My son may have been abused, and is now oppositional. Could it be ODD?

To answer your questions, yes—it could be oppositional defiant disorder (ODD), and it could be attention-deficit hyperactivity disorder (ADHD) as well.  These disorders can occur separately or together in children.

But to uncover the underlying causes of your son’s troubling and inappropriate behavior, it is necessary to treat the oppositionality first. It seems that this is the behavior that is interfering most with your attempts to help your son, and with his participation in the weekly therapy. It sounds like you’ve tried a lot of behavioral techniques, but it’s hard to say without being there how consistently they were implemented.

Without knowing all of the details it is hard to make a treatment recommendation, but I can say that parent-child interaction therapy (PCIT) can be incredibly effective at helping children and families manage impairing disruptive behavior. In addition, for kids with problem behaviors a highly structured environment is very important. This could be a therapeutic school environment with a small class size, sufficient support and monitoring, and teachers with specialized training to manage his behavior.

After his behavior is more under control, a professional can more accurately assess and evaluate your son, and perhaps offer a diagnosis. From what you’ve told me about your son and his history, I believe his problem could be pure ODD behavior. But it might also be symptomatic irritability and hyper-arousal, which belong to a cluster of symptoms associated with post-traumatic stress disorder (PTSD).

It seems that his teachers are concerned with his targeting and possibly harming other children. Of course, sometimes kids do engage in sexual play as a typical phase of development, but given what your son said about the man who was living with you and his sexually inappropriate behavior, it could be “re-enacting” behavior—which is something that kids with PTSD do. All people with PTSD have “re-experiencing” symptoms, but often kids will re-enact the experience through their play or their behavior. Fortunately, treatment for childhood PTSD is very effective.

I should also note that you may have experienced a lot of stress as a single mom in the military, especially if you’ve been deployed. I hope that you have an adequate support system, because making sure that you are healthy will greatly increase your ability to help your son.

In closing, whether your son has ODD, ADHD, PTSD, or doesn’t meet diagnostic criteria, his behavior is very concerning. And you can’t even try to assess for or treat ADHD or PTSD until this oppositionality is better controlled, which can be achieved with a highly structured environment, your commitment to a well-designed behavior plan, and a support system for you and your son.