Ask An Expert / Trauma and Grief

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

Disruptive behavior disorders are certainly possible explanations for these symptoms, but so is PTSD

Jamie M. Howard, PhD
Jamie Howard, PhD

Clinical Psychologist, Anxiety Disorders Center, Director, Trauma and Resilience Service

Child Mind Institute

I am a single mom and active duty military. I had a roommate for part of last year. About 7 months ago, shortly after my son turned 4 years old he told me something that was highly disturbing. He called my former roommate "the man that put his peepee in my mouth." For the last 6 months my son has been seeing a social worker for weekly therapy but nothing has been helping his behavior. His outbursts have been getting progressively worse, he has been very violent and deliberately defying all adults in every way possible. He recently got kicked out of his daycare for touching other children. On one occasion he locked a child in the bathroom with him to touch her private parts. We have tried positive reinforcements but nothing has helped, and nothing seems to faze him! Does this behavior sound like a child with ODD? In addition, he cannot sit still, he has trouble paying attention and sticking to one project at a time. Does this behavior sound like ADHD?

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.