Monday, September 10, 2012

Making a Diagnosis: Hyperactivity, Oppositional, or Anger Overload

Dr. G,
I just happened across your blog while researching my son's behavior. You have described him almost to a tee. He has been diagnosed as hyperactive and also as oppositional defiant. Although he has showed some behavior relating to those disorders I have never felt like they were spot on. My question is:  How would I go about getting a proper diagnosis? (I am positive he has anger overload) and How do I help my son?
Thank You! I feel you are an answer to my prayers.

Hi,   A diagnosis can be made by a medical doctor (M.D.) or a doctor of psychology (Ph.D. or PsyD. degree) or a licensed clinical social worker (LCSW).  You would want to see someone in your area who has experience with children who have anger issues.  You could ask who your school or family doctor recommends, or check with your state's psychological association.  My book on defiance in children explains to parents the characteristics of the diagnoses you mention (oppositional defiant disorder, hyperactivity, and anger overload) and gives suggestions for what to do for each diagnosis.  My book on anger overload focuses on that issue and has a step-by-step guide for parents.  Ultimately if you are trying to decide on a diagnosis and there are several possibilities, it would be wise to check with a clinician who has experience seeing children with these diagnoses, so he or she can help you decide what is going on and what to do.

It is possible your child has aspects of two or more diagnoses.  It is not unusual to have a couple of things going on.  Furthermore, in the real world, people do not always fall perfectly into one diagnosis or another.  Your child could have some aspects of oppositional defiant disorder for example and not meet full criteria for this diagnosis.  To fully meet the diagnosis of oppositional disorder, the a child's argumentativeness with authority figures needs to be frequent and persistent over time (6 months or more), and must affect the child's performance in school, or social situations.  In other words, the child is oppositional  even in situations where it hurts his performance in something where he ordinarily does well:  in school, or in a sport, or in some other extracurricular activity, or affects his social standing with people outside the family.   If a child just argues frequently with his parents in the home, but not with other authority figures, there are some oppositional features but the child would not meet criteria for oppositional defiant disorder.

For more information on this or other diagnoses, read my book "Your child is defiant:  Why is nothing working?"  My book will help you think about what is going on and have suggestions for you.  But you can't really make a diagnosis yourself; it's best to check with a professional in your area to decide among the diagnoses you are considering.  Take care, Dr. Dave Gottlieb

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