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Talk to me about ODD, especially in combination with ADHD, Anxiety, Giftedness


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A relative is in his first year of college, with this mix, but he has not been formally diagnosed with ODD I don't think.  

I am concerned that he is depressed based on the family's description of behaviors, but the family is interpreting it very differently. They aren't saying it is ODD per se (I don't think they like that label), but more selfishness/defiance maybe? 

What is your understanding of ODD and how it presents in a 2e kid like this?

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3 hours ago, cintinative said:

What is your understanding of ODD and how it presents in a 2e kid like this?

My experience is that I would be looking to see if an ASD diagnosis had been missed with that particular combination. The transition to college is a classic time for a high functioning kid to have major issues, and it can present as very oppositional.

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1 hour ago, KSera said:

My experience is that I would be looking to see if an ASD diagnosis had been missed with that particular combination. The transition to college is a classic time for a high functioning kid to have major issues, and it can present as very oppositional.

To be honest, I  have wondered about that.  He has always had sensory issues since he was a toddler. He has expanded his food choices a little from when he was small and only ate four foods.  They said they tried some kind of OT with him but I think he was late elementary by that point, and their report is that it didn't work.

Is there a way to gently recommend evaluation for ODD and ASD?  How would you word such a recommendation to a close family member? I think they are going to be very resistant to labeling him with either formally.  

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1 hour ago, cintinative said:

Is there a way to gently recommend evaluation for ODD and ASD?  How would you word such a recommendation to a close family member? I think they are going to be very resistant to labeling him with either formally.  

That’s super sticky. I don’t think I would outright recommend an evaluation, but if they’re talking to you about some of the behavior stuff, you might say something like, “I know someone [on an online forum 😂] with a kid who sounded very similar and it turned out they were actually on the spectrum, but it never got picked up as a kid because they compensated so well.” 

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1 hour ago, cintinative said:

To be honest, I  have wondered about that.  He has always had sensory issues since he was a toddler. He has expanded his food choices a little from when he was small and only ate four foods.  They said they tried some kind of OT with him but I think he was late elementary by that point, and their report is that it didn't work.

Is there a way to gently recommend evaluation for ODD and ASD?  How would you word such a recommendation to a close family member? I think they are going to be very resistant to labeling him with either formally.  

I think the key would be to talk about how damaging it could be to him or to their relationship to treat him informally as having ODD if it’s not the right diagnosis, or if they aren’t using evidence-based strategies.

I hate having a ringside seat to head in the sand behavior. I am so sorry! 

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16 minutes ago, kbutton said:

I think the key would be to talk about how damaging it could be to him or to their relationship to treat him informally as having ODD if it’s not the right diagnosis, or if they aren’t using evidence-based strategies.

I hate having a ringside seat to head in the sand behavior. I am so sorry! 

I found via google a study done following ODD male kids through their teen years and outcomes, and some of the potential issues are scaring me a bit.   Gosh I am worried about this kid.  

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ODD is an interesting diagnosis, because it only has to be present in one environment. DS18 had/has an ODD diagnosis, though he is only outright oppositional with us at home and will generally cooperate at school (though sometimes grumpily). At school he will refuse to do things if offered an option, but if told to do something, he will comply with teachers. At home, he is still very hard to live with.

But I agree that someone who qualifies for a list of diagnoses like that could actually have a more global explanation, such as autism. That was true for DS, who accrured a whole list of diagnoses before getting to ASD at age 15.

It's possible that someone with ODDish behaviors could be a bear to live with but do fine in another environment, like college. Are his troubles interpersonal with his family, or is he struggling with school? On the other hand, I know that people with struggles often do crash at college when they are without the supports they are used to at home. It could go either way.

Depression definitely could go along with other undiagnosed issues.

I think whether you can bring up your ideas with the parents depends on your relationship with them. I've always been relieved when someone confirms what I think with their comments -- because it took so long to get anyone to see what we see. But some people could be offended.

