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Is it Autism or Oppositional Defiant Disorder (ODD)?

Understanding the Difference between Autism and ODD

BY: Elizabeth M. Felder, MD

When a child repeatedly throws tantrums, what is the meaning of the meltdown? Is the child being defiant, resisting authority, refusing to follow the rules, or is he or she reacting to an unpleasant situation, task or noise? The answer to this question can provide a valuable clue to a possible underlying mental health or developmental problem.

Autistic behavior and the behavior associated with oppositional defiant disorder are often difficult to distinguish. It can take a bit of investigation, knowledge, observation and intuition to get to the root of the meltdown.

WHAT IS OPPOSITIONAL DEFIANT DISORDER (ODD)?

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines oppositional defiant disorder (ODD) as a child who displays at least four of the following characteristics:

  • Often loses his or her temper.
  • Is often touchy or easily annoyed.
  • Is often angry and resentful.
  • Often argues with authority figures or adults.
  • Often actively defies or refuses to comply with requests from authority figures or with rules.
  • Often deliberately annoys others.
  • Often blames others for his or her mistakes or misbehavior.
  • Has been spiteful or vindictive at least twice within the past six months

Other factors are also considered, such as whether the frequency and intensity of the behaviors are outside a range of normal for the child’s developmental level, gender and culture, and whether or not the behaviors are due to a mood or psychotic disorder.

There are differences in the way the symptoms show up in boys as compared to girls. Boys with ODD tend to be more physically aggressive and have outbursts of anger, while girls will often lie, refuse to cooperate, or show symptoms in more subtle ways. Also, a child with ODD rarely takes ownership of his or her behavior and the effect it has on everyone around them.

DIFFERENCES BETWEEN AUTISM AND ODD

The diagnostic criteria for autism are based on social communication, rigid and ritualistic patterns of behavior and sensory processing difficulties. To list all of the specific criteria would be too lengthy for this blog. One could summarize the difference between the two disorders this way: Autism is characterized primarily by deficits in social skills, communication barriers and inflexibility. ODD is all about defying authority. If you tell a child with ODD not to do something, that is the very thing that they HAVE to do right that minute. Children with autism can also have ODD. It is uncommon, but it can make it difficult to find the cause of a meltdown.

A child with autism can be easily annoyed and lose his or her temper, but they are not usually resentful or vindictive. He or she often has difficulty regulating negative emotional reactions. The outbursts and defiance of ODD are more purposeful and manipulative. The similar behaviors seen in a child with autism are usually more reactionary. The child with ODD is trying to control their environment. The child with autism is triggered by unpleasant circumstances.

For example, if a teacher instructs a student to sit down and work on their math sheet and the child has an outburst, he could be reacting to sensory overload, maybe his pencil isn’t working or her crayon broke, his hand could be tired from writing his spelling words ten times each and he doesn’t have the language skills to tell you what is wrong. That would be more characteristic of a child with autism. Additionally, if it was supposed to be time for reading and the schedule of the day changed, and now he has to do math instead, that could also cause a meltdown as children with autism have difficulty changing their routine.

A child with ODD in the same scenario is reacting to the authority of the adult by becoming angry and wanting to assert himself or herself as an equal or higher authority. A downward spiral occurs, with the adult trying to control the child and the child feeling he or she must not give in and must defend his or her autonomy. Both the adult and the child become angry and refuse to back down as they try to defend their self-esteem. The situation continues to escalate. This gives the child an increased amount of one-on-one attention and the situation causes them to be able to avoid doing the work, both of which actually reward the child’s negative behavior.

DIAGNOSIS 

It can take some detective work to figure out why a child is reacting in a negative manner. Children with either ODD or autism may not want to do schoolwork, homework or chores, but for the child with ODD, it is much more about defying authority than avoiding the work (barring any learning problems). To truly determine the cause of difficult behavior, it often requires a full psychological evaluation. The benefit of knowing the underlying cause gives the adults in the child’s world information and guidance about how to interact with him or her. Encouraging compliance with instructions and de-escalating a meltdown for each diagnosis requires very different strategies on the part of the adult. Treatment and therapy are also very different.

If you suspect your child has either one of these conditions, call Connections today at (601) 261-5159 to schedule an appointment with one of our providers.

Information on this page should be utilized as a guide, not medical advice. If you feel you need to speak with someone regarding yours or a loved one’s behavioral or mental health, please contact our office.

Connections serves as a regional resource center providing medical, educational, speech/language and dyslexia evaluation services for children and teenagers. Following diagnosis, we work with you and your child to determine the best course of treatment and therapy for them. If you would like to schedule an appointment, please call us at (601) 261-5159.

Tate Rutland

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