How young can a child be to have ODD?

[sniffles]

You may think I'm crazy for even considering this, but I think a 9-1/2-month old baby I watch may have ODD.

I have been around and taken care of a LOT of babies in my 35 years (being an aunt to 24 kids is just the tip of that iceberg), and have a 10-month old of my own. I stay home with my son and watch a few other children through the week, one of them being the baby above. She and my son went to the same daycare previously, which closed and so I now run my own so I can stay home with my boy. Now she comes to my house.

Her parents, while very nice and earnest, seem fairly clueless about babies in general, and admit neither have been around babies much before she came along. They thought her behavior was normal, at least up until they were around my son a lot. At first I thought maybe the baby's behavior was just adjusting to being at a new daycare (mine), but after the first month I figured that couldn't be it. Little by little her parents have been admitting her difficult behavior goes on at home as well, and they often feel overwhelmed and helpless by it.

She screams at the top of her lungs when she doesn't get her way. She wants to be carried around at all times, but not engaged in anyway, but as if she's just an accessory. (She is crawling and standing just fine.) Of course I can not and will not carry her around like that. When I do hold her and try to talk or have fun with her she may smile a bit but then is bored with it and wants to be left alone. Same for when we play on the floor. She's just not very joyful. When she's ready for her bottle, she immediately screams for it, bawls incessantly until the nipple goes into her mouth. I try to get it ready ahead of time and sneak it nearby, but as soon as she sees it she begins the screaming. When she cries for no reason, I sit on the floor near her instead of picking her up, and she crawls up to me but if I reach for her she turns away. When she's attempting to do something and can't (like if she tries to stand and falls on her butt, or open a door but can't because her own body is in the way), she throws a full-on tantrum - stiffens up and screams at the top of her lungs. She can touch and crawl on the other kids all she likes - in just play mostly - but sometimes if she's in a mood, if any of them so much as lean on her she immediately goes into a screaming fit. It wears on my patience and it really bothers the other children (except my own - he's used to it from the other daycare, and laughs at her). She will take a toy away from my son repeatedly just to throw it down behind her, even if they have identical toys in their hands. When I'm feeding one of the other kids, she gets very upset and now has begun to intentionally do things she knows she's not supposed to. (And yes she'd just been fed herself. I always have to feed her first.) Yesterday I stopped feeding my son and had to remove her from the behavior (pulling books off the shelf and ripping them) several times, and would try to distract her with a toy. But as soon as I went back to feeding, she'd throw the toy down and crawl as fast as she could to the books and start pulling them off. The more I would tell her no, the more she would look right at me and do it again. It was aggravating. When feeding her, she will start a tantrum because the next bite isn't coming fast enough.

I've tried several tactics. Attempts to console her when she's throwing a fit don't work because she refuses to be touched (confirmed by her parents) - she actually removes your hands. I've tried what I've seen her dad do: gently tap her belly and shake head while softly but firmly saying "no." I've split the "not otherwise specified" into different phrases for each offense, instead of just "no" : "no fits", "no pulling hair", "no biting", etc. While the low "no" is the best, these tactics still only work about half the time or the results are short-lived. I've been trying to work with her after she's had her lunch while she's still in the high chair. I give her little bite-size baby snacks, and if she starts to throw a fit (no cause, naturally, just whenever she feels like it) I stop and say "no more" and put them down, then I say "be a good girl" until she calms down and then give her the snack. I do this hoping she understands the bad behavior is unacceptable and the good behavior is favorable. It's too soon to know if this is working.

Ignoring her when she's just crawling around bawling and screaming, though I hate to do it and it's hard, works fairly well. She eventually starts playing with a toy or gets distracted and stops. But as soon as she gets me eye-to-eye or I talk to her, she will start up again.

I have never encountered a child so young with such anger, throwing fits and tantrums, engaging in such defiant behavior. So many days I have considered telling her parents not to bring her back, but not only do I feel bad doing that, but also the next day she may be better, and I have the hope that eventually with work and patience I can modify her behavior. At first my husband assumed she was ignored at home, but I know that can't be true, and I think they cow-tow and rush to appease her every whim, which only supports this behavior. Now we believe there's definitely some kind of psychological problem going on with her. I decided to do a little research, and came upon this site.

Does anyone have any insight for me? Could it be possible this child already has the onset of ODD? I know her behavior can't be normal, and I'm getting at my wit's end.