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Do you know what specifically makes ODD on the table? That’s a pretty severe diagnosis. nothing just from the above would make me be thinking in that direction, but I realize there may be more. I would be thinking other kinds of mental health struggles more and still thinking that ASD should be on the table as a possibility. There is one presentation that is used as a diagnosis/descriptor in the UK but not the US but that I have found helpful, and that is that of pathological demand avoidance.  Your description of his college lifestyle right above is pretty much one of my kids on the spectrum. It also sounds like anxiety and depression. 

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It’s hard for me to imagine a college kid who would “want” to live that lifestyle, and very easy for me to imagine a struggling kid adopting that lifestyle as a coping mechanism.  Autism seems like a *strong* possibility to me.  It is so, so common for us to get overwhelmed in college.  He should be on a meal plan.  The executive functioning to shop and cook is just asking too much.    

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It sounds like his parents have done a great job of creating what they didn't want.

They have plenty of justification for their boundary issues, but they're still boundary issues. What should we diagnose their anti-social behaviours as?

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ADHD and anxiety can be enough to result in this kind of non-functioning. I'd consider Pathological Demand Avoidance over ODD, though if memory serves that may only a formal diagnosis in the UK not the US. In any case I think it goes along with both ADHD and autism spectrum.

Editing --just saw that ksera mentioned the same thing!

Edited by maize
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Thank you all! I did mention to the dad I wondered if the video games are an avoidance strategy.  I mentioned he sounded depressed to me also.

@Rosie_0801 I know what you mean. It truly has been hard to watch. I have tried to gently bring it up. Long story, but it didn't change. 

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2 minutes ago, cintinative said:

Thank you all! I did mention to the dad I wondered if the video games are an avoidance strategy.  I mentioned he sounded depressed to me also.

@Rosie_0801 I know what you mean. It truly has been hard to watch. I have tried to gently bring it up. Long story, but it didn't change. 

There isn't really a positive way to tell people they're parenting badly, is there?

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46 minutes ago, KSera said:

Do you know what specifically makes ODD on the table? 

I don't think he has ever been "formally" diagnosed with that. It was thrown around because of his struggles as a young child.  

I think that when he is being what they believe is defiant they think that is ODD.  Not being knowledgeable of what makes it ODD versus something else (like: let me learn to adult already or I am super depressed so leave me alone), I just don't know. That's one reason I am asking. I am trying to understand. My first instinct is to say depression, but the parents are rejecting that idea. 

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12 minutes ago, cintinative said:

 but the parents are rejecting that idea. 

Well, they would need to. 

However great their intentions, their son is *experiencing* their behaviour as emotionally abusive. 

A depression diagnosis wouldn't help anyway. It's not a problem that requires pills or will be fixed by him being put in therapy.

Does he want to be in college? 

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1 minute ago, Rosie_0801 said:

Does he want to be in college? 

I can't tell. Over the summer he seemed to fight the process for it to a point where I outright asked if he didn't want to go. 

It was never an option for him to choose not to go.  The parents would not have allowed it. They said if he stayed home he would have just played video games. 

It has made me sad over the years to watch this play out.  I have even been blunt and confrontive at times.   It's like watching a train wreck in slow motion.  =(

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Well, it's an option for him to flunk out, and that doesn't seem like a good use of money or relationship. 😞

It sounds like he'd be better off stacking shelves or something. That's respectable, or ought to be viewed as such.

Ugh. People need larger families so kids in these phases can go live with an auntie or cousin like they do in Indigenous and Islander cultures.

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43 minutes ago, Rosie_0801 said:

A depression diagnosis wouldn't help anyway. It's not a problem that requires pills or will be fixed by him being put in therapy.

How do you mean on this part? I agree that depression doesn’t always need medication and therapy doesn’t always help, but if he is depressed and not coping with being depressed, I’m wondering what your thought is on why diagnosing that might not help him. I’m in the category of not thinking antidepressants have the degree of evidence for effectiveness we’d like them to have, but I know they have been life changing for some people, and if he might be one of those, it seems worth a consideration. But I might be misunderstanding what you mean. 

