Could his anger just be a part of ODD?
I think anger is what drives ODD, in the same way an engine drives a car. Frustration and anxiety lie behind the anger in most cases, and there are a number of disorders that can cause the frustration and anxiety.
Treat the symptoms and you can ease off the problems, but it is complex. Children are humans, humans are complex. Their environment is also a huge factor - how we respond to the underlying disability in the child is perhaps the most important part of their environment, and this has a direct impact on the degree of ODD you will observe.
On the topic of whether ODD is real - yes, it is, in my opinion. But does it deserve its own stand-alone label? I'm not so sure. I don't believe ODD is something a kid "catches" like a cold, or is born with, like spina bifida. I do think ODD is something that can develop as a result of a lot of complex inter-connection between a number of underlying disorders and the way we handle them in our children. Some children learn far more by imitation than others. Also, some children are far more anxious and frustrated than others. They tend to try to wrest control form those in authority, but if in such a case, the authoritarian responds by trying to clamp down tighter and retain control, you set up a fast-track training program actually teaching the child to develop ODD. In a way, it is the parent (or teacher) modelling controlling, oppositional behaviour (from the child's point of view) that is the final piece of the puzzle. To resolve the ODD, you need to step back and change direction from the need to dominate the child by control. It is a matter of unlearning the need for control, and instead teaching self-control. But the adult has to be the hero first, and set the example of not controlling and not resisting. By that stage, it is a lot harder to do it this way. But it can be done.
Medication can help, especially when these kids hit their teens. If he's talking about self-harm, then you have to balance the fear of possible harm from medications (bearing in mind, you will be watching) vs the almost certain promise he WILL harm himself if you don't do something.
We tried medications. Antidepressants were first tried with difficult child 3 when he was 5 years old. He could not tolerate them at the time, although he did show immediate improvement. difficult child 1 went on Zoloft at 15 when he was suicidally depressed and cutting himself. We should have put easy child 2/difficult child 2 on Zoloft at the same time; she was a closet cutter. I know Zoloft especially is a medication of concern, since there have been links to suicide attempts. From my reading (and experience, sadly) those who have suicided have done so within a couple of months of starting Zoloft. They reported mood problems and suicidal ideation from the time they began taking the medication, and this should have been addressed. There were two cases within a year, in our village. Both were people I knew, I was so angry when I heard, that the doctors in each case ignored the warnings and concerns expressed by both patients and families.
But I have never heard of someone who has been on Zoloft for a longer time with no earlier problems, later on developing a severe depression from the medications. It is very much something that happens right away, and even then only in a small number of cases. If the person is aware of this risk, they themselves are likely to be the first to report it to someone. In the cases I knew, the patients did not know of this side effect. One of the deaths is still officially listed as an accident, but close family and friends quietly are fairly sure it was suicide, spur of the moment. She had come through so much already, the hard times were behind her - no reason to suicide, except for how she had been feeling, with no explanation (other than having just started on a new medication).
Zoloft is what two of my kids take. They have been on it long enough for me to not worry. daughter in law was recently taken off Zoloft, and I think needs to go back on it. The new medication is causing her a lot more trouble. I once took the medication she is taking and had similar extreme mood swings and depression. It would hit half an hour after taking my morning dose, it was nasty. I reckoned at the time that Stephen King must be on that stuff, it caused such vivid, nasty nightmares that I could have written some bestseller horror books. Considering I didn't have depression to start with (I was on the medications for pain relief) suddenly being depressed for no reason felt really, really weird.
Taking all this into account (the good and the bad, as well as the worrying) I would still seriously consider antidepressant medications, under careful supervision, for a teen who is Obsessive Compulsive Disorder (OCD), has anger and anxiety issues and is threatening to self-harm.
For me it's a no-brainer.
Marg
