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ADHD & ODD
ADHD and ODD
Caroline Stackhouse & Jennifer Ferraro
Introduction to Attention Deficit Hyperactive Disorder
Attention Deficit Hyperactive Disorder, commonly referred to as ADHD, is a disorder that includes symptoms of distractibility, impulsivity, and hyperactivity. ADHD is broken down into three subtypes: Predominantly Inattentive Type, Predominantly Hyperactive-Impulsive Type, and Combined Type. Children diagnosed with Predominantly Inattentive Type demonstrate symptoms such as poor sustained attention to tasks, whereas those diagnosed with Predominantly Hyperactive-Impulsive Type demonstrate symptoms of impaired impulse control and delay of gratification as well as excessive activity and physical restlessness. Those with the Combined Type have symptoms consistent with inattentiveness, impulsivity and hyperactivity.
In order to meet the diagnostic criteria for ADHD, behaviors must appear before age seven and continue for at least six months. Behaviors or inattentiveness, impulsivity or hyperactivity must be excessive, long-term, and pervasive. The behaviors associated with the disorder must create difficulties within at least two areas of life, including school, home, work, or social settings. In order for the condition to be considered ADHD, symptoms must extend beyond the usual distractibility and impulsive behaviors of childhood.
Below is the Criteria for ADHD taken directly from the Diagnostic and Statistical Manual of Mental Health, Fourth Edition (DSM-IV):
DSM-IV Criteria for ADHD:
Either A or B:
Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted.
Is often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
Often fidgets with hands or feet or squirms in seat when sitting still is expected.
Often gets up from seat when remaining in seat is expected.
Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
Often has trouble playingor doing leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively.
7. Often blurts out answers before questions have been finished.
8. Often has trouble waiting one's turn.
9. Often interrupts or intrudes on others (e.g., butts into conversations or games).
This is a helpful simulation of what reading a short passage might be like for a person with ADHD.
Intro to Oppositional Defiant Disorder
Oppositional Defiant Disorder, commonly referred to as ODD, is often found in conjunction with ADHD. ODD is a disorder in which children exhibit a consistent pattern of uncooperative, defiant, and hostile behavior toward authority figures. Symptoms of ODD are often seen in multiple settings, including both home and school. 1-16 percent of school-age children and adolescents have ODD. In order to be diagnosed with ODD, behaviors consistent with the symptoms of ODD must cause significant distress for the family as well as interfere with academic or social functioning. These behaviors must persist for at least six months. The effects of ODD can be greatly increased by other disorders such as ADHD.
DSM-IV Criteria for Diagnosis of ODD
Frequent temper tantrums
Excessive and aggressive arguing with adults
Questioning of rules
Defiance and refusal to comply with adult requests and/or rules
Deliberate annoyance or upsetting of people
Easily annoyed by others
Has few friends or has lost friends
Frequent anger and resentment
Mean and hateful talking when upset
Spiteful attitude and revenge seeking
Similarly to ADHD, ODD is diagnosed using a checklist. For this particular diagnosis, there needs to be a presence of at least eight symptoms listed. The checklist is then scored on a scale in which descriptive words are converted to a quantitative score. The descriptors “never” and “sometimes” are converted to a score of 0, and the descriptors “often” and “almost always” receive a score of 1. (DSM-IV, Ghanizadeh 180). These numbers are then evaluated along with andecdotal records in order to determine if a person should be diagnosed with Oppositional Defiant Disorder.
Although the exact cause of ODD is unknown, it is believed that a combination of biological, genetic, and environmental factors contribute to the condition. If children have a chemical imbalance in the brain, messages may not make it through the brain correctly, leading to symptoms of ODD or other mental illnesses. Also, many children with ODD have other mental illnesses such as ADHD, learning disabilities, depression, or anxiety, which contributes to their behavior problems. In addition, many children diagnosed with ODD have family members with mental illnesses as well. Environmental factors including a dysfunctional family life and inconsistent discipline by parents can also lead to the development of behavior disorders such as ODD.
