Conduct disorder diagnosis

[busywend]

I have been watching this thread for heated responses. I think we are getting pretty close.

Everyone take a deep breathe and realize we are all different parents with different children. No 2 stories are exactly alike. If you can not accept that you have bigger problems than having a difficult child.

This thread is informative - let's not get it locked. OK? OK.

 

[Nancy]

I would like to say that this comes up very often with certain people and then those of us who try to defend our position because we are always feeling like we have to defend it, get told to take a deep breathe. It would be nice if the members who constantly cause this by suggesting that everyone has bipolar and no one has ODD would be asked to refrain.

Perhaps the threads that should be locked are those that constantly question a certain diagnosis and those where the person expresses their opinion and then says they're out of the thread, as if that makes it OK, they start the fire and sit back and watch it burn.

Nancy

 

[Fran]

Reactive Attachment Disorder (RAD) is another diagnosis that is always questioned if it really exists or not.
My easy child takes depakote for seizures. He doesn't have a mood disorder.
I read a lot of stuff with my difficult child and I sure would never presume that medicine/psychiatry has a clear handle on all the issues of mental illness.
Our pediatric psychiatrist is the first to say that they don't enough to have absolute answers. Why would I say my experience is the bottom line truth? It would be pretty stupid on my part.

We are in a grey area. Not only grey but shades of grey. Do your research, ask questions, get second opinions and learn to think for yourself and ask yourself "what does your child needs."

I figure I share what I learned but it isn't the bible on mental illness or developmental delays. There are many disorders that the info has changed since my difficult child dragged me into this world.

I don't speak to juvenile court issues, drug or alcohol issues,attachment issues, conduct disorder issues as I have no experience. I would not ever say that your child is going to

Discussion and sharing ideas is good but if we don't turn down the emotions it becomes to hot to be productive. It becomes a distraction and even entertainment.

 

[Allan-Matlem]

Hi,
in my humble opinion diagnosis's on the whole don't tell you much. The ODD/CD diagnosis tells you what the kid does and not why - it could be personality, neurologically based, developmental delay , poor behavior can also be seen as a type of learning disability. Even if a kid does not fit into a diagnosis , it does not mean the kid has not got a problem.

from http://thinkkids.org
'the CPS model suggests that challenging kids often lack crucial cognitive skills – executive skills, language processing skills, emotional regulation skills, problem-solving skills, and social skills – and that this makes it extremely difficult for them to respond to life’s social, emotional, and behavioral challenges in an adaptive fashion. For a list of the skills we frequently find lacking in challenging kids, click here.

This orientation has important ramifications for clinical care and practice. For example, we don’t put a lot of stock in diagnoses, since diagnoses don’t help people specify the skills a given child may be lacking (and therefore don’t help people understand the child’s difficulties very well). Nor do we have much faith in standard contingency management programs because consequences don’t teach lagging thinking skills. '

As for medication ,medications are primarily treat symptons and the same medication can be used across many dxs.

Interventions especially behavioral ones are a function of how one views a kid. Is it mainly kids do well if they can or kids do well if they want to. If it is kids do well if they want to , this may justify standard behavioral modification reinforcements.
I believe that the majority of kids want to do well if they can , they want to be successful , liked , get on with their families. Often distorted thinking , poor coping skills gets in their way. Do you have a difficult child or a child with difficulties ?

There are different approaches and naturally you parent according to what feels right to you.
With or without dxs , the kids here have issues and in most cases we have to go beyond the label

Allan

 

[Sunlight]

I believe in ODD and Conduct disorder. I found this site after ant was diagnosis with conduct disorder. I had never heard of it and when he was diagnosis I typed it in and found this site. someone here told me a few times ant is bipolar. he isn't. he was thru 4 psychiatric grps and no one thought that. ever. professionals do the diagnosing not laymen.

I also had juvenile authorities tell me they did not believe in ODD or conduct disorders and that the kids could behave if they wanted to. I find that to be a very uneducated opinion.

my purpose here is not to give or get diagnosis's but to give and get support. period.