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5 minutes ago, KSera said:

How do you mean on this part? I agree that depression doesn’t always need medication and therapy doesn’t always help, but if he is depressed and not coping with being depressed, I’m wondering what your thought is on why diagnosing that might not help him. I’m in the category of not thinking antidepressants have the degree of evidence for effectiveness we’d like them to have, but I know they have been life changing for some people, and if he might be one of those, it seems worth a consideration. But I might be misunderstanding what you mean. 

The cure for situational depression is to mend the situation. He may have clinical depression under that, but who could tell until the situational stuff is sorted? Neither pills nor therapy will make him feel safe from continued stressors long enough to see how much of himself he can sort out. He is displaying a very normal reaction to those kinds of stressors. 

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It's really, really hard to tell from the outside what is going on when you see that dynamic in play. I wouldn't be too quick to blame the parents, because I wouldn't want someone to be blaming me, and we have similar struggles at our house. We provide DS18 with scaffolding and help that he doesn't want, because without it he will fail Big Time, and our particular kid does not learn from failure, so part of our role has to be to protect him from himself in many ways. Letting a teen fail is not always the right way to go. If we don't supervise DS's schoolwork, for example, he is at risk for not graduating from high school (not a perceived risk on our part; he is in actual peril of not meeting graduation requirements).

Our DS will not go to college, but we will definitely have guidelines for him after he graduates. It will not be healthy or acceptable for him to hang around the house being unproductive full time. It would not be good parenting for us to allow that.

It sounds like the parents are still trying to provide the scaffolding for their son that they provided in high school, so that he won't fail college. There is a boundary there that may be hard for them to see. They may be convinced that he needs a college degree to become independent, and they want him to be independent, so they are pushing him into a situation that is not good for any of them. They may not see an alternative, because if they let him quit college, then what? He moves home, and then what? If he is so hard to live with, they may have some relief from stress with him in the dorms (assuming he is not living at home). If they can't get him to study, can they get him to work at a job. Has he ever held a paying job?

There can be crossover between ODD and something like ASD. With ASD, there can be trouble with perspective taking, which means the individual only sees things from their point of view. This can create an oppositional dynamic in relationships. What you are describing could be ODD or ASD or depression or a combination. My DS has all of these things (and others) together in combination.

It doesn't sound like the parents are open to opinions from you, though they are either sharing their struggles with you, or you are witnessing them. I'm not sure what you can do, honestly, if you have suggested ideas, and they have rejected them. Other than to offer them your emotional support, because it's really, really, really hard to be the parent in this kind of dynamic, and it's also really, really, really hard to be the kid. I would assume they are all doing the best that they can, even if it does look like a trainwreck.

If they do ask for your advice or seem open to it, I would recommend family counseling (there are limits to what counseling can do, but it is worth trying). I would tell the parents that if the teen can get some kind of evaluation and documentation, that a disability office at the university can provide some of the supports that they have been trying to provide themselves. I would suggest that someone will not benefit from college if they do not have their own internal motivation, and a break to reconsider might be helpful. Many times young adults who aren't ready for college the first time around are successful later (true for my brother). Other times, there is more at play, and college ends up not being a good choice at all. I would suggest that with evaluations and more understanding of the root issues, more help can be found.

Well, my heart goes out to them, because we are living something similar here, and we worry about how to get DS launched, even though we have a lot of support from various sources, due to his diagnoses. It does sound to me like you see the parents as responsible for things being this way. I don't know. That's possible. It's also possible that they have done their very best when dealt with a hard situation, making mistakes along the way, as all parents do. But, whatever their mistakes, I think it's likely they did not cause their son's troubles but have tried their best to figure out how to help him. Sometimes what seems like too much scaffolding from an outsider's perspective has not not actually been too much help but has been exactly what was needed for that individual. Sometimes too much help can keep people from trying things themselves, and it would have been better to back off.  Sometimes parents muddle through and try their best, but they could have benefited from help that they didn't pursue, like official diagnoses or counseling or medical intervention. I would hope that they would be more open to new ideas. I think the most you might hope for is that being supportive and caring might show them you are a person who can be trusted and who may have good advice when they are ready to share with you and listen.

