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ODD, PDD or ADD?
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ODD, PDD or ADD?

I just had an appt. with a seasoned pediatrician for serious issues we are facing with our 4.5 yr. old son. He is out of control at home, defying, screaming, hitting and throwing for no reason. He occasionally bites his older siblings hard out of anger or frustration. He is not affected by consequences, he doesn't seem to care. He seems to try to annoy people for no reason, although on the other hand he is extremely emotionally needy, constantly asking for kisses, hugs etc. He has no control over his impulses ie he would dart out into traffic, get too close to the flame on the stove, etc. No sense of danger at all. He has a gross motor delay ie can't pedal a bike. He also shows signs of some kind of PDD ie some echoing, toe walking, speech delay (expressive at first, now articulation), parallel play, lining up his toy cars every day, etc. He does make eye contact usually and can hold a dialogue in conversation about various topics. He has extreme separation anxiety, even needing reassurance when I leave the room to shower and on the verge of tears when I drop him off at school after many months. He exaggerates his physical sensations ie if we remove him from an area he yells "don't push me" or if I move a toy with my foot, he yells "don't kick my toys". He just seems so "different" than his siblings. We have taken the 123 Magic course, to no avail. We have firm limits that we enforce by promptly removing him and bringing him to his room. This goes on over and over all day with no improvement. The stress in our home is overwhelming, although we strive to maintain calm demeanors. The odd part is that he attends a Montessori nursery school and never misbehaves. He is more of a "loner" who is extremely focused on detail and reminding others of the rules and schedule, although he is making academic progress and seems to be a bright child. He has never shown any aggression or defiance there. Now, this is an independent kind of classroom where he chooses what to work on. We thought he would outgrow this and we're devastated. He is due for a complete developmental assessment next month. The pediatrician did a checklist kind of test on him and believes he has overlapping symptoms and the possible diagnosis differential he gave is 1. ODD 2. PDD 3. ADD. Does this seem at all reasonable? Could the PDD cause the ODD? He is advising us to start Risperadol. I told him I'd like to wait until after his assessment is complete, so we have a more realistic picture. Is this an appropriate drug for such a small child? Would it really help him and our family? Are there heavy duty side effects? I don't want to turn him into a zombie. Are there other drugs we should be investigating? What are his chances of doing well in a traditional school setting? I have a family history of ADHD, learning disabilities and a brother with severe bi-polar disorder that tragically ended in his suicide at age 21. Do you have any advice for us? Thank you so much for this valuable service.
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Basically I am going to support you in the direction you are headed. You are receiving very sensible guidance. The developmental evaluation is without doubt the correct course to pursue. There often are a number of conditions which exist alongside one another, and all those mentioned by your pediatrician are reasonable possibilities. Risperdal is a wise choice and may offer your son considerable relief. It would not be wrong to hold medication in abeyance until the evaluation occurs, but it also would be appropriate to proceed to provide some relief now. Without doubt a recommendation for pharmacological treatment will be forthcoming from the evaluation.
3 Comments
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To WalkersD,
Thank you for writing your letter.  I can not believe that I came accross it by accident.  That letter could have been written by me.  Every single thing your child does (he is 4), mine does.  I am so sick and tired of hearing people say to me about his behavior "he's a boy".  These people don't live with my child and have no idea what my son and I go threw every single day. And of course his behavior is always "my fault" according to other people.  My son even beats up kids he does not get along with not to mention the babysitters!  To make matters worse, he has a twin sister who is so easy going (thank God), that she misses out on so much of my attention.  I am at my wits end and have recieved help from no one.  I have tried to get help for this child since before he was 2.  I was ignored by my pediatrician so I went and had him evaluated on my own through the state.  Well they walked out because they could not stand to listen to him scream any longer.  And of course his montisorri preschool (which is wonderful) states he has no problem at school (like your son) so they will not give him services any longer.  And I have also had him evaluated by a phycologist who thought he had ODD.  I will keep pushing for him (and myself) to get help.  Most days are a nightmare.  But thank you again for writing your letter.  It really helped me to feel not so alone in the world of difficult children.
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Avatar_n_tn
I'm sorry you have to go through this terrible time with your son. It is a nightmare beyond belief! If you would like to correspond with me, to share experiences,  feel free to e-mail me at : ***@****  (walkersehATaolDOTcom)

Good luck.

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