History of Psychological Disorders
Attention Deficit Hyperactive Disorder, commonly referred to as ADHD, has a diverse and controversial history dating back to the 18th century. In 1798, Sir Alexander Crichton, a Scottish-born physician, addressed a mental state consistent with the inattentive elements of ADHD within his writings. He referred to symptoms of this disease of inattention as “mental restlessness.” Crichton inferred that the disease had implications in education. About a hundred years ahead of his time.
ADHD was first addressed as a disorder in the 20th century in 1902 when Dr. George Still, a British doctor, documented cases of impulsive behavior. Dr. still named the disorder “Defect of Moral Control” and believed the disorder to be a medical diagnosis. Throughout the early 20th century, methods of treatment for children who exhibited signs of the disorder were experimented with. In 1937, Dr. Charles Bradley used the first stimulants to treat children who were through to have the disorder. In 1956, Ritalin was introduced to treat children considered to be hyperactive. Through the 1960s, stimulants were increasingly used to treat children who were overly hyperactive. In the early 1960s, the disorder was called “Minimal Brain Dysfunction,” but the name was changed to “Hyperkinetic Disorder of Childhood” by the end of the decade. Throughout the 1970s, more symptoms were associated with the disorder. In addition to hyperactivity; impulsiveness, lack of focus, and daydreaming were identified as symptoms of the disorder. In 1980, the name “Attention Deficit Disorder” was coined and then revised to “Attention Deficit Hyperactive Disorder” in 1987. In 1996, Adderall was approved to treat ADHD. In 2004, the United States Senate established the National Attention Deficit Disorder Awareness Day as September 14 to educate the public as well as raise awareness about ADHD.
ADHD and Medication
The decision of whether or not to medicate an individual with a psychological disorder is an extremely important and difficult decision to make for both the individual and their family. Here are two different perspectives on the subject. The perspectives do not reflect our personal views, just those that we have come across in our research.
People with Attention Deficit Disorder and Oppositional Defiant Disorder can benefit from medical stimulants.
ADHD is one of the most common childhood disorders as it affects three to seven percent of all school-age children (Sciutto & Eisenberg, 2007). Due to its prevalence, the rate of use of stimulant treatment has significantly increased over the last ten to 15 years (Sciutto & Eisenberg, 2007). When a child has ADHD, their quality of life is dramatically impacted. Children and their families experience effects of the disorder at home. Also, ADHD can negatively impact children’s school performance due to lack of attention. In order to remedy the symptoms of ADHD, stimulants are used and research has found that stimulants are effective in minimizing the symptoms of ADHD.
ADHD is one of the most prevalent childhood disorders, affecting three to seven percent of all school-age children. When a child is diagnosed with ADHD, they experience symptoms ranging from inattentive behavior to impulsivity. Symptoms of ADHD can hinder aspects children’s everyday lives. Stimulant treatment is the single most effective treatment for ADHD and alleviates the primary symptoms of the disorder. Stimulant medication can positively impact the lives of children with ADHD as well as those around them and has been used as a form of treatment for ADHD since the early twentieth century. 90 percent of children with ADHD will receive some form of medication as a treatment regimen with 70 percent receiving a stimulant medication. Research has shown that at least two out of three patients treated with a stimulant medication has a positive response. Stimulant medication has resulted in improvements in the symptoms of ADHD across a variety of settings. Medication can help reduce symptoms of hyperactivity, inattentiveness, and impulsivity in children with ADHD. Stimulant medication has positive implications for students with ADHD in the classroom, resulting in increase in in-task behavior as well as improved educational productivity. Also, stimulant medications have a positive impact on children’s home lives through improving family functioning and reducing the stress that ADHD often causes. Stimulant medication can also remedy the social difficulties that some students may have due to the disorder and improve self-esteem. Stimulant medication has positive implications stemming across multiple facets of the lives of children with ADHD and those around them.