 

[DammitJanet]

My objective in starting this whole thread was to open a dialog so we could discuss what I had noticed happening on the board. I dont think I am alone in noticing the trend here in ...how can I put this...advocating a bipolar or autistic diagnosis.

It seems like lately everyone who comes to the board is advised that whatever symptoms their child is exhibiting must be bipolar or Pervasive Developmental Disorder (PDD) depending on who is answering them. The board is slowly turning into a two disorder board instead of the multitude of disorders that are out there.

I used to tell people all the time to come here when I met them and they had kids with ADHD, ODD, Anxiety, Obsessive Compulsive Disorder (OCD), CP, Tourettes, and you name it many other things. I was very actively involved in childrens mental health locally. I still meet people online and tell them about this site but I now only refer them if I know they have bipolar or Pervasive Developmental Disorder (PDD) kids. Seems to me we have got off track but thats not my call.

 

[smallworld]

Janet, I don't agree at all. I answered a post just this morning in which I told a poster our positive experiences with an SSRI. I said, "I think we get a skewed view that SSRIs are evil and will always cause a manic reaction. I just wanted you to know that some kids do really well on SSRIs." A few days ago I told another poster who was pushing mood stabilizers, " . . . this is a child who hasn't even been diagnosed with bipolar disorder. He's only been diagnosed with ODD, a condition for which there are no medications. Raging is not synonymous with BiPolar (BP). Raging can accompany anxiety, depression, Autism Spectrum Disorder, etc. The treatment and medications are different for each disorder. From Alison's description, it sounds as if her difficult child has anxiety. What else he has is anyone's guess. in my humble opinion, Alison needs to push the doctors for an evaluation that gets her difficult child closer to a true diagnosis. From that diagnosis, the medications will follow. I think it's irresponsible at this point to say he needs a mood stabilizer."

I think there are those of us on the board who are trying to present a balanced point of view. I have two kids with suspected bipolar disorder, and I don't think every kid coming through here has bipolar disorder. In fact, I think quite the opposite -- that parents and doctors tend to jump on the BiPolar (BP) diagnosis when they don't know exactly what's going on. I happen to have read a lot on the condition and can share my knowledge and experience. I think that knowledge can be helpful to someone just starting out on this journey.

 

[BusynMember]

Agree with smallmom. SSRIs work for me. I do think you need to be VERY careful when a child takes an AD because, since there are no blood test, nobody knows if there is a mood disorder that a child may respond badly to however. Both ADs and stimulants have the potential (not WILL, but have POTENTIAL) to cause raging, activation, violence and even psychosis, especially (but not limited to) kids with mood disorders.

I do think we owe our kid the best evaluations and resources available so that we don't get stuck with a wrong diagnosis. My son got stuck there twice. His neuropsychologist, who came from Mayo, told us, "Doctors make mistakes all the time. Mayo makes mistakes all the time." Since Mayo is considered one of the best, you can imagine how often Joe Average Therapist misdiagnosis. We parents have to educate ourselves to make sure we are aware of what might be wrong with our kids. in my opinion we can't just accept because often the professionals just don't know.

On ODD: Even in The Chandler Papers, Dr. Chandler states "ODD rarely stands alone." Check them out.

Mood stabilizers, work for seizures and mood stabilization. I've been on Lithium and Lamictal. They mellow out your moods quite a bit. Lithium almost made me too "flat" (the only way I can describe it). I didn't like it--made me "fuzzy-headed" too. Lamictal was better. My best advice: Go to the top: Child Psychiatrists with the MD and Neuropsychs. I highly recommend both with them working together to try to find the answer. A wrong diagnosis, like my child got, can waste many precious years. At the worst, a child can end up a criminal due to an untreated psychiatric disorder...trust me, the justice system doesn't care. Lately, I've seen a lot of CD on the board, but I've been told it is an over 18 diagnosis and I would not accept this diagnosis for my child unless it was verified by second or even third opinions. It's an extreme diagnosis, and can be a misdiagnosis. Be sure you learn all you can. Knowledge is truly power when it comes to difficult children.

