ODD part 2

No one knows for certain.  The usual pattern is for problems to begin between ages 1-3.  If you think about it, a lot of these behaviors are normal at age 2, but in this disorder they never go away.  It does run in families.  If a parent is alcoholic and has been in trouble with the law, their children are almost three times as likely to have ODD.  That is, 18% of children will have ODD if the parents are alcoholic and the father has been in trouble with the law. (13)

ODD is diagnosed in the same way as many other psychiatric disorders in children.  You need to examine the child, talk with the child, talk to the parents, and review the medical history.  Sometimes other medical tests are necessary to make sure it is not something else.  You always need to check children out for other psychiatric disorders, as it is common the children with ODD will have other problems, too.

A lot of children!  This is the most common psychiatric problem in children.  Over 5% of children have this.  In younger children it is more common in boys than girls, but as they grow older, the rate is the same in males and females.

It is exceptionally rare for a physician to see a child with only ODD.   Usually the child has some other neuropsychiatric disorder along with ODD.  The tendency for disorders in medicine to occur together is called comorbidity.  Understanding comorbidity in pediatric psychiatry is one of the most important areas of research at this moment.

Marianne is now 4 years old.  Her parents were very excited when she turned four that perhaps that would mean the the terrible twos were finally over.  They were not.  Her parents are very grateful that the Grandparents are nearby.  The grandparents are grateful that Marianne's aunts and uncles live nearby.  Marianne's Aunt is grateful that this is her niece, not her daughter.  Why?  Marianne requires an incredible combination of strength, patience, and endurance.

Marianne begins her day by getting up early and making noise.  Her father unfortunately has mentioned how much this bothers him.  So she turns on the TV, or if that has been mysteriously disconnected, bangs things around until her parents come out.  Breakfast is the first battleground of the day.  Marianne does not like what is being served once it is placed in front of her.  She seems to be able to sense how hurried her parents are.  When they are very rushed, she is more stubborn and might refuse it altogether.  It would be a safe bet that she would tell her Mom that the toast tastes like poop.  This gets her the first time out of the day.

In the mornings she goes to pre-school or goes off with her grandmother or over to her aunts.  Otherwise Marianne's mother is unable to do anything.  Marianne can not entertain herself for more than a few moments.  She likes to spend her time purposefully annoying her mom, at least so it seems.  Marianne will demand over and over that she wants something.  For example, playdough. She knows it must be made first.  So her mom finally gives in and makes it.  Marianne plays with it about one minute and says, " Lets do something" .  Her mother reminds her that they are doing something, the very thing that Marianne has been demanding for the last hour.  " No, Lets do something else"  So after Marianne's mother screamed so hard she was hoarse when her husband came home, Marianne gets to go out almost every morning.  At preschool she is almost perfect, but will not ever do exactly what the teacher wants.  Only once she had a tantrum there.  Marianne gets along with the other children as long as she can tell them what to do.

Her relatives wish that happened at their homes!  Her grandmother and Aunt all follow the same time out plan.  This means she goes to a certain room until she calms down.  The room is empty now at Marianne's grandmother.  Marianne broke the toys, and they were removed.  She banged the furniture around and it was removed.  What sets Marianne off is not getting to do what Marianne wants.  She screams, tells people she hates them, and swings pretty hard for a four old.  After a half hour it is usually over, but not always.  Marianne will usually tell her mom or Grandmother about these tantrums.  The story is always twisted a little.  For example, Marianne will tell her Grandmother that her mom locked her in her room because she was watching TV.  Her grandmother used to believe these stories, and Marianne could tell the whole story of how she was watching this show, and her mom just came in and dragged her to her room.  Now it turns out that Grandma doesn't think much of TV anyways, and so this made a certain amount of sense to her.  This led to more than one heated argument between the Grandma and her mom.  Of course there was almost no truth to this at all.  It took the tables being turned for the Grandma to really believe that her Granddaughter could set up an argument like this.  Marianne came home and told her mom that Grandma let her eat four cookies and an ice cream cone for a treat and that she was very full.  Marianne's mom doesn't think much of treats, and could see how this might happen and thought she would have to talk to her mom.  Finally they both realized what Marianne was doing.

Most of the afternoon with Marianne is spent chasing her around trying to wear her out.  It doesn't seem to work, but it is worth a try.  When she is at her aunts, she tries to wreck her cousins stuff.  When is she good?  When there are no other cousins around and she has the complete attention of her Aunt or Grandpa.

Marianne loves the bedtime battle.  She also loves to go to the Mall.  But she never gets to go there or hardly anywhere else.  She acts up so badly that her family is very embarrassed.  Her mother shops and visits when Marianne goes to preschool.  It is hard to know who is more excited about Marianne going to school next year, her mother or Marianne!