 

[SRL]

I don't think ODD is a reasonable diagnosis for a 9 month old but I would offer a few possibilities. First, there is a TREMENDOUS variation in babies at this age and anyone who has had two or more will tell you they're like comparing apples and oranges. If your own son is the same age as this little girl, differences are going to jump out like red flags waving. I know people who have had irritable, demanding, feisty babies without any neurological issues as well as irritable, demanding feisty babies with neurological issues. It's not at all uncommon for a baby of this age to ignore an instuction (No) or to go exploring and take books off the shelf and rip them (perfectly normal baby behavior, in my opinion). While the difficult behavior may be a sign that something is up, it's really too soon to tell unless there are other telltale signs, including her developmental milestones over the next few years. Some kids just will need a much higher level of management, including babyproofing, than others.

One thing that did catch my attention is that she doesn't like to be touched. One of my (neurotypical) babies was like this from an early age--by 6 months he'd be pushing my hand off his leg, even if I was carrying him. But refusing to be touched can be a red flag for several problem areas as well. Does she refuse touch from everyone all the time? How about overly bothered by lights or sound?

by the way, I wouldn't advise you to start on a behavioral modification plan such as you are doing with food in the high chair unless the parents are aware of it and in full agreement.

 

[Big Bad Kitty]

Hi, welcome to the board!

I don't know if a baby can be properly diagnosis'd with ODD, but I know that ODD is overdiagnosed to start with. Also, it rarely if ever stands alone.

Her angry cries could very well be frustration cries. I'm no doctor but it sounds like she may have some sensory issues. She is awfully young to diagnosis anything as far as I know, but her parents should keep an eye on her and mark her milestones. It could be plain old ODD, but it could be something more, like autism or a mood disorder. When the child is old enough to get a proper diagnosis, the parents will want as much of her history documented as they possibly can.

Weekends are notoriously slow on this board, but others will be along soon to give their sage advice.

 

[Sara PA]

No, a nine month old cannot have ODD. This is the criteria for diagnosing ODD. Nine month olds cannot meet the criteria.

If a child's problem behaviors do not meet the criteria for Conduct Disorder, but involve a pattern of defiant, angry, antagonistic, hostile, irritable, or vindictive this mental disorder of childhood may be diagnosed. These children may blame others for their problems.

Diagnostic criteria for 313.81 Oppositional Defiant Disorder
(cautionary statement)

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

I think you are attributing far more intent to her behavior than is developmentally possible. She's a baby and barely, if at all, beyond the age where she understands that others exist for any reasons other than to satisfy her needs.

 

[BusynMember]

I'd think more along the lines of some sort of autism since the child doesn't really engage, especially if she doesn't make eye contact and has little interest in people. Not liking to be touched is another red flag. Is she sensitive to light or sound? Does she stare at objects a lot? I don't see this as behavioral because she's too young and there are too many red flags here. Autism can be diagnosed young, although most of the time it won't be. Her parents may do well with a developmental pediatrician keeping a close eye on her. I don't personally feel she is a typical baby or has ODD (which, as Sara says, is almost not possible at her young age). Plus ODD rarely stands alone.

 

[SRL]

It sounds to me that this one is very aware of what's going on around her and DOES engage a great deal!

Here's developmental milestones:
http://www.cdc.gov/ncbddd/actearly/milestones/index.html

 

[BusynMember]

But not with people?

 

[Marguerite]

Small babies CAN be very individual and also, in my opinion, very able to reason. Sniffles, welcome to the site and I applaud you for your sensitivity and observation.

I do not think this is ODD. My own opinion of ODD is that it develops as a result of an underlying condition such as ADHD, autism or any one of a number of possibilities, which means that the usual discipline/parenting techniques not only do not work, but can make problems worse. I dislike the label intensely because "Oppositional Defiance Disorder" implies that the child has some degree of deliberqate choice in behaviour, when I do not feel this is necessarily choice - more frustration, anger and anxiety than calm deliberate defiance. Especially anger. But there has to be a reason for teir anger to be so heightened and it takes time to build up such a high level of frustration and anger.

When easy child was a baby I had the chance to observe her behaviour in a group of peers, and see the range of behaviours exhibited. I placed her in a child care centre near work, and would also chat to the other breastfeeding mothers there. We watched each other's babies as they developed, three within two weeks ofeach other's age. easy child was perhaps the least cuddly of them all despite my willingness to cuddle her all she wanted. Otherwise, she was a very good baby who rarely cried.

When easy child was six weeks old her behaviour suddenly changed and she was screaming constantly, arching her back and impossible to console. She wouldn't sleep either, but would lie there and scream. At six weeks old, she sounded angry. It was bizarre. As she was only breastfed and otherwise she seemed well, I thought about possible causes. The only change was in my diet - I had changed from orange juice to an artificial substitute, lacing both with Vitamin C powder. I checked the label of the substitute and found two artificial colours. I stopped taking the supplement and after three days easy child's behaviour was back to normal.