 

[DammitJanet]

Ok...I am so done here. Ya know...I dont even care if this gets locked. MWM I thought you werent going to revisit this thread. This wasnt aimed at you but you seem to have taken it personally as an attack.

You continue to claim that you know better than all the psychiatrists in the country as far as psychiatric diagnosing procedures. You say that "your" psychiatrists tell you that CD is an "over 18" diagnosis when it clearly states in the DSM-V that it is not and it has been that way for years. If you would like I can go dig out the earlier editions. You are not the only one who has been dealing with the psychiatric community for years honey...so have I.

 

[BusynMember]

Janet, I didn't read any of the threads until smallmoms. I don't know what you said. I saw she posted and I like her point of view so I read it. In between that, I didn't read anything.

The DSM is constantly being revised. Early onset bipolar isn't even in it yet, but it will be. Psychiatry is constantly evolving.

My only message is to get informed evaluations by top diagnosticians, in my opinion, especially with CD being a grim diagnosis. I know I am not the only one with a long track record in mental health, but I did get GOOD help, and am doing well, as is my child. I am passing along what worked for me. I'm not going to argue with you because my intention is to help the parents.

Have a good night.

 

[flutterbee]

I find it offensive and frightening when one (usually a newbie) posts on the board, say she's had extensive evaluations and 2 psychiatrists diagnosis'd ODD and CD and someone comes along and says oh it can't be that. That simply isn't our place. Our place is to provide support, resources and share our experiences. But to dismiss a diagnosis out of hand is irresponsible and not our area of expertise.

The notion that CD is not a childhood diagnosis has been corrected previously on this board to no avail. I know because I've done it, quoting right from the DSM. That information is available all over the internet. It's not a secret.

 

[mistmouse]

You know I am one who believes in the ODD and CD diagnosis. I know from the DSM-IV and my studies for my bachelors in psychology that it can be a stand-alone diagnosis and isn't just the symptoms of some underlying disorder, bipolar or otherwise. In our classroom discussions and as is my belief, if ODD goes away when any medication is given, then it most likely wasn't ODD in the first place.

I have a daughter who was kept in a time-out room when she was 6 and 7 years old for nothing more than not following adult directions. She was kept there for 6, 7, and 8 hours because she had not completed five minutes sitting one particular way. She is claustrophobic and hypoglycemic and was locked in ther alone and not given snacks or meals "because she had not done her five minutes". During the course of these time-outs she began to have regressive behaviors and to pull her pants down and defecate (she wasn't provided bathroom privileges either). As a result of her behaviors in the time-out room, the SD felt they needed another psychiatric evaluation because there had to be something else going on. She had been to see a neuropsychologist and had a psychiatric evaluation with a psychiatrist (who in our state does nothing more than spend a few minutes with the parent and then prescribe medications)the previous year. The neuropsychologist evaluation and child psychologist we saw were how we got the IEP the SD denied all kindergarten year because the SD said that ODD didn't qualify her for an IEP, but the neurpsych and child psychologist set them straight.

Once they hand-picked a different psychologist to do an evaluation based on their concerns of her behaviors in the time-out room, the diagnosis came back bipolar. The SD placed my daughter on homebound saying she could not return to school until she was stabalized on medicationa and through psychotherapy. My daughter was on depakote and had it at a therapeutic level, with no change in her behaviors...if anything they were worse. She has seen many professionals over the years with various degrees they have earned, but not one has upheld the bipolar diagnosis. She still has a mood disorder not otherwise specified listed, but she isn't bipolar and she doesn't take mood stabilizers. However, the SD still considers her to be a bipolar child who isn't properly medicated.

Once she began stimulants for the ADHD and ADs and mood stabalizers were stopped, she has been able to maintain much better. She still has anxiety, but much of it is related to what she endured at the hands of the SD who had a belief that ODD is just an undisciplined child and she needed to be taught who was in control...hence the hours and hours in time-out for not following adult directions.

