Wednesday, January 6, 2010

O.D.D.-- What is It? An Interview With Dr. Jennifer Hartstein

I have been working as a substitute teacher for the NYC Department of Education now since April 2009. I have come across children with a variety of psychological issues, one of which is called "O.D.D." I had never heard of this diagnosis before. So I decided to consult a professional for more information.

Enter Dr. Jennifer Hartstein to the rescue.

Dr. Hartstein took the time to answer some of my questions about O.D.D. Take a look:

1. What is O.D.D.?

ODD (oppositional defiant disorder) is a psychiatric diagnosis given to children and adolescents who have some extreme, yet specific, disruptive behaviors. In fact, according to the DSM-IV, it falls under the category of Disruptive Behavior Disorders. Normal development for children includes tantrums, oppositional behaviors (what two year old hasn't said "no"?), and periods of being mean or lying. Most children will grow out of these behaviors over time. Children and teens that meet criteria for ODD go beyond the "normal" lying, cheating and oppositional or defiant behaviors, meaning that these behaviors are more the norm than the exception. These children will suffer impairments in all aspects of their lives, with family, friends, teachers, etc.

According to the DSM-IV, the criteria for ODD require that four of eight symptoms be present for at least 6 months and that each of these symptoms be present "often". The symptoms include: often loses temper, often argumentative, often defiant, often angry, often blames others, often purposefully annoys others, often touchy or easily upset, often spiteful and vindictive. (adapted from DSM-IV, American Psychiatric Association, 2000). The biggest distinction here is that while all children will, at times, experience some of these symptoms, this occasional difficulty is not enough to meet criteria for diagnosis.

2. How does O.D.D. manifest in children?

Children who have ODD suffer a degree of impairment that is beyond that of their "normal" counterparts. They will not only occasionally lie or cheat and demonstrate disruptive oppositional and defiant behavior, they will demonstrate these behaviors on a regular basis. Often, they behave in ways that demonstrate no regard for the rights and concerns of others. As a result, they will have difficulty making and maintaining friends, responding positively to adults, following the rules in class, etc.

To be more specific, there is a significant pattern of hostile, negative defiant behavior, which includes frequent loss of temper, arguing with adults, actively defying or refusing to follow rules, deliberately annoying others, blaming others for one's own mistakes, being touchy or easily annoyed, being angry and resentful, and being spiteful and vindictive.

Many children who meet criteria may have low self-esteem. They may also demonstrate low frustration tolerance, significant mood swings, cursing and may often experiment with drugs and alcohol earlier than healthier counterparts.

3. Can a child have both A.D.D. and O.D.D.? If so how does this manifest?

Yes. Very often, ADD and ODD walk hand in hand. In fact, ADHD is one of the most commonly co-occurring diagnoses with ODD. According to the DSM-IV, approximately 50% of children with ADHD also suffer ODD, while 70% of children with ODD suffer ADHD.Presentation is similar for children with both ADD and ODD as it is with children with ODD singly. If diagnosed with both, however, in addition to the symptoms associated with ODD, there will be an increase in impulsivity and hyperactivity.

4. What can parents do to help a child that has O.D.D?

The good news is that it seems as though even without direct treatment, may children who are disruptive at a young age will demonstrate improvement over time and no longer meet criteria foe a disruptive behavior disorder. However, with the presence of treatment or help, it is possible to decrease these symptoms more rapidly.

It is important to reach out for help from professionals if a parent is concerned about his/her child's behavior. First and foremost, it is so important to get a clear diagnosis and to understand if there are multiple diagnoses occurring together. Often times, addressing the concurrent problems (especially ADHD) can help to alleviate some of the disruptive behaviors. Generally the best intervention involves behavioral modification strategies, particularly those aimed at helping the parents make changes in their parenting styles. Medications may be indicated, if behavioral modifications do not influence change. If nothing works up front, the diagnosis may need to be revisited.

5. What can educators do to help a child with O.D.D?

Similar to parents, behavioral modification in the classroom can really help children with these types of difficulties. Generally, the teacher should be considered part of the team working with a child with these problems. When thought of in this way, all changes being implemented should be brought to the classroom as well.