WHen she was 7 months old she developed thrush. A doctor put her on Nystatin liquid. Almost immediately her behaviour changed again and she was a screaming banshee. I had noticed the Nystatin was yellow-coloured andchecked the ingredients - one of the two colours in the OJ substitute was in the Nystatin (as if a baby cares what colour its medicine is!). I asked the doctor for an alternative, but all tat we could get was spearmint flavoured lozenges, which I crushed up and put in her rice cereal. She hated it and I had a fight to get it into her, but a screaming fight three times a day is better than 24/7.

What I'm suggesting - there could be something in this kid's diet which could be causing her problems.

Another alternative - there is something more serious wrong. Not ODD though, but something which could possibly lead to ODD if it's not handled well.

I also am thinking of autism, but there are other possibilities. She sounds like she could have sensory issues, a high frustration level, some Obsessive Compulsive Disorder (OCD) (going back to the same thing even when removed - the books) and is very impatient. It also implies that she is very egocentric (understandable in a baby) but is not learning as fast, that there is a process, an order in which things happen and her needs may not always instantly be met. An autistic kid at this aged (and older) believes that other people instantly know their every thought, and that everyone else exists only to serve their needs.

There are things you can do. Read "Son Rise" and maybe change the way you interact with her, to see if you can work with her more effectively. It's a different mind-set needed, you need to plug in to her.

Also, read up on "The Explosive Child" by Ross Greene. There is some dfiscussion on this at the top of this forum. I'm not sure how much you can really do at her age, but it can at least help you understand a bitmore about what is going on in her head.

I'd like to say more but it's late, tomorrow is a big day and I have to get to bed. I'll try to check in tomorrow afternoon (my time).

Marg

 

[Sara PA]

Interesting, Marg, about your daughter's behavior when you changed your diet. When my son was quite young, he had three episodes of that behavior, twice on days/days after I ate ham and once when I gave him some milk I had frozen that I had expressed on the one day I ate ham. I'm not sure what in the ham caused the problem, but I didn't eat ham again until I stopped breastfeeding.

 

[JJJ]

Her parents can call the local school district and ask about having her screened. By law, the school must screen her and offer testing if the screening flags problems. Their pediatrician is also a good source for more information.

 

[KTMom91]

I agree with the possible food allergy. Miss KT would have horrible screaming fits from day 1. I wasn't breastfeeding, and I changed formula more times than I could count. The worst was the soy. My obstetrician (not the pediatrician, she was a joke) suggested the low iron formula, and that made a world of difference. She was still highly active, crawling at 3 mos, standing at 5 mos, walking with-out support at 8 mos, and she hasn't slowed down since, but removing the iron fortified formula made a world of difference in her attitude.

 

[SRL]

She's only a 9 month old baby so if the parents are concerned they should start with the pediatrician.

 

[DammitJanet]

I have my doubts that an infant...not even a toddler could be diagnosed with something like ODD but that doesnt mean they cant be difficult. Babies, just like people, come with temperaments. Some are just more contrary than others. Some babies you can tell right out of the gate are going to be easy going, funny, people pleasing kids. Others are going to be active, hard to soothe, fussy, bossy little beings. 1 of mine was the first, 1 of mine was a combo of them and one of mine was the latter. My oldest grand daughter seems to be the first way and my second seems to be heading into the latter. She is a finicky little thing who wants her way and only her way. I have a feeling she is going to give her parents a run for their money.

But I have also met a baby that I knew...just knew...in my gut from the time that child was maybe 6 months old that there was something just not right with the child. She didnt interact with people appropriately. There was none of that baby cooing or making faces or giggles that you get from babies. She had these blank stares going on. She didnt attempt baby sounds. But she was extremely active...extremely. I thought autistic spectrum from early on and tried to steer the parents to early intervention with no luck. She still acts autistic and she is almost 4. I guess maybe it will get picked up in school. There is just that look...and the out of control behavior.

 

[Marguerite]

Early Intervention is woderful if you can get into it early.

Sara, it does sound like something in the ham was the trigger for your son. I was maybe faster off the mark with easy child because a friend of mine went through it with her child first, when he reqacted to her diet while she was breastfeeding. The interesting thing is that for easy child, it was tatrazine that was the culprit but she seems to have finally grown out of it.

I'm not saying that in this case, the child is reacting to something in her diet; only to mention that there can be many possible reeasons all of which need to be checked out. It's not good, especially in such a young child, for her to be struggling with interactions and mood.

