Child Diagnosed with ODD

[MMO]

Hello.  Concerned about a child that will turn 6 in March.  He was diagnosed with ODD last year.  He started taking Straterra Aug 20, 2003.  He entered kindergarten in the fall and had the best social behavior in a social, group environment ever.  His meds were increased from one pill to two late last year.  Since Christmas, his behavior has been rapidly deteriorating.  He has starting chewing on his sheets and clothes again.  He is violent and disrespectful to his mother, but tends to not display the same traits (or degree of traits) to his father.  (they are divorced)  The past 2-3 weeks, he has gotten worse.  We are all fearful of his future.  He says things like: I am going to get a gun and kill you, I hate you, I want a new "mommy" or "daddy".  He got a scholarship warning from school last week and has been getting into a lot of trouble there since back from holiday break.  He receives time out, praise when he is good, toys taken away, all different methods of discipline.  He has issues dealing with groups and wants to be the center of attention.  He has been under the care of counselors, psychologists, and a psychiatrist.  What can we do now?  How do you know when ODD is moving into CD?  Should he be re-evaluated?  How does he back slide so rapidly when there have been no "changes" in his life?  It's tearing us apart.

[Kevin Kennedy, Ph.D.]

You may notice good improvement with the mood stabilizer that your son is now taking. Neither Adderall XR nor Straterra would have been predicted to benefit him in re: to mood problems such as anger or volatility. Tegretol, on the other hand, may well be useful for such symptoms, which often typify children who display ODD.

[amy1272hou]

Are you at all aware of Stratera's history? My Pediatrician Rx'd this drug to my son and we followed up that visit for testing with a highly respected Developmental Pediatrician for testing. The Developmental specialist about came out of her skin when I told her that my son was on Stratera.
First problem.. no one has any idea what this drug's long-term effects will be in children. It is new on the market and has never been tested in children in clinical trials.
Second problem... The drug was developed, originally for treatment of depression in adults. The drug did not perform all that well in clinical trials but received FDA approval anyway. The manufacturer released it to market to recoup some of the development cost and the drug failed to sell shortly after as it was not effective in treatment. The manufacturer has now decided to market the drug for use in the treatment of ADHD in children. The drug has never been indicated in use for children in the original FDA approval and never really worked well to begin with.
You should SERIOUSLY consult with your child's doctor about changing the medication. As the online specialist suggested, Fluoxetine (or Prozac) has been in use for a number of years with great results and very few side effects. The drug is indicated for use in children and, by all accounts, is quite safe and effective.

[samantha28]

My son will be 5 next month and has recently been diagnosed with ODD by his neurologist. He has put my son on Tegretol for this. We start counseling next week to help us deal with this disorder. His father acts the same way and has for his entire life. I do not want to give up on my son. His father is extremely abusive to everyone. I fear for my sons future as well. I am trying everything. I have tried everything his old counselor suggested. It all worked for 2 or 3 days and then quit. Because of this disorder my daughter (7), is now fighting with depression. I need someone's help. He has been on aderall xr and straterra. They did not help either.

[Kevin Kennedy, Ph.D.]

Relative to the difference between ODD and CD, the main variable to consider is the degree of antisocial behavior involved. It's a bit unusual for a six-year-old to be diagnosed with Conduct Disorder. But all this aside, the problem that demands attention is your son's anger and the way he expresses it, regardless of whether he displays ODD or CD. It's the symptom, not the diagnosis, that's crucial. Your description indicates that his decline coincided with the increase in his Strattera dose, and this invites scrutiny. It would be prudent to return to the intial dose and monitor his progress. If he does not improve, talk with the psychiatrist about alternatives. Possibilities include Fluoxetine (one of the SSRI's) or antihypertensive med (such as Clonidine or Tenex). Mood stabilizers can be effective in treating angry/volatile behavior, but may not be the first choice in a child so young.