Jennifer L. Hartstein, PsyD, is currently in private practice in New York City, specializing in the treatment of high-risk children and adolescents. Prior to entering into full time private practice, she was the Clinical Director of the Discovery Center at the Child and Family Institute of St Luke’s-Roosevelt Hospital Center. The Discovery Center provides short-term substance abuse prevention and early intervention strategies for adolescents. Before working at the Child and Family Institute, Dr Hartstein was the Director of the Group Psychotherapy Program, Intake Coordinator of the Adolescent Depression and Suicide Program, and Attending Psychologist, at the Child Outpatient Psychiatry Department of Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

Dr. Hartstein received her BA from George Washington University in Washington, DC before earning her MA in Dance/Movement Therapy from Hahnemann University in Philadelphia. She worked as an Allied Therapist on two adolescent inpatient units, creating and implementing group therapy programs, before returning to Yeshiva University to complete her doctorate in School-Child Clinical Psychology. Dr Hartstein works with children, adolescents and their families who have a wide range of psychological diagnoses. She has received intensive training in adolescent suicide assessment and has specialized in this population for several years, using a variety of treatment approaches, including Dialectical Behavior Therapy. Dr. Hartstein has published and presented on teen-related issues, and been asked to speak as an expert on a variety psychological issues in print and on television and radio.

Dr. Hartstein lives and practices in New York City.


  1. Ok, here is me being me again. While I think these behaviors exist, today in the world, I think the modern world created them with how crazy it is, and that it isn't something inherently in the child's (or adults) brain. Depression makes sense as being a disorder regardless of time and space (well, in tribes it is rarely ever seen because I guess they just can't afford it and their whole system is different). She actually mentioned that later on by saying that a treatment is for the PARENTS to change parenting style. Maybe all this ties into what I've been talking about with you; all the new hostility in the world only breeds more.

    Also I think parents are too quick to label their children as having one of these issues, when a few years ago, it didn't exist and you have to make due. Even good kids are bad sometimes, and people need to learn how to deal with it as best they can instead of pumping them with drugs. I think a very important point about this "behavior" is that it talks about kids. When we act passive aggressive like we do, we are mature enough to understand the nuances of it and how it works. Children don't understand it (and they are right to think its stupid and offensive) and react to it. I know I did!

  2. I found this blog very informative. It is great to know there are options for help out there. Ms. Hartstein sounds especially knowledable and experienced on these topics and other complex issues. Kudos to you for finding and making this information available to parents and teachers.

  3. Cordy- I agree that labeling can be hazardous. However, I also think that it can be helpful to have a diagnosis when something is plaguing your child. When you can't put your finger on what is wrong and the symptoms add up, a diagnosis makes sense and gives parents piece of mind.

  4. Having worked with ODD children myself, I have often maintained that, although a child may have a predisposition to ODD chemically, there has to be a parental aspect that encourages its development. Every single child I know with ODD has absent, ineffectual or disinterested parents. I believe that a child with an ODD predisposition can be "headed off at the pass" by involved, educated (about ODD) parents who use appropriate structure and discipline. I have an borderline ODD son who sticks to the rules and toes the line because of our expectations, nurturing and readjusting of parameters to suit a particular situation. I'm not saying that we are perfect parents by any stretch of the imagination. We just learned all we could and kept firm, loving rules and factored in plenty of "do what you want" opportunities for him to feel unconfined and in control. Let me know if I'm off-base in my opinion. This is my experience with every ODD case I've worked with.

  5. From my understanding of ODD, parental behavior has a profound impact on the treatment of the disorder. Like you said, Alana, I believe ODD is partially a product of a particular parenting style in conjunction with a predisposition to the disorder.

    The point is, it is essential for parents to be aware of HOW they parent. This will certainly impact their children, and potentially alleviate ODD symptoms.

  6. I don't completely agree with Alana. (We were discussing this the other day.) I think she underplays ODD, but she would disagree with someone who said the same thing about ADD. In all these cases, parental involvement makes a difference, but to say that a child only has ODD inclinations that necessarily be overcome is like saying "Shake off that diabetes."

    I think it's a real thing, but no doubt overdiagnosed (like ADD) and therefore not dealt with head-on in cases where the diagnosis is an overstatement. Yes, some kids can shake it off with proper parental guidance, but that doesn't mean it's always the case. (I acknowledge Alana's professional experience, but just because she never had a kid that far gone it doesn't mean they don't exist!)

