We are putting this article in “The Counselor’s Corner” section because counselors, therapists and clinicians are often faced with making distinctions of diagnoses as they would pertain to the intervention or treatment they provide. Certainly, this information should be valuable to parents, teachers and other child-service professionals as well.
The line separating ODD (Oppositional Defiant Disorder) and Asperger’s Syndrome sometimes can be quite fine. That being said, I can’t see where I would diagnose both conditions in the same child or teen, although I’ve seen it done. In the case of these conditions, I believe it’s best to stay with one diagnosis or the other.
First of all, it’s quite possible that behaviors characteristic of ODD will continue without ever being diagnosed. Short-term interventions might bring just enough compliance for a child to clear a hurdle, such as doing just enough work at the end of the school year to pass–barely. Everyone then draws a sigh of relief and takes a break, until the next hurdle.
A child with Asperger’s Syndrome, the highest level of functioning on a diagnostic continuum called Autism Spectrum Disorders, is less likely to slip through the cracks undiagnosed. Youngsters with Asperger’s tend to have unusual mannerisms that, over time, are bound to be recognized and addressed.
Let’s compare these two youngsters on five characteristics: Etiology, Language and Communication, Social Awareness and Interaction, Capacity to Adapt, and Nature of Noncompliance.
Etiology: The behaviors characteristic of ODD are mostly related to temperament and the youngster’s perception of and reaction to circumstances and events close to them. External events can influence behavior dramatically, a critical notion in intervention. There are many theories as to the causes of Asperger’s, but genetics and organicity (brain chemistry and neurology) are thought to play a big part. With these children, issues of the condition are thought to be more internal than external.
Language & Communication: Although Asperger’s youngsters might have strong language skills, they are apt to comment inappropriately and even talk incessantly about a topic of their interest. The tone, volume and even the precision of their speech can be affected. They also have trouble with communication that contains humor, especially when it is subtle. ODD kids, on the other hand, “get” the message in humor, can have excellent language and communication skills, and can use them well. In fact, they’d often rather talk than do–which is precisely the problem.
Social Awareness & Interaction: ODD youngsters tend to be socially aware and responsive. They can participate in groups, enjoy athletics and are good leaders (partly because they don’t care to be compliant to another leader). By contrast, Asperger’s youngsters don’t handle social contexts well at all. In fact, they tend to isolate. Avoidance of eye contact is a big issue, and it is diagnostically significant. These youngsters often fail to sense a group code of conduct, something that can be reflected in their interactions.
Capacity to Adapt: ODD children and teens can and do adapt pretty well to new and unique situations. It’s interesting to note, however, that new and unique circumstances often put a temporary halt to defiant behavior, as the child is not yet “comfortable” enough to be defiant. (There’s a hint for intervention.) Youngsters with Asperger’s Syndrome don’t handle change well at all. Change for them is uncomfortable; it’s apt to bring on significant tantrum behavior and even meltdowns.
Nature of Noncompliance: ODD youngsters generally understand the compliance expected of them. They just don’t want to do it. There can be a strong quality of arrogance and passive-aggression in their noncompliance. Asperger’s kids, on the other hand, can distract themselves from compliance. They don’t necessarily intend to refuse, but the job doesn’t get done. They also can have trouble distinguishing that a compliance request is a specific direction, not a suggestion.
As one can readily see, treatment of these two conditions would be quite different.
Dr. James Sutton is a child and adolescent psychologist and former Special Education teacher. He is the founder and host of The Changing Behavior Network. [website]