When difficult child 3 was 9 and a half months we could already see some unusual things - he was obsessed with numbers and letters. He was already using a computer (very basic software) and playing piano (individual notes and simple chords - improvising but melodiously). He made good eye contact but was not talking at all. He wouldalso focus extremely intently on numbers, letters and music so that you could not get his attention away from them. I remember noting this because a cousin of mine was reported to have been like this with music, from infancy - he later became a music prodigy (and, I strongly suspect, was Aspie).

The behaviour at the moment may look like ODD but there are sound reasons for this. There are ALWAYS sound reasons, from the point of view of the child.
An example - I was at a family barbecue watching my toddler niece. She was totally absorbed in picking up clods of earth from ther garden bed and dropping them onto the cement path. She watched as it fell, stood for a few seconds, then picked up another clod of dirt and did the same thing. To me, she seemed to be studying the way the earth fell, trying to learn its pattern.
Her mother called her to come and have lunch. She didn't respond. Another sister said, "She's being disobedient; deliberately defiant."
I said, "No, she's concentrating on something; I think she's studying the way the dirt falls and it's more important right this minute than having lunch."
The second sister said, "Don't be ridiculous! She's a baby - how can she be thinking anything of the sort? No, she's just being naughty, deliberately defiant."
Luckily, my niece's mother & I are on the same wavelength. She gave her daughter a little time to finish her experiment and then come and have lunch. But to our other sister, the baby seemed defiant. To us, she had her reasons. And as she grew we could see this pattern continuing - she would do something and sit back to observe the reaction. A very scientific mind like her brother - and like me and her mother, which is why I think we understood her.

It can be difficult to assess a child as young as this, but you don't have to wait for assessment to begin to work with the child. In "Son Rise" the author describes how he began by being with his child and mimicking his play. His son would spin plates so the dad sat beside him with hisown plate and would spin it. Eventually his son noticed that dad was doing the same thing - and a door began to open between them. The next step was when they could both spin the same plates. But you don't push it - you take it slowly and let the child take the lead in controlling the interactions.

She sounds like she is having difficulty understanding the sequence of events - she sees the bottle and screams because it is not already in her mouth. She hasn't yet learned that there are a couple more steps. While at this age a "normal" child still does not have theory of mind, they do begin to have some of the steps that lead towards it, which can include a sequence of steps.
Something you can do - it won't help now, but it can begin to pave the way - describe aloudwhat you are doing. Use simple phrases, as few words as possible but show her the object and name it, then tell her what you are doing. "Look - bottle. Bottle is cold. We make bottle warm like this. Getting warmer, getting warmer, nearly ready - now to test. [shake bottle drops onto wrist] Is it warm? Yes! Now I bring you your bottle. Here it is!"

Do the same thing in play. Talk to her, tell her what is happening. Observe her reaction - it could be interesting.

This is what we were told to do with difficult child 3, when he was 3. By this stage howewver, he would reject any play which involved simplified language (I suspect because he felt patronised) but when I moderated my language ("normalised" it) to a level where he would continue to play, then we did better.

I do feel a speech pathologist is going to be needed at some stage, to assess her language development. I am referring to language here, as distinct from speech. There is a difference. For example, a parrpt can talk, but does it have language? For that, there needs to be understanding of the meaning of the words being used. We now know that in some parrots, they CAN have understanding of the meaning of words they use; but they learn a word first before the meaning is learned.
Part of learning language is learning non-verbal language, and also learning behavioural sequences. Her behaviour over her bottle tells me she is not good with understanding the connectedness within a sequence - and a good speech pathologist deals this isues like this.

As I indicated in my original post on this thread, the problem in the baby's underdstanding can be as simple as a reaction to something in her environment (as with my daughter's reaction to food colouring). Or it can be part of an underlying disorder. The cause needs to be identified and dealt with, as far as possible, to give the child the best chance to finally begin to understand.

In Australia, a pediatrician is the first port of call. For full ujnderstanding and most accurate diagnosis, we also need speech pathologist assessment and a psychologist's report. What is needed will vary in other countries.

I'd be talking to the parents and suggesting an assessment. If there is no problem then her behaviour issues need to be dealt with. But if there is, then the sooner it is identified then the sooner she can get some useful help and can begin to progress as she should.

Also, it needn't be bad news - the problem could be health-related (such as chronic low-grade tonsillitis) or it could be Pervasive Developmental Disorder (PDD) in some form, which if dealt with, can sometimes allow a child to develop fast and reveal a remarkably high intelligence. No promises - but until you make enquiries, you just can't know.

Be prepared for initial resistance from the parents, especially if she's their first - parents hate to have to accept their child is not as perfect as they want to believe.

Marg