Kick-ass defiant teenagers

[HooDunnit]

There are eight criteria for oppositional defiant disorder (ODD) in teens:

1. Often loses temper.
2. Often argues with adults.
3. Often actively defies or refuses to comply with adults' requests or rules.
4. Often deliberately annoys people.
5. Often blames others for his or her mistakes or misbehaviour.
6. Is often touchy or easily annoyed by others.
7. Is often angry or resentful.
8. Is often spiteful or vindictive.

At least four of these criteria must be met to make a positive diagnosis.

My ADHD-teen exhibits all of these characteristics, but what is meant by the word "often"? How can you look at this numerically?

Arthur L. Robin writes:

"The clinician should review each of the eight criteria with the parents and determine whether they currently apply and whether they have applied for at least six months. None of these criteria involve either overt aggression and fighting or such covert antisocial behaviors as stealing and lying, which are part of conduct disorder (CD). Because most adolescents lose their temper, argue with their parents, and can be touchy or easily annoyed anywhere from several times a month to once or twice a week, here the word "often" means five to seven times a week or virtually daily, to meet the criterion of being more than is typical for that age. Also, the stage of adolescent development should be used as a referent point. The base rate of defiant behavior is higher in early adolescence (ages 12-14) than middle (15-17) or later (18-20) adolescence. Clinicians should ask themselves the following key question, 'Is the adolescent's primary mode of response defiant behavior and an angry, hostile mood, and has it been this way for at least six months?' . . . I typically evaluate the nuisance value and bothersomeness of the defiant behavior to the adults in the adolescent's environment. When a teacher must stop teaching to deal with defiant behavior whenever it occurs, or when a parent must significantly alter his or her routines to deal with defiant behavior whenever it occurs, the impairment criterion is met. Furthermore, if the adolescent is losing friends, making enemies, or losing part-time jobs because of defiant behavior, clinical impairment is significant." (ADHD in Adolescents: Diagnosis and Treatment)

So if a minimum of six instances of four criteria of defiant behavior needed to be met per week, for a minimum of six months, then 6 times 4 times 26 = a minimum of 624 instances of defiant behavior in the last six months. Since some of the other criteria might have lower numbers, you might be looking at 700 or 800 total instances of defiant behavior in half a year. That is ODD in teens by the numbers.

[AnneM]

This is very interesting..... Thanks for sharing this Barry.

When Sam was 13 I was convinced he had got ODD ... but the p.doc said he definitely wasn't ODD .. I figured at that time that the p.doc had no idea what he was talking about! ... However, what Sam actually HAD at that time was depression which can mimic many of these ODD criteria when present. Once the depression was helped there was no further sign of ODD symptoms.

So... based on our experience ... I would add that depression should always be ruled out before making a diagnosis of ODD ...

[aimee30]

Is this like ADHD in the sense that it has to be present in more than one setting? I see many of these behaviors in my DD but her teacher says she doesn't. Is it the same for young kids too (DD will soon be 7)?

[HooDunnit]

The book that I was looking at was on ADHD in adolescents. ODD is considered to be one of the comorbidities of ADHD. I can't say for sure that the list of ODD traits for younger children is identical, but I think that it is at least very similar. Perhaps you could search that on the web.

As far as your other question goes, this material did not specify that the behaviors needed to be present in two or more situations. As far as ADHD was concerned, the book was very specific in saying that the behaviors needed to be present in two or more situations. At the same time, the discussion of ODD behavior mentioned classroom situations and home situations.

What impressed me about this material, was the shear volume of defiant behavior that must be seen before a diagnosis of ODD can properly be made -- 600 to 800 defiant episodes in six months. If you have a big blowout with your child or teenager a few times a week, you can't really consider them ODD. You need something like 24 defiant and disruptive episodes per week -- week after week after week after week and so on.

[camismom]

This describes my dd pretty good right now. I have blamed it on her age, changing hormones etc.... hmmm..... will have to bring this up with her doc next time she goes in.

Thanks Barry!

[sierra]

This is interesting!

Bean Sprout was right there with at least 4 of those criteria at the beginning of the school year but you could see that inside he was torn up and confused and just miserable. His eventual diagnosis was depression. And treatment for depression really gave him back to himself.

One of the kids that really got under his skin when he was very depressed said something about him to a friend today.

"Bean Sprout is too happy and his parents love him too much". I call that a very revealing statement about the kid who made it and his family situation

3 months ago this would have sent Bean Sprout in a downward spiral. Today, he laughed and said this kid is just jealous and has lousy parents. Probably true.

Now Li'l Sprout who is ODD exhibits more than 4 of these symptoms and is very comfortable being ODD. It's who he is. He doesn't spend a bit of time feeling bad about losing his temper, arguing, being defiant, etc. It's not his fault. It's the world's fault and he's right as rain. I think that's the tell-tale sign of ODD. The other difference we saw between ODD and Depression is that Li'l Sprout has been ODD since he was 2. Probably earlier but we didn't see the significance of ODD behaviors in a 3 month old. I've got some camcorder footage from his infancy that I ought to donate to a think tank, though . Depression can come and go, and it can start at any age. It's a brain chemical imbalance that can just come over somebody. I'm sure I would have been diagnosed with depression based on 3-4 month periods in my teen years through about 22. As far as I know I haven't been depressed since then. Too dang busy to notice if I'm depressed anyway. Tho I did have post partum depression with Bean Sprout. Not with Li'l Sprout tho. I enjoyed the heck out of his early weeks.