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Just reread, and I'll add that it may be that the parents' perspective about there being irresponsbility and lack of empathy has some validity. Because that is the result that they are seeing. The question is what is the CAUSE of the behaviors. This is very tricky to sort out. Even when there is a diagnosis, it doesn't necessarily change the outward appearance of behaviors. So, yeah, I know my kid has X, Y, Z diagnoses and has trouble with A, B, and C, and I can understand him better and hopefully adopt different ways of working with him. But that doesn't magically make him easy to live with or more responsible or more motivated in school or more kind and caring and empathetic. Some people are just hard to be in relationship with.

My brother was a really difficult child. I grew up and thought that I could be a better parent than my parents were, and that I wouldn't have that kind of difficult relationship with my kids. I would just handle things so much better. I have sought much more help than my parents did. I have looked for answers other than, "this is a bad kid," whereas my mother just blamed my brother. Even so, with all of that trying on my part, we still have a hard dynamic. Sometimes it is just that way.

It does sound like college is not the right choice at this time for this kid. But the parents may not be able to accept that yet. It sounds unlikely that he will successfully finish a college degree with the way things are going. It sounds like the parents are desperately trying to get him to turn things around. I think it's likely that things will spiral down until something has to change. I don't think the young adult seems to have the capacity to change right now, and that the parents' expectations will need to change eventually. Things are likely going to get messier. I know it's hard to watch.

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43 minutes ago, Storygirl said:

With ASD, there can be trouble with perspective taking, which means the individual only sees things from their point of view.

Or from too many points of view, without enough clues to decide which to settle on.

This is not something I've ever heard the professionals talk about, and they really should.

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My dad is gifted and Autistic, although he doesn’t recognize the Autistic part.  He dropped out of college his freshman year when he was 18.  Did an aimless fine arts degree in his mid-twenties.  Still had no direction. Became a self-taught motorcycle mechanic.  Finally got a masters degree in computer science when he was almost thirty, and had a reasonably successful career in that field.  So many Autistic people are late bloomers, especially Autistic men.  Finding your direction is hard for neurotypical 18 year olds.  It’s cognitively even harder for someone with executive functioning and self-awareness deficits.  If college isn’t working now, it doesn’t mean it will never work.  I mad huge strides in my ability to function independently from 18 to 25.  I’m still Autistic, and independent living is still not my super power, but we do keep growing and learning.  As an earlier poster said, I feel badly for the parents and the kid. It’s hard for everyone. 

Edited by Lawyer&Mom
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@Storygirl Thank you. It do realize it is infinitely easier to armchair quarterback.  I am just very, very concerned.  Based on some recent conversations there is potential for the family relationships to be completely destroyed.  

ETA: I see that you said your dc doesn't appreciate the scaffolding.  I corrected my prior question.

In this case, because he is very gifted, he is unlikely to fail classes (at least right now with gen eds). He may very well get C's though, and that would lose him the scholarship. 

 

Edited by cintinative
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6 hours ago, Storygirl said:

 

There can be crossover between ODD and something like ASD. With ASD, there can be trouble with perspective taking, which means the individual only sees things from their point of view. This can create an oppositional dynamic in relationships. What you are describing could be ODD or ASD or depression or a combination. My DS has all of these things (and others) together in combination.

 

Can you talk a little more about this?  From what I am reading ODD is not a part of ASD. Are you saying that your dc has something "like ASD" but that is not ASD? Or that your dc has ODD and ASD?