I also get upset when it is implied the only place you can get the correct help is from the psychiatrist. It is true they have a an MD, but I haven't had one whose goal was more than to do medication management. I have had the best luck with two different licensed psychologists, and my daughter sees a developmental/behavioral pediatrician for medication management. With her current licensed psychologist and the developmental/behavioral pediatrician we have had the best growth and progress for my daughter behaviorally. We have given up on trying to change the SDs thinking regarding my daughter's behaviors as they believe the IDEA is just that...an idea. My daughter still has a difficult temperment (mood disorder not otherwise specified), and she probably always will have. I believe she is still ODD along with the ADHD, and treating the ADHD had not changed that.

Just my thoughts on it, but if ODD and CD weren't a stand-alone diagnosis, why would it be in the DSM?

mistmouse

 

[Running_for_the_shelter]

I haven't been around much lately (lots of reasons) but here's my two cents, anyway. In my family's experience, a label doesn't mean squat. My son (now 6) ended up with an ODD diagnosis, another "mood disorder - not otherwise specified", and a bunch of docs who wouldn't commit on him. The school district declared him within normal limits -- that's a hoot and a half. [Survey says they liked this conclusion so they didn't have to offer him any services. Whatever.] Anyway, my son's current doctor, whom I like a great deal, says there really isn't a good label for people like him yet and this I believe. They tried "hyperactive" on me back in the 60's; didn't stick. My father, back in the 20's and 30's, didn't get a nice label at all, just the "rotten kid" sort of thing. If my son has children (and karma says he'll get them), he will have one just like him and me and my father and guess what? That cub will have a different label we don't even have today.

I think the label is only as good as the help you get with it. Some folks can't get any treatment unless they are called x, y or z. I understand "mood disorder - not otherwise specified" is a label my insurance company understands, so yeah, I go with it. If the letters get you your medications or services, take 'em, is my opinion. But in the case of my own genetic line, the only label that led us to useful information was the ODD one. I hear the "ODD doesn't walk alone" but all I can say is that it (and it alone) is the closest fit there currently is for three generations of extremely similar people. [I also have the opinion that there is some significant advantage to this personality we have or it wouldn't present itself so strongly over the generations but that's a thread for another day.]

Research is always progressing, so labels and treatments are going to change. That's good! I have full faith that eventually -- probably not with my son's children, but maybe with that child's -- we will have a good idea of what's happening upstairs and how to handle it. In the meantime, I live with the imperfect tools and remember that none of those diagnosis's and treatments came down from the mountaintop written on stone tablets. We are what we are .. and the labels and treatments just aren't there yet for some of us.

Heck, I typed so much, I think that was really worth a nickel. Anyway, good luck to everyone here, regardless of viewpoint -- we all need it! Much love to everyone -- I've missed you folks.

 

[totoro]

Thanks Janet- Nice can of worms!!! JK... Honestly though, I think this has made everyone think about what they say and maybe how they say it. Regarding diagnosis's.

I know I was pushed for the Autism diagnosis when I first came here, I know everyone was being helpful, but part of me felt like I had to get the Autism diagnosis... that had to be what she was.
I myself am too new to all of this to push various diagnosis'd or thoughts on other disorders. But I try to speak of my experiences. Especially with my extensive family of mental illness. My difficult child 1 has had a diagnosis in the Autism spectrum, but it was from a SW who was pushing it for funding purposes through the SD and Mental Health Dept. Everyone else has discounted any Autism spectrum, but I still get pushed in that direction... which is fine. I understand diagnoses can change for our kids, but this is what I have right now.
Whether her ODD, Severe ADHD is just a symptom of her BiPolar (BP) or an actual seperate diagnosis??? Who knows???
I just want her to recieve help, for the symptoms, and if some of her symptoms are Autistic-like, then I am trying to get therapies to help those symptoms. Regardless of her diagnosis.
The only reason I want the diagnosis is for school and for smart medication choices... I am so greatful for this place it has helped me so much and given me so much insight into my children and my family.
I think we are all a little bit difficult child'ish at times and hold these things so dear to our hearts that we are passionate about these topics. For some of us it is all we know at this point in our lives... can you blame some of us for flying off the handle regarding the thing we love most in the world, our children?
I know I need to lighten up at times, my life right now is filled with a severely depressed, manic, violent child... I am sure lots of us are in the same boat just deperate for an answer...
-Be Kind

