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Oppositional Defiant Disorder

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By Clarice J. Kestenbaum, M.D. Q: My 10-year-old son, Jason, does nothing but yell "no" at anything I ask. He won't pick up clothes, help with chores, or do homework. He picks on his sister every time he gets the chance, and he's been suspended half a dozen times for fighting at school. The school is upset about his cursing and rudeness to teachers. His teachers say Jason is bright, maybe even brilliant, but he's become a tremendous problem this year. Sending him to the principal doesn't help. What should I do? A: Young children are oppositional from time to time. They may talk back to parents and teachers and occasionally strike out at peers. However, when openly uncooperative or aggressive behavior is strikingly different compared with other children of the same age and developmental level, it can be a cause for concern. The diagnostic term for this condition is oppositional defiant disorder (ODD). It would be prudent for Jason to have a comprehensive evaluation to determine whether he has this disorder or another, such as ADHD (attention deficit hyperactivity disorder), a mild learning disability, a mood disorder such as depression, or an anxiety disorder.

Consider: How much of Jason's behavior is environmental in origin (a reaction to his surroundings), and how much is constitutional (part of his inborn temperament)? Are other members of the family highly competitive, or irritable and moody? Does Jason cover up feelings of helplessness with bluster and defiance? You need to be supportive and understanding in your dealings with Jason. Parent counseling can be extremely useful for helping you develop positive reinforcement strategies — praise for good behavior, choosing one's battles carefully, and setting age-appropriate limits. Understanding Jason's underlying feelings and concerns so you can deal with them effectively should be the goal of evaluation and counseling.

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