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I'm posting after some info has been removed, so I'm just making some guesses based on other responses. I'm another who thinks this poor young adult needs some evals. It sounds like his parents aren't open to that right now? Do you have any sort of relationship with the teen himself? Might he be interested in seeking out help on his own? I like the idea of just saying you know someone else who had similar struggles and eventually found out they were autistic and how it made their life so much better to understand and get appropriate support.

One of my gifted boys was originally diagnosed with ODD. Several years later he was finally evaluated for ASD, which he has, and ODD diagnosis was removed. I've been told that ODD is almost never the actual underlying diagnosis and that usually it just labels behaviors actually caused by autism and/or anxiety, ADHD, etc. My DS has PDA-profile autism. Basically, demands intensify his anxiety, causing him to appear oppositional. Despite the fact that PDA isn't clinically recognized in the U.S., there's a whole toolkit of strategies that are super helpful for folks like this.

Here's an info sheet aimed at parents: 
https://www.pdasociety.org.uk/wp-content/uploads/2021/09/Helpful-approaches-for-parents-and-carers.pdf

And here's info specific to teens:
https://www.pdasociety.org.uk/life-with-pda-menu/pda-teens/

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5 minutes ago, Cake and Pi said:

Despite the fact that PDA isn't clinically recognized in the U.S., there's a whole toolkit of strategies that are super helpful for folks like this.

Here's an info sheet aimed at parents: 
https://www.pdasociety.org.uk/wp-content/uploads/2021/09/Helpful-approaches-for-parents-and-carers.pdf

And here's info specific to teens:
https://www.pdasociety.org.uk/life-with-pda-menu/pda-teens/

Wow, I had no idea it wasn't clinically recognized.  Does that mean that if they did get him evaluated that the person would likely point to some of his behavior as ODD just because they don't accept PDA is a thing? Or is it something they talk about off the books sort of thing?  

I need to think about how I would phrase this if I brought it up. I am under the impression dad and mom really don't want an ASD diagnosis but I could be wrong. 

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21 minutes ago, cintinative said:

Wow, I had no idea it wasn't clinically recognized.  Does that mean that if they did get him evaluated that the person would likely point to some of his behavior as ODD just because they don't accept PDA is a thing? Or is it something they talk about off the books sort of thing?  

I need to think about how I would phrase this if I brought it up. I am under the impression dad and mom really don't want an ASD diagnosis but I could be wrong. 

Could you bring it up from a descriptive, rather than a diagnostic, perspective? It sounds like he already has an anxiety diagnosis, so leaning into that such as saying something like: I know some kids have a form of anxiety that ramps up severely in response to demands placed upon them, such that they come across as deliberately oppositional, but it's actually stemming from the anxiety.

Depending on response, you could go further and say, maybe looking into helping kids with that condition would be helpful. If you look up "Pathological Demand Avoidance" you should find some guidance. If ASD is in the mix, they could end up coming at it from the backwards direction--first recognizing the PDA, and then the ASD, or they could not and even still, understanding the way anxiety-->avoidance could still be helpful.

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Thanks, I made an attempt to introduce the idea that some kids are misdiagnosed with ODD who actually have PDA, and linked the pdasociety.org.uk stuff.  I really hope I worded it in a gentle way.  

Totally a spinoff but it seems like there is this generalized idea of what being on the spectrum means and my guess is that for most people, that idea is way, way too limited.  I am grateful for what I am learning. I have so much more learning to do.

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3 hours ago, cintinative said:

Totally a spinoff but it seems like there is this generalized idea of what being on the spectrum means and my guess is that for most people, that idea is way, way too limited. 

I think that's a safe bet. 🙂 I feel like having a kid with ASD is just the tip of the iceberg of understanding someone else's kid's autism sometimes. Other times, there is a lot of overlap.

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I missed the descriptions of the thread, but I'm going to guess I can imagine the dynamic. 

I have difficult, anxious, oppositional kids. It has taken a LOT of work to figure out how to deal with them while making them feel like I'm on their side. It's a hard job 😕 . 