The symptoms of ADHD found within the Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition (DSM-IV) demonstrate a significant connection between ADHD and difficulties within the classroom. According to the DSM-IV, children with ADHD often do not pay close attention to details, leading to careless mistakes in schoolwork. Students with ADHD may have difficulties accurately completing assignments. Due to difficulties with accuracy, students with ADHD’s academic performances are inhibited. Also, children with ADHD have difficulty keeping attention on tasks and listening when spoken to. This symptom can affect students’ performance within the classroom as well. For example, when teachers give assignments in class or dictate lessons, students with ADHD have difficulties completing the tasks or listening to and comprehending the lessons. Children with ADHD often do not follow instruction and fail to complete assignments. When teachers give instruction, students with ADHD have difficulty remembering and therefore following them. Children with ADHD are often disorganized, forgetful and easily distracted, which all negatively impact a student’s academic performance. Also, it is difficult for children with ADHD to complete tasks that require a lot of mental effort for an extended period of time. This symptom can negatively impact students’ abilities to successfully complete assignments during class as well as homework. Students with ADHD consistently perform lower than their peers without ADHD on forms of assessment as well (cite).
Stimulant medications can alleviate the symptoms that are consistent within students with ADHD that negatively impact their education. A case study by Nicholas Hartlep (2009) examined the effects of ADHD and stimulant medication on the educational performance of a second grade boy named Dmitrov (pseudonym). Hartlep describes Dmitrov’s adjustment to school as being extremely difficult. In the classroom, Dmitrov often blurts out answers in class and exhibits a lack of self-control. His behavior is described as disruptive to those around him. In addition, his behavior negatively impacts his own learning as items on his desk as well as activity around him consistently distract him. His teacher has tried numerous interventions to change Dmitrov’s behavior such as moving his seat closer to the classroom; however, none positively impacted his attention. Dimitrov has a history of having outbursts in class as well. These outbursts are extremely disruptive to his peers. When asked questions about school, Dmitrov responded that the thing he likes the least is that “a lot of things are difficult” for him. Dmitrov’s teacher described his impulsivity and lack of ability to concentrate for extended periods of time as the greatest factors connected to Dmitrov’s difficulties in school.
In order to reduce the effects of Dmitrov’s ADHD on his learning within the classroom, he was prescribed a dosage of Concerta, which is a stimulant medication. Dmitrov began reciving medication in January of second grade. At the beginning of the year, Dmitrov’s phonics, vocabulary, and spelling were all significantly below grade level. In addition, he was reading below grade level and had difficulties with reading fluency and comprehension. At the end of the year, Dmitrov’s scores improved to at or above grade-level for each area. His teacher described a drastic change in his ability to focus after taking Concerta and contributed his academic improvement to him receiving treatment. Prior to receiving the medication, Dmitrov’s interruptions in the classroom peaked at 15 each day. However, after he was prescribed Concerta, his number of interruptions decreased to two per day after a month of treatment. The positive impact of a stimulant medication on Dmitrov demonstrates the benefits of ADHD medication.
Symptoms of ADHD extend beyond the educational setting and affect students’ social skills and interactions with others as well. Children with ADHD experience major difficulties in social relationships (cite). Studies have shown that children with ADHD are more rejected by their peers than children without ADHD (cite). Children with ADHD tend to be more aggressive and less popular and neglected by their peers as well has have difficulty making and keeping friends (cite). Also, studies have shown that children with ADHD are more likely than children without ADHD to be victims of bullying and to bully others (cite). In general, children with ADHD exhibit lower levels of social competence and social knowledge (cite).
In the case study of Dmitrov, which was previously discussed, social factors greatly influenced his parents and teachers to suggest placing him on medication to reduce his symptoms of ADHD. Dmitrov’s symptoms, like many children with ADHD, segregated him from