 

[SRL]

No matter what is written or not written in the DSM there will always be doctors, specialists, and parents who disagree with what it says to variying degrees. This is a fact of life both on and off of this board. In fact, one of the co-authors of the most recently published diagnostic tool for Asperger's Syndrome sat at my kitchen table and told me point blank that the DSM for AS isn't very good--that in the real world they're seeing far more variation in individuals with AS than is described by the DSM criteria.

It is also a fact of life--verified by research--that sometimes doctors make only partial diagnosis's or misdiagnose completely.

Those of us reading a description of a child by a newbie look at it through our own knowledge and experiences. I think the beauty of the board is that a new parent visiting here does get a variety of responses for their consideration--they are free to choose what is or isn't appropriate for their situation. If you don't agree with the opinions of a previous response, it's very simple: respond with your own opinion. That's why we're here.

 

[flutterbee]

SRL -

The DSM is a living document in that it evolves over time - new disorders are introduced and outdated disorders are removed. What is important to remember is that in order for that to happen, a consensus among psychiatrists (not sure about psychologists, but maybe them, too) must be reached.

It's not the variation in opinions or responses that is the issue here. If we were all of a like mind, this board wouldn't be needed. It is when misinformation is presented repeatedly as factual that it becomes a concern for me.

 

[tiredmommy]

There has been an issue on this board, as long as I can remember, of a few long term members digging their heels in about more controversial topics. This serves no one but their own egos. This topic has been allowed to go on because there had been a fruitful exchange of information, but now there is a definite mean streak emerging. To our newer members: it's important to take what you can use and leave the rest. You are the expert on your child and must advocate in your child's best interests. Follow your gut. Don't allow yourself to be bullied by family members, medical professionals, our members or any one else. Ultimately, it;s up to you to find what will work best for family.

 

[Nancy]

I don't understand meanstreak tiredmommy and I would certainly hope you weren't referring to me or Janet as the long term members in your comment because I for one am extremely proud of Janet and her accomplishments and contributions to this board. I see it that some of us are tired of being made to feel that our opinion, our experiences are not as good as someone elses. That we just don't know what medications are right for our child, that the diagnosis that we were given is not right for whatever reason, that our psychologist/psychiatrist is all wrong, that the DSM is wrong. As I see it there is one person who continually starts this fire over and over again and finally when it becomes a forest fire the rest of us are admonished for not putting it out.

Mistmouse thanks for the information, it was helpful to me. I believe my difficult child is very similar to yours.

Running I agree with your comments regarding labels. I've never cared much for them. Treat the symptoms and as the symptoms change, change the treatment.

I believe this thread would get back to being helpful or just fade away if we were not continually told that "we" are the ones being mean. I am proud of the members who steppped up and gave very good, informative information ont his thread. It is that kind of information that needs to balance the other.

As a suggestion, why doesn't one of the moderators contact the person involved and suggest that she moderate her words more carefully and tone down her opinions about ODD/CD (about which this board was founded). I think that would be more helpful in the future.

