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How does a therapist diagnose Oppositional Defiant Disorder versus Conduct Disorder?

There is a large overlap between Conduct Disorder and Oppositional Defiant Disorder, with similarities in both disorders that include:
  • anger
  • bullying of peers and siblings
  • defiance
  • disobedience
  • rebellion against authority
  • resentment
  • school problems

In order to differentiate between the two, one of the things a therapist will generally look at is how the adolescent treats animals. Is he or she mean or cruel to the family pets or kind to them?

Another area that is looked at is whether or not there have been legal problems, what those legal problems were, and if they are recurring or one-time events. For example, many adolescents experiment with shoplifting and end up getting caught, but this does not mean they have either a Conduct Disorder or Oppositional Defiant Disorder. However, if they keep shoplifting, or their activities turn to more serious stealing behavior, it is probably safe to assume that there is a more serious behavior problem going on.

In addition, setting fires and stealing (e.g., breaking into cars and stealing stereo) are more serious offenses that would generally tend to indicate a Conduct Disorder rather than Oppositional Defiant Disorder.

To further complicate the process of making a diagnosis, some research is now beginning to show that Conduct Disorder may be a component of childhood Bipolar Disorder, and there is a possibility that the behaviors attributed to Conduct Disorder or Oppositional Defiant Disorder are perhaps motivated by a mood disorder.

Bipolar disorder, formerly known as manic-depressive illness, described in simplest terms is a chemical imbalance in the brain that causes major mood swings, from elation to severe depression, which many times can be helped greatly with the right medication. Adolescents with Bipolar Disorder can experience mood shifts from very elated to very depressed several times in a day, making it nearly impossible for these adolescents to concentrate and get anything done. These mood shifts can cause symptoms that are similar to ADHD, and therefore this is just one more diagnostic dilemma for the therapist.

Other research shows that adolescents with ADHD can also present in a very similar way as those with either Conduct Disorder or Oppositional Defiant Disorder. The possibility that both Conduct Disorder and Oppositional Defiant Disorder may be a component of ADHD or Bipolar Disorder is being researched. Therefore, Bipolar Disorder and ADHD - as well as Conduct Disorder or Oppositional Defiant Disorder - are processes that the therapist must take into consideration when attempting to diagnose an adolescent who is displaying severe behavior problems.

The therapist may resolve the problem of overlapping behaviors and disorders by assigning more than one diagnosis to a youngster (called “dual diagnosis”). And as many moms and dads have discovered, because distinguishing among these disorders can be quite difficult, their youngster may receive one diagnosis from the therapist and a different diagnosis from the psychiatrist. This only adds to the concerns of the moms and dads, leaving them to wonder if anybody at all knows what is really going on!

More than half of adolescents with Conduct Disorder stop exhibiting these behaviors in early adulthood, but about one third of the cases persist, developing into antisocial personality disorder or other mood or anxiety disorders.

Parenting Children and Teens with ADHD, ODD and CD

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