[First published on Nathen’s Miraculous Escape]

The most useful assessment tool is the DSM-IV-TR Diagnostic Criteria:

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 or 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 or older, criteria are not met for Antisocial Personality Disorder.

There are also several assessment tools, which have varying degrees of consistency with clinical-interview-derived diagnoses, test-retest reliability, and source-variance problems. They also cost a lot. What you basically need to know about them is that using these rating scales, teacher and parent opinions about ODD barely agree, and if their agreement was necessary, ODD would be about .2% of the population, down from up to 16%, according to the DSM. Parents’ opinions tend to be more closely related to clinicians’ and are probably more accurate. Note that the DSM does not require ODD to be present in more than one context, but consider your stance on this. If teacher says ODD and parents say no ODD, or vice versa, will you make the diagnosis?

Here are a list of common assessment tools, so that you can recognize them: Diagnostic Interview Schedule for Children, Child Behavior Checklist, Behavior Assessment System for Children: Second Edition, Disruptive Behavior Disorders Structured Parent Interview, Burke’s Behavioral Rating Scale, IOWA Conners Teacher Rating Scale, Disruptive Behavior Rating Scale, Oppositional Defiant Disorder Rating Scale, SNAP-IV Teacher and Parent Rating Scale. I did a fair bit of research on the use of these systems for ODD. If you’re interested, see my summary here.

Considerations for making a systemic diagnosis: I have my doubts that this diagnosis can be made in good faith by a system thinker; it pathologizes an individual child for a condition that is very likely contextual in nature. However, it is medicated less than many of its alternatives, such as ADHD, CD, and RAD, and its treatment goals are inherently relational, so a case can be made to use this diagnosis to funnel resources to families in need. In making a systemic diagnosis, remember that ODD is correlated with disrupted attachment, parenting that is authoritative, neglectful, or abusive, parental psychopathology (especially maternal depression), and marital discord.

Some books which might be helpful: Books for Parents: Your Defiant Child, Russell A. Barkley, PhD, Guilford Press, 1998; The Explosive Child, Ross Greene, PhD, Harper Paperbacks, 2001; Raising Your Spirited Child, Mary Sheedy Kurcinka, Harper Paperbacks, 1998; The Angry Child, Timothy Murphy, PhD, Three Rivers Press, 2002; How to Behave So Your Child Will Too, Sal Severe, PhD, Penguin Books, 2003; It’s Nobody’s Fault, Harold Koplewicz, MD, Three Rivers Press, 1997; Books for Children: The Behavior Survival Guide for Kids, Thomas McIntyre, Free Spirit, 2003; How to Take the Grrrr Out of Anger, Elizabeth Verdick and Marjorie Lisovskis, Free Spirit, 2002; Josh’s Smiley Faces: A Story About Anger, Gina Ditta-Donahue, Magination Press, 2003; Learning to Listen, Learning to Care, Lawrence Shapiro, Instant Help Publications, 2004; Books for Professionals: What Works for Whom: A Critical Review of Psychotherapy Research, Anthony Ross and Peter Fonagy, Guilford Press, 2004; Helping Children with Aggression and Conduct Problems: Best Practices for Intervention, Michael Bloomquist and Steven V. Schnell, Guilford Press, 2005