  7. I think I get that once a month.

  8. Donna- Ha ha!

    Jack- I completely agree! It is over-diagnosed, however when there ARE legtimate cases of ODD, it can be VERY hard for both the children and the parents involved. While it is difficult to determine the exact cause of the symptoms, regardless the symptoms still effect the whole family.

  9. We were talking about this over dinner last night. (I told Alana I commented.) She's convinced that Yitz has "ODD tendencies," which she successfully headed off with parenting. I disagree that he has or had such tendencies. (Of course kids whose parents ignore them and don't discipline them will act out! That doesn't make them "ODD-inclined," it makes them kids with lousy parents!)

  10. I think there is a major difference between having defiant tendencies and being consistently unruly on a regular basis. In my opinion, Yitzy does not have it, although I never witnessed him in his particularly defiant period.

  11. I disagree with Jack, I think its bullshit and basically bad parenting. But that's me. But I also think ADD is sort of similar. I think neither are like diabetes...I think ADD is more social but also equally as 'modern' and not so mental. Its made to be a problem now. I don't think it existed before.

    Bad kids/teens on a "normal" level is expected, and teens can be REALLY bad. That doesn't mean anything. If it exists, oh well, my kids will never get tested for it because I refuse to medicate them on these issues, and they probably won't run into that problem anyway.

  12. I do think that we, as a society, are quick to rush to "medicate a problem," however, there are instances when medications are helpful in psychologically based situations.

    When a child has severe ADHD so much so that he cannot sit still, focus, read to interact effectively with others, medication can be exponentially helpful.

  13. Hi Everyone....
    I'm so glad that this topic has started such a lively conversation!

    I think everyone's take on it is valid. No one exists in a vacuum...the disorder is part chemical, part environmental (school, home, neighborhood, and a lot of it is impacted by the interaction between the two.

    I think there are MANY kids who are defiant and oppositional at times that will not meet criteria for ODD (Remember that there is a time component to the has to be over a period of time AND to an extreme).

    One of the toughest questions I have to answer when working with kids is what's "typical" versus "atypical?" Additionally, I have to remember to look at developmental age as well. I also agree that as a society that wants "quick answers" we look to diagnostics to provide answers. Children and adolescents are so much more than a list of symptoms, which may appear differently from child to child. Thus, when looking for help, make sure you find someone who is willing to see your child first and their symptoms as a part of them, not a definition.

    Regarding parenting, it is a key component in treatment. Children with ODD can be scary at times, which may make setting rules and limits difficult. It is important to set clear expectations, with equally clear, time-limited consequences if the expectations are not met (and rewarding the behaviors you want is of the utmost importance!). Children learn the rules of life at home, and then at school. Strong, consistent parenting is so important in building consistency and helping these types of children learn how to maneuver in the world.

    Every family is going to approach these situations differently, and it's important to recognize that, certainly. Ultimately, it is important, in my opinion, to help children and teens learn how to be in control of themselves, and teach them how to navigate the world. Sometimes, they just cannot, due to an ongoing chemical imbalance or a lack of skill. At these times, medication may be indicated or therapy may be needed to help them improve and enjoy life, rather than feel stuck and unable to move forward.

    Feel free to contact me with questions or thoughts. I'll certainly check back in as well!

  14. Hi All,

    I have to agree with the eloquent coments of Dr. Hartstein. We sometimes get so caught up on whether or not a child or adolescent meets criteria for ODD or ADHD, that we forget to look at the indivicual kid in front of us. Diagnosis are to help develop a treatment plan. If they don't do that, they aren't really very usefull. The main point is to find out what will help a kid develop optimally. When there are problems that are close to any diagnosis (whether we believe in them or not) it is a good idea to seek the help of someone who can assist us as parents in navigating these issues. And to second Dr. Hartstein's opinon, find someone who will look beyond a diagnosis to see both the strengths and struggles of your child.

  15. Jonathan,

    I agree that it is important to look at the child rather than the diagnosis. I feel badly for the children I meet who are in self-contained classrooms and are hyper aware of their diagnosis's. I have met children who tell me that they have ADD and such.

    But you are right, the diagnosis can assist in creating a effective treatment plan for the kid.


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