Is there any way you can help out yourself? Do you have a relationship with the kid? 

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10 hours ago, Not_a_Number said:

 

Is there any way you can help out yourself? Do you have a relationship with the kid? 

I do, but it is not much of a relationship. But he is friends with my son.  He is a multi day drive away. I'm praying about it. The mom has recruited other relatives to get after him about things--I don't want to seem like I am one of them. So I need to know how to approach it. 

Edited by cintinative
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On 11/23/2022 at 7:31 AM, cintinative said:

Can you talk a little more about this?  From what I am reading ODD is not a part of ASD. Are you saying that your dc has something "like ASD" but that is not ASD? Or that your dc has ODD and ASD?

Please don't quote

DS was a delayed talker and was diagnosed with sensory processing disorder and delayed pragmatics at age two. He was diagnosed with ODD, as well as ADHD and anxiety, around age 10 by a psychiatrist. Soon after, he was diagnosed with Nonverbal Learning Disorder. very low processing speed, and multiple learning disabilities by a neuropsychologist. NVLD is a complicated diagnosis, because it is not in the DSM, but the neuropsych was certain, and I agree that he fits the diagnostic pattern. Over the next years, he added a diagnosis of Tourette syndrome, and the psych that we worked with on tic control confirmed he met the ODD criteria.

We always wondered about autism. But all of the other evaluators thought he didn't have it, though none of them ran the ADOS or other comprehensive autism testing (don't get me started). We had him evaluated at age 15 specifically for autism, and he met the criteria without it even being a close call.

To be more clear in my original remark, I should have said "something such as ASD," instead of "something like ASD." What I meant was that there are other things that can cause oppositional behavior that are not autism. But autism can include oppositional behavior, whether it's called ODD or not. It really takes an expert to sort it out.

Many people, like my son, amass a bunch of diagnoses that explain pieces of the issues they face, before they get a more global diagnosis, such as ASD. DS happened to get the ODD diagnosis first and the ASD diagnosis later on. If I were describing DS to a new provider or therapist, I would definitely say that he has ASD, and I would say that he is oppositional in temperament and has a previous ODD diagnosis. Are they two different things? Is the opposition part of his ASD? I don't know. There are definitely people with autism who don't have the oppositional piece.

As far as Pathological Demand Avoidance -- having dealt with a diagnosis that is not in the DSM, I'm not eager to rush into thinking that DS would qualify for a PDA diagnosis. It's tricky to suggest to someone else that their kid might have something that psychiatrists here would not acknowledge or diagnose. On the other hand, if the parents are for some reason willing to consider PDA but not willing to think about ASD, I guess it's a way to suggest that there are more things to look into.

 

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On 11/26/2022 at 3:23 PM, cintinative said:

Thanks, I made an attempt to introduce the idea that some kids are misdiagnosed with ODD who actually have PDA, and linked the pdasociety.org.uk stuff.  I really hope I worded it in a gentle way.  

Totally a spinoff but it seems like there is this generalized idea of what being on the spectrum means and my guess is that for most people, that idea is way, way too limited.  I am grateful for what I am learning. I have so much more learning to do.

I have gotten to know a few of the other LC boardies pretty well over the years, and it's safe to say that if you could somehow line our boys up and compare them, they would be wildly different from each other, even though they all have ASD diagnoses.

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14 hours ago, cintinative said:

I do, but it is not much of a relationship. But he is friends with my son.  He is a multi day drive away. I'm praying about it. The mom has recruited other relatives to get after him about things--I don't want to seem like I am one of them. So I need to know how to approach it. 

What do you think he needs? 

I know that sometimes, when things were hard with my mom, I just needed a space where adults didn't need anything from me. I wonder if you could provide that. 

Sometimes that can get lost with difficult, oppositional kids is that they still need someone on their side and someone to listen to their perspective. Even if it's unreasonable. (And aren't we all unreasonable sometimes?) 

Edited by Not_a_Number
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