What are the differences between the diagnoses - ODD and PDA?

[IDontLikeTuesdays76]

Can someone explain to me the differences between these two diagnoses please, and why ODD is controversial while PDA less so? So far the only thing that stands out to me is ODD is linked to past experiences, while PDA is a profile of autism so more biological?

It's the origin of the behaviour. ODD is usually anger/defiance based. PDA is anxiety based. So PDA can be modified by changing to a low demand approach. ODD requires a lot of co-regulation to build a relationship of trust and overcome the anger, etc.

Either of them can be standalone diagnoses. Often they occur in the neurodiversity spectrum, ie: correlated with autism or ADHD, but they don't have to.

For a complete picture you could use google I guess as for them to be discrete diagnoses and not different flavors of the same thing someone at some point decided they were different things.

In my own experience my son has both diagnoses. He got the ODD diagnosis first as he was constantly disruptive and violent. ODD was that you'd ask him to do a thing and he'd explode with anger, defiance - it was like by asking him to put his trousers on I was starting a fight with him.

We got a lot of help and he had a lot of therapy and then they added a PDA diagnosis (I still find it weird they didn't replace the ODD one as he's not defiant any more... almost like psychiatrists don't like being wrong?). So now he's able to explain that when I ask him to do something it feels like I'm telling him off and makes him upset.

But basically PDA people aren't necessarily explosive. They might try and avoid demands through procrastination and distraction - or indeed explosion. Where ODD the diagnosis was definitely associated with a lot of anger and destructive behaviors.

My honest opinion is that ODD is just mismanaged PDA. If we'd known my son was PDA all along and managed it appropriately, he probably wouldn't have become the violent angry kid who got the ODD diagnosis. Once we understood he was autistic and managed his behaviour correctly the violence fell away.

But what's the root of the anger and defiance with ODD? Basically anxiety right? Like sad bad feelings you can't express which cause you to act in a certain way.

I agree with @Thingything that there is usually something else under anger. Makes sense for me to think of both conditions as related.

Another question - how do you address anger/aggression in PDA where low demand approach is not always feasable e.g. behaviour is very controlling of others and they get hurt if they don't follow?

I have some pupils who I think have undiagnosed PDA. Female, obliging, high expectations but absolutely frozen and overwhelmed very easily. Incredibly anxious. I think there will be variations in presentation as time and research continues.

The thing which helped with my son was all scaffold, scaffold, scaffold. In practice, this means anticipating things and planning all the time. Because waiting until you get to the event and then saying 'do x', it aint gonna happen. And telling him off 'after' he's done something bad - no way hosay, doesn't work, makes him crazy, I need to prevent him from doing the bad thing in the first place. It's hard to break it down because it's a million interactions every day we've learned how to manage in a way that often feels counterintuitive. The first time a psychiatrist explained what life would need to look like I thought they were insane.

I think a lot is making sure there are no surprises. Because a surprise equals a demand equals lack of choice and autonomy.

Examples:

Every night we sit down and plan what he'll eat the next day. He's involved in choosing and prepping food. If I plonk a plate of food in front of him it's a 'demand' and there's always a melt down.

Getting dressed is usually I dress him whilst he's floppy in bed (I know this sounds crazy but it works). If I told him to get dressed he would never ever do it and if I tried to make him he'd go bonkers.

Going anywhere we plan it in detail before, who will go where, when he'll hold my hand, what form of transport, what we'll stop and look at. So when we go to do the thing he's following a joint plan and there are no demands as he's following the script we've decided.

A lot of this is outlined (although terms like PDA are not used) in the book the explosive child which is helpful.

I just give the above as examples. But yes, if for example we went for an unplanned trip to the shop, he'd want to be super controlling (because he'd be anxious) which would result in more and more unreasonable demands, to stop, or go a different way, or buy something insane, with an inevitable melt-down when I'd have to say no.

Most of his friends are also autistic and they all tend to plan their games, who will say what, or play what, etc in advance (it's funny watching them!) as they all tend to like very controlled play. Funnily none of them like games of chance like board games where it's unpredictable who will win or lose. I tend to keep him away from kids who don't want to play like this as it just ends up in fights.

My son was diagnosed with ODD as part of his ADHD diagnosis a few of the boys who attended the same ADHD family support group also had the same combination of diagnosis. In his case it was very anger/ confrontation based. In my volunteer job working with kids with various mental health issues I was only aware of kids with Autism also being diagnosed with PDA. I am not an expert though, just my personal observations.

Just asking out of curiosity (young relative with PDA but not close enough to ask his parents) so don’t reply if you don’t want to but will this level of scaffolding/ behaviour management last forever or is it expected that he’ll grow out of it/ learn coping strategies himself? Otherwise it seems very hard to sustain that level of managing around forever.

I also worry this level of scaffolding is hard to sustain, especially as the child grows... and what about e.g. their siblings? Or if the child is aggressive to them?

Well yes, the scaffolding is hard, I'm not pitching it as an easy solution - it's just the only thing that really works with PDA / ODD. That's SEN life basically - we have to work 8 times harder than any other parent sadly.

On a more positive note though, if 5 years ago I could see what a day / interaction with my son would look like I would not believe the superhuman level of steps I go through and effort I have to make. BUT. It's come on gradually and now it's instinctive - it's just life and how I parent him. So it doesn't feel as hard as it did at first.

And yes, we do have a younger sibling, and yes we went through some very dark times of extreme aggression. My child is 10 now and I'd say until they were 8 I would never leave them alone with younger sibling ever, so if I went to the loo I'd bring younger sibling (now 8) with me. We did a lot of things apart as a family as elder needed a lot of one to one for all the scaffolding. And then interactions very structured, very supervised, very planned. Yes, it's not ideal. But long-term, we got it all under control and now the two of them are best buds.

Oh speech and language therapy can be super helpful. My child had loads of it but we started quite late as they are very articulate. I hadn't realized that a lot of SLT is actually teaching communication and social skills. Now they can say 'this is stressing me out' because they've been taught to recognize and communicate scary feelings, rather than just going straight to explosion and violence.

Based on my comments you'd probably imagine my child as severely disabled - he's not, he's bright, articulate, chatty, funny. But his behaviour was so out of hand we had to parent him in a very very involved way. All I'd say is it worked, and when he was 6/7 I honestly thought he was on a one way street to being institutionalized as he was such a danger to himself and others.

My adult son was diagnosed with autism when he was about 4 - he got dyspraxia added on during primary school and I’m pretty sure that he has PDA but that’s not been officially diagnosed (he hasn’t seen a mental health specialist for years) - he hasn’t periods of extreme depression. For him, externally imposed requests/deadlines cause him intense anxiety - he literally curls up into a ball and if the pressure remains/increases he’ll lash out to make it stop, usually verbally but occasionally physically. He couldn’t cope with school or work (constant stream of requests/deadlines). If he has a degree of control he can cope now - he’s been doing an online access to higher education course for the last year and has been ok with that partly because it was completely his choice to enrol and as it’s online he’s been able to choose when and where he does the work. I’m not sure he will ever be able to live independently though