so often used by itself, and doesn't come with good options for how do deal with the behaviors, that is interventions that are simply based on having that label. That is because behavior is communication. Non-compliant, angry, and other negative behaviors communicate that something is wrong in a child's world. Unfortunately, children, especially young children, don't have the communication skills and the life experience to be able to describe exactly "what" is wrong and/or are powerless to take action to improve internal &/or environmental conditions which may contribute to the behaviors.

 

If oppositional behaviors are so prominent in your daily experience with your child that you are seeking help, especially since you have an older child who is already diagnosed with an ASD, I would suggest a comprehensive evaluation which would look at all aspects of cognitive, educational, social, and emotional functioning. Such an evaluation may illuminate underlying reasons for oppositional behavior. Once those issues are addressed, oppositional behavior often improves.

 

Something else, maybe before you actually see someone, is to read works by the following authors:

 

Ross Greene (known for the Collaborative Problem Solving Approach): The Explosive Child

 

Howard Glasser (originator of the Nurtured Heart Approach): Transforming the Difficult Child

[Loowit]

My DS was diagnosed with ODD and ADHD by a psychiatrist.  His therapist (a play therapist who worked in conjunction with the psychiatrist) who was meeting with him for over a year was about to do a reevaluation when she moved and we haven't had a chance to really revisit the diagnosis.  His therapist was not happy that he was diagnosed with ODD at his age (he was 6 when he was diagnosed) and told me that this is a very serious diagnosis.  I wish we had been able to have a team evaluation by a developmental pediatricians like my older DS had at an autism clinic.  I think that because my younger DS had mostly behavior issues they weren't looking at the big picture.  There has been some speculation by his therapist that he may be on the spectrum but his current insurance will not pay for him to have an evaluation at the autism clinic.  Trying to get the referral was my biggest struggle because until a pediatrician saw one of DS's meltdowns in person no one really believed how bad it was. In my personal opinion I would do as thorough of an evaluation as possible.

[Ottakee]

ODD is usually a symptom of something else going on---spectrum issues, ADHD, depression, bipolar, etc. The autism place might be a good place to start if you see any other spectrum issues that concern you. We did a neuropsych and a pediatric psychiatrist about the same time and very soon afterwards a neurologist.

 

A good physical with blood work can be helpful as well. Sometimes these kids have blood sugar issues, thyroid problems, anemia, etc. Our doctor did the whole thing and found out my dd was hypothyroid, anemic, and had a urinary tract infection. Now, none of those were the cause of her issues but by treating them, we could better treat the other stuff as well as have a baseline in case any medication was tried.

[kbutton]

My son who has Asperger's can look very oppositional at times (he cycled through times of it). In his case, his anxiety problems look oppositional (self-preservation, I think). When he's on overload, he looks anything but anxious, but anxiety it is. Now that we know it's anxiety, we have a lot more success keeping him out of oppositional mindsets and behaviors, but it took some time to get there.

[kbutton]

On the anger front...this is much better now that we realize he's anxious, but my son gets really angry when he feels trapped by his emotions, choices, mistakes, etc. He also gets this way if he's tired and anything goes wrong. If something is high stakes and goes wrong, he gets very upset (new toy breaking on Christmas). When he was little, he would push and push until we punished him, and that would give him an emotional release (we didn't see this for a while, and when we did, we didn't know what to do pre-diagnosis). If he's had a bad day with self-control/tired/mistakes, he has to work hard to forgive himself, and he's terrified the next day will be the same. It's like the lid won't go back on the box once it's blown off. If being tired is the issue, we do a drastically earlier bedtime, chamomile tea, etc. when we catch him between cycles of emotion. Sometimes two nights of early stuff. (If he can relax enough to sleep, he is very compliant and relieved about the early bedtime.) We make sure he gets his sensory needs met, and we back off almost completely on all expectations. We talk a lot about how we feel when we have things go wrong. If we stumble onto words that describe his feelings, and he's not been able to do that himself, he just melts (in a good way) with relief. Sometimes just helping him see that we care and know he's not trying to be that way is all he needs to pull himself back together.

 

He also likes music in between episodes to help put words to his feelings. Tenth Avenue North has a song that says, "You are more than the sum of your past mistakes," etc. He craves that kind of reassurance when he's had a bad day.

[erikdeb]

Thanks so much, everyone.

 

So, I'm all about getting as thorough an evaluation as possible. The last few days with this child have been........um, awful.

 

The autism place, though we are familiar with it and I am satisfied with our older ds diagnoses from there, and they have a very fantastic reputation, I don't feel will be as thorough. The evaluation there is only about 90 minutes,followed by a parent meeting.

 

So, what is the title of the type of person I would go to? I a feeling very desperate.

[Tokyomarie]

I think I would go to a neuropsychologist to get the most thorough evaluation of cognitive, academic, and social functioning. But depending on the list of difficult behaviors, your son may need to also see a speech pathologist, an OT, a medical doctor, and/or a psychologist. Depending on your insurance you may need a referral from a physician to get evaluation services covered. If that's the case, I would look for a developmental pediatrician who can rule out medical issues that need treatment and coordinate referrals to other providers.

[erikdeb]

We do not need a referral per insurance (though lots of specialty clinics here require a referral).

 

The university has a Behavioral-Developmental Pediatrics clinic that I can see several things he suffers from on the "things we treat" list. It also has a dr. involved (who is a professor in these things as well) who also works in specialty at the Autism spectrum and neurodevelopmental disorders clinic. Thoughts?

 

Or do I try for a neuropsych?

[LLMom]

I took my 20 year old to a neuropsych. for his evaluation when he was 10.  He received several labels including ODD. 

[kbutton]

Maybe you can ask both a relatively local neuropsych and the developmental pediatrician some of the same questions to see how comfortable you are with their answers. Getting the right person is often as important as getting a person with specific credentials. I have heard good things about developmental pediatricians, but I think it's kind of a newer specialty.

[Tokyomarie]

Getting the right person is often as important as getting a person with specific credentials.

 

This is a very true statement. You want to find someone who communicates well with you and resonates with what you are thinking. The particular degree or qualification of the first person you see is less important than the above and whether or not the person you see views himself/herself as a coordinator of a treatment team. You want to be able to build a team of people who can be helpful. A person who is able to make referrals to specific others who can be helpful can be a real gem.

 

One question I would have for any potential care provider would go something like this, "I am struggling with behaviors x,y,z that I know sometimes get labeled ODD. How will you evaluate this situation to help us understand why he's behaving this way?"  You definitely don't want to get locked into ODD as a one-stop label because you won't get the help you need to get to the underlying reasons for the oppositional behavior.