Nancy

 

[BusynMember]

The DSM is indeed evolving. When I was a kid (soooooooo long ago) there was absolutely no explanation for my problems. As I got a little older "hyperactivity" became popular, but when I was growing up even ADHD was relatively unknown and few kids took medications. I didn't know ANY who did or admitted they did. Bipolar was "manic depression" per the DSM and only valid if you had definite high highs and low lows, so I was really sunk, as my bipolar was more subtle, although no less debilitating. Then "manic depression" changed to bipolar. Autism was almost never diagnosed. Only kids who were classically autism even got the diagnosis and it was considered a form of schizophrenia--a cold mother--a very cruel sentence for any parent. Kids with Aspergers and Pervasive Developmental Disorder (PDD)-not otherwise specified probably were called "mentally ill" or "retarded" and maybe some were homeless. I have a brother who got an Aspie diagnosis. recently--he has never had a date in his life at age 49 and could do long division in kindergarten. He is doing well financially, but he has no friends. It's sad to me, but he doesn't seem to care. Aspergers was not even in the DSM ten years ago. We all bring our experiences to the table. That hopefully helps parents decide which advice they want to take or disregard. For me, I'd never accept a diagnosis of Conduct disorder or stand alone ODD without second and third opinions. And they would be opinions of professionals who had the highest credentials. In the end, I don't think anyone really knows what it is wrong with many kids/adults who are different. You hopefully get good help so that your child can function. My now 23 year old was a drug addict at one time. She had a slew of diagnosis. back then, including bipolar, and was put on Depakote. She hated it and threw it out. She's clean now and doesn't appear to have any mental illness at all--at worst perhaps she has ADHD, but she is VERY organized. She would have been labeled CD by some psycologists at one time as she met the entire criteria, but CD doesn't go away without treatment and she refused to seek therapy--she quit using on her own. She is not "that person" who took drugs anymore. Clearly, since she no longer steals, lies, etc. she "outgrew" the criteria for CD. I'm glad she never owned that label--I may have felt hopeless about her rather than hopeful, and maybe she would have felt hopeless about herself. I think the bottom line is you ask for advice, you get it, you won't get a total consensus, but you do what YOU think is right. In spite of the various opinions, I don't believe ANYONE is being mean-spirited. I think everyone is trying to help the best way they know how. Our upbringings, experiences with professionals, etc. color our responses. I did not read this entire thread. I know I rarely agree with Janet or Nancy so I skipped their posts, not to be mean, but just because they bring what THEY belief and fighting over it does no good. Nobody is all right or all wrong. There is no such thing. I just hope parents get enough from all of us to make decisions that help with their kids. I like to bring my happy endings because I feel it encourages parents who think there is no hope. There are so many kids who are over twenty and still floundering that I feel it helps some people to read that some kids were messes and turned out fine. Furthermore, neither of my kids is on medication for those who feel medications has to be the answer. Sometimes it does need to be, but in some cases, especially when a child is misdiagnosed, certain medications can make things even worse. If any parent here wants to accept an ODD or CD diagnosis and not see if there is anything else going on, that is 100% their choice. It is not something *I* would do, but, at the end of the day, we all do what we feel is best for our kids. in my opinion all this thread did is to intimidate some people into NOT saying what many of us have heard all along--that ODD and CD don't stand alone. I still maintain that they usually don't. There are no medications for either. If a child is suddenly not defiant after being putting on medications, especially a mood stabilizer, in my opinion (and nobody has to agree) and in the opinion of my Psychiatrist, it is more than ODD. As for borderline, there IS quite a bit of research going on that links borderline to bipolar. Borderline is being treated often now with mood stabilizers, that on the mind of Psychiatrists. Psychiatrists: Not ALL Psychiatrists don't diagnose and just hand out medications. I would never go to one who did that. As with everyone here, this is all JMO and your trusted professional should be the person you go to with serious questions. Just choose a good one :smile: That, in my opinion, is the key. My son, in particular, would not be the calm, contented fourteen year old he now is if we had believed his earlier diagnoses. It can take a long time to sort it all out. Good luck to all on their very tiring journey.

 

[flutterbee]

MWM -

Noone on this thread was ever suggesting that a thorough evaluation not be done. Noone ever suggested not questioning the diagnosis. Noone ever suggested taking the first diagnosis thrown at you and that's it. I believe that was reiterated often.