Man I'm all over the map tonight. I'll probably edit and clean this up some tomorrow.

Somebody sent me an article on teen depression. The checklist has some similarities to ODD, but it's more about how someone seems to feel than how they act. ODD seems to be about how you act. The rages we saw with Bean Sprout's undiagnosed depression near scared me spitless. His emotional pain came through loud and clear. Very similar behaviors, but very different emotions driving them. If we didn't have someone with true ODD for comparison I'm not sure what we'd have made of Bean Sprout's problems. I hope we would have acted just as fast and gotten him more intensive therapy and medication.

On the two or more environments or situations although a psych won't look for that for diagnosis we had a school 504 admin tell us Li'l Sprout wasn't ODD anymore because he wasn't exhibiting the behaviors in school. I laughed in her face because he exhibits ODD in school all the time. He's just sneaky about it and they don't catch on. Or they don't want to call him on it because then they have to recognize it and admit it and address it.

Schools seem to be able to make up whatever rules they want. The psych's diagnosis doesn't seem to count for much when it comes to writing up annual plans. The only thing that counts is being a parent with a broom and pointy hat and staying that way all year. And they still slip a few over on us.

Here's the depression article and links.
--------------------------------------------------------------------------------
www.aacap.org/publications/factsfam/depressd.htm

THE DEPRESSED CHILD
No. 4 (10/92) (Updated 8/98)

Not only adults become depressed. Children and teenagers also may have depression, which is a treatable illness. Depression is defined as an illness when the feelings of depression persist and interfere with a child or adolescent’s ability to function.

About 5 percent of children and adolescents in the general population suffer from depression at any given point in time. Children under stress, who experience loss, or who have attentional, learning, conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.

The behavior of depressed children and teenagers may differ from the behavior of depressed adults. Child and adolescent psychiatrists advise parents to be aware of signs of depression in their youngsters.

If one or more of these signs of depression persist, parents should seek help:

-- Frequent sadness, tearfulness, crying
-- Hopelessness
-- Decreased interest in activities; or inability to enjoy previously favorite activities
-- Persistent boredom; low energy
-- Social isolation, poor communication
-- Low self esteem and guilt
-- Extreme sensitivity to rejection or failure
-- Increased irritability, anger, or hostility
-- Difficulty with relationships
-- Frequent complaints of physical illnesses such as headaches and stomachaches
-- Frequent absences from school or poor performance in school
-- Poor concentration
-- A major change in eating and/or sleeping patterns
-- Talk of or efforts to run away from home
-- Thoughts or expressions of suicide or self destructive behavior

A child who used to play often with friends may now spend most of the time alone and without interests. Things that were once fun now bring little joy to the depressed child. Children and adolescents who are depressed may say they want to be dead or may talk about suicide. Depressed children and adolescents are at increased risk for committing suicide. Depressed adolescents may abuse alcohol or other drugs as a way to feel better.

Children and adolescents who cause trouble at home or at school may actually be depressed but not know it. Because the youngster may not always seem sad, parents and teachers may not realize that troublesome behavior is a sign of depression. When asked directly, these children can sometimes state they are unhappy or sad.

Early diagnosis and medical treatment are essential for depressed children. This is a real illness that requires professional help. Comprehensive treatment often includes both individual and family therapy. It may also include the use of antidepressant medication. For help, parents should ask their physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat depression in children and teenagers.

Also see the following Facts for Families:
#8 Children and Grief, www.aacap.org/publications/factsfam/grief.htm
#10 Teen Suicide, www.aacap.org/publications/factsfam/suicide.htm
#21 Psychiatric Medication for Children, www.aacap.org/publications/factsfam/psychmed.htm
#38 Manic-Depressive Illness in Teens, www.aacap.org/publications/factsfam/bipolar.htm

[AnneM]

Hi Sierra .. and thankyou for sharing this article and I could relate so much to Bean Sprout's depression AND the lifting of it ... This was exactly the same with my son Sam .... !

I loved the comment from the school friend!! ... but also related to Bean Sprout's reaction to it NOW -vs- BEFORE depression was treated! ... Oh yes !! I can see some big similarities here! ..

[Honeysmom]

Amiee, the actual criteria for kids is the same, but I am not sure if the number of instances is the same. Part of the problem with younger kids is that doctors have to decide if these behaviors are a product of raising, like we have always let him X, but now we want it to stop. Or if it is a behavior that the family has never approved of and we can't get him to stop.

IMHO, I also think that attitude has a lot to do with it. Sierria said that one of her kids thought they were "Right as Rain." Honey feels the same way. He can't figure out why WE are not all acting like him. For instance, loosing his temper is never his fault, and doesn't acknowledge that he lost it. It is always the fault of the person who is tried to help him or didn't let everything go exactly his way. In his eyes, he has no faults. That is a person that is VERY hard to help or change. I think all of us can admit that we have a fault here and there. These kids don't see it and I think that adds fuel to the fire.

I have said before, looking back, we saw strange behaviors in Honey as in infant, (temper problems and such), but you don't think at that age it is anything but cute. Well, at 5, it is no longer cute...

Just my 2 cents...Becky