Does my DS aged 4 have opposition-defiant disorder?

[PrinceCorum]

My 4 year old is a bright, lively little boy. He loves learning, and is very social with his little brother and his friends. But over the last 6 months he has got quite disruptive and aggressive at home. He often hits me (I?m his Dad) and his Mum when he gets cross about something, and it can be something really trivial such as he doesn?t like the way I put one of his toys back in his wardrobe ! I?ve read the DSM-IV definition of ?Oppositional-Defiant Disorder? and I?m wondering if he has this, as he does have about 4 of the listed symptoms, which I understand is enough to be disgnosed with it. But is 4 years old too early to diagnose ODD? He is fine for the two days he spends at nursery and the nursery do not find him disruptive. He?s often also OK while we?re out ? it?s at home he has meltdowns that can turn violent towards Mum or Dad (occasionally towards his little brother too). We have tried time out and reward charts but so far they haven?t stopped this behaviour. Could it be that he is anxious about starting school in a couple of weeks? Any thoughts on the ODD issue?

[bigbadtiger]

What difference do you think a diagnosis would make to your DS?
If he has behavioural problems which you are struggling to deal with at present then assessment and parenting advice (if appropriate) should be available to you, regardless of whether he meets diagnositic criteria for ODD. Diagnositic criteria for ODD are simply descriptive rather than implying any particular cause.

[PrinceCorum]

If I seek guidance who would it be from? GP? Health visitor? And would this automatically then be passed onto his new school and go onto some kind of record for him?

[raspberryhead]

If he is fine in one setting that would suggest that it is not ODD. Symptoms are generally present the majority of the time. Your Health Visitor is good at discussing behavioural problems for pre-school kids. Otherwise its your GP.
Also suggest any book by dr christopher green, and "the incredible years" by Carolyn Webster-Stratton. Hopefully your local library will have them.
Good luck!

[bigbadtiger]

Either the HV or the GP would be fine. You might find the HV better if you think that the problem is purely behavioural, and the GP if you are concerned about an underlying medical diagnosis. Either should be able to deal with either scenario though.

You would have to agree to medical information being passed to the school, they cant do it without permission.

[nenevomito]

If you have worries about your DS like this then I'd speak to your GP. If he is OK at nursery and out and about then its unlikely to be ODD as that tends to present more consistently and cause a huge amount of anxiety, but it doesn't mean that there isn't something else going on.

Children with ODD / AS / ASD will often be harder work at home as they need to get out the stress of dealing with the outside world somewhere. If you are concerned that his behaviour is out of the normal range then you can ask your GP for a referral to a developmental paediatrician or a dev clinical psychologist for your concerns for them to do a formal assessment - but be warned, waiting lists these days are huge.

If there is an underlying problem then it may well show itself in school where things are more formal than they are at nursery as this will be more stressful for him, so School may well pick it up - NB if you have a good school, others will do nothing.

[Lougle]

I think 4 year olds are going through an incredibly demanding time in their lives. They are suddenly becoming aware that there are real expectations around their behaviour, often marked by the incidental mentions of 'school' 'big boy/girl', etc.

Nothing in your OP rings alarm bells for me, tbh, my DD1 has SN and has quite oppositional behaviour at times (lots of the time!).

DD2, however, is perfectly NT, and has just turned 4. She is a living nightmare at the moment

[Tgger]

He sounds like a normal 4 year old. They test their parents the most as that's where they feel safest. My DS has been similar but has changed a lot over the last few months- I don't think it's anything we've done, I think his brain has just caught up and he understands and can process expectations of behaviour etc a bit better now (he's nearly 5 now).

[kayah]

I would shy away from labeling him so soon.

[PrinceCorum]

I'm very reluctant to label at age 4 - just wanted somne reassurance I guess that the behaviour I have described is within the normal range for a 4 year old. The hitting, by the way, is 99% directed at Mum and Dad, and not at other kids. Funny thing is, the day I posted this forum message he was a little angel, very laid back and not aggressive at all.

But am I the only parent to sometimes get anxious about whether their child has a behavioural or psychiatric issue?

[colditz]

Ds2 has this behavior at aged five, but it's fairlyage appropriate - not acceptable, but normal. Don't worry abuot his behavior for 6 mkonths and spend that 6 months cracking down on it with a time out every time he raises his hand to hit

[camdancer]

DS (4) is like this. He has a lot on his plate at the moment and sometimes he can't quite cope with things. I get hit quite a bit. Talking to friends with slightly older children, this seems to be very common - getting especially bad around this time of year with starting school until about half term. Sounds like we have a long few weeks in front of us all!

[Oblomov]

It was suggested to me that ds1 had ODD. The first Paed that saw him said there was nothing wrong with him, just wilfull, nothing that a hard smack with a switch (!!!!!) wouldn't sort . Second paed thought he may have ODD. He did fit the bill, very well. Finally, they said he had ASD, specifically Aspergers.

It is very very hard to know if your ds is just NT - normal behaviour for a 4 yr old, or if there is something else, more to it. But no, its certainly not unusual to question this.
I think you may have seen more signs all along though. I know I did. At 2. At 3. At 4. At 5. Everyone kept on telling me it was all normal. But I couldn't work him out, found him very hard to parent. When I finally got a diagnosis, I felt vindicated.

[hettie]

mmme, well as others have mentioned, you would be looking for the behaviour to be across all setitngs and nursery say he is fine....
All kids develop at different ages and are individuals with personalities that cover all spectrums. My ds has poor impulse control/emotion regualtion and can be agressive. This is partly becasue at his age (4.5) he hasn't hit that developmental mark yet (even though some kids have) and partly because poor impulse control is something that runs in the family . Not becasue he has ODD. Kids like this are harder to parent, consistency is they key. Every time he hits/kicks instant time out.... look for any glimmer of good behaviour (like the day he was doing well when you posted) and reward it like hell.... you should praise praise praise when he isn't hitting- time playing with you (or dw) as a reward for example.....
Tbh the first thing a HCP would recomend is a parenting course anyway (not becasue it's a 'blame the parents' thing, but becasue it can help with strategies to manage the behviour). If you're worried you can find them localy yourself. Look for webster stratton (incredible years), you can get the book on amazon...

[Dorje]

Be careful you are not over reacting to what sounds like normal 4 year old behaviour to me.

Check your DS is involved in all decisions related to him - that you're not ordering him around and telling him off a lot. Have a family conference every week at the dining room table and write down what he thinks he needs as well as what you need for the week. Listen to what he wants and teach him to negotiate. Make deals, be imaginative.

He sounds frustrated, tired and maybe dehydrated. It's a four year old's job to start pushing the boundaries - he's getting ready to interact with a wider community (school) Also, are you going out to the park with him enough and providing him with a social life of his own??

All these factors can make the world of difference to your Ds's behaviour. Try out some of these things before sending him off for a ?guilt relieving diagnosis. Remember that diagnosis will stay in his files: be dutiful to your DS and ensure you are doing everything you can to help your DS channel his energies and frustrations before you go to the doctor, and not just taking an easy way out.

try this book by the parent Maggie Reigh: it's incredibly good.

[Oblomov]

"guilt relieving diagnosis"

[PrinceCorum]

Thanks all.

There appears to be some inconsistency in posters understanding of ODD - I have read on various web sites that ODD can indeed present in just the home setting, leaving behaviour in other contexts such as nursery or school relatively normal/non-ODD.

Any health professionals care to clarify this issue about whether ODD can present in just the home environment?

[nenevomito]

While children with ODD may well manage better outside of the home I'd be surprised if there were no issues at all in any other setting.

[bigbadtiger]

How would a diagnosis of ODD change the way that you deal with DS?
The criteria are descriptive - all they do is list the symptoms. Even if he does meet the criteria, it still tells you nothing about why he is that way.
If he doesnt meet the criteria then you still have the same DS.
There is no treatment that is specific to children with a diagnosis of ODD.

[PrinceCorum]

bigbadtiger - don't we all just want to know "is this within the realms of what is deemed 'normal'" ? And don't most parents want to know if they are letting their child down by not seeking professional help.

You keep asking me why I want to know if he has ODD - I'm trying to answer you here.

Ultimately, if his behaviour is not clinically diagnostic of a known syndrome such as ODD I am happy to sit it out and try different advice about behaviour management. If on the other hand, his behaviour suggests a clinical problem, I might feel it is in his best interests to seek professional support and guidance.

You seem to feel my quest to know if my son has ODD is somehow futile. I hope I have answered your posts and at least given you a window into whhere I am coming from. The bottom line is that I want to do the best for my child.

[ptangyangkipperbang]

I work in a reception class where we have some children that have demonstrated this behaviour. Some at nursery, some at home and some a combination. The 'professionals' are very reluctant to diagnose at this age and rarely statement a child. Often the children mature and the difficulties pass. This is not a criticism at all of your parenting skills so please don't be offended! However, we have noticed improvements in a child's behaviour when they are aware of the boundaries that are in place. Hence, some behaving more appropriately in a school/nursery setting rather than at home.

We spend a lot of time explaining the consequences of their actions and following through any sanctions. We also concentrate on praising 'good' behaviour. It's quite draining being so positive all the time, particularly praising behaviour which should be the norm, but it does seem to have a positive effect.

Good luck! And please don't worry too much when he goes to school. Home and school work in partnership and want the best for the child (and the parents)

[Hassled]

To an extent I think you should be reassured by the fact that 4 year old boys are notoriously hard work - all three of mine were horrors at 4, and had calmed down by 5. Someone told me that there's a major testosterone surge at 4, which explains the aggression etc, but I don't know if that's true.

If I were you I would give it a couple of months. Let him settle into school (and yes, he's bound to be anxious about that, even if he can't articulate it). In the meantime go for a total zero-tolerance policy - the first flicker of aggression and he's in time-out/loses a toy/whatever. It will be hell for the first few days but zero-tolerance is the way to go; he's pushing his boundaries and needs the reassurance of where those boundaries are. They need to be very clear, and consistent.

[madwomanintheattic]

contact your local sure start or hv to discuss parenting courses. at 4, even if he meets some of/ any of the criteria for odd (which has also been suggested along the way for my now 9yo) it is extremely unlikely that he will be dx or offered any help. you will likely be offered parenting advice etc.

as he is not displaying the behaviour/s in the educational setting, it would be pointless to request senco or ed psych involvement. no additional support iis necessary at nursery and he is able to access the nursery curriculum.

i would maintain a watching brief, and as others have said, get a couple of decent books (i do love chris green, i know others hate him) and get as much parenting advice as you can. is he your eldest? i note you have at least one more younger boy at home.

kids do display some very odd stuff sometimes at different points. what you describe so far does not seem out of the ordinary enough to ring alarm bells, but clearly you are of the belief that he does/ may have some underlying issues. instinct is often right, but tbh i've reasonably often tricked myself into all sorts of amateur dx of my 3 (well, only two of them lol the other one is frighteningly nt) to the point of conviction, only to change my mind six months or a year later. i was also pretty convinced about odd with ds1 a year or two ago. i'm unconvinced now. he's definitely quirky. he's oppositional and blardy annoying (!) and he's obstinate as hell. it doesn't mean he's odd though. i did dx dd2 with cp though. 18 mos before the professionals who were trying to get me not to sue.

watch. wait. think. ponder. and get some parenting advice from profs to help you along the way.

[bigbadtiger]

The point I'm trying to make is that treatment is essentially based at the 'symptoms' ie the behavioural problems, and from that perspective it doesnt make a lot of difference if there is a diagnosis of ODD or not.

ODD is not a diagnosis that implies any particular pathological process or cause, it is a way of describing a child with major behavioural difficulties, as you can see by looking at the definition.

All I'm trying to say is that I'm not sure that focusing on whether he meets the diagnostic criteria for ODD or not is that important. If your DS has significant behavioural difficulties then that can be addressed regardless of whether or not the extent of his behaviour meets the level required for a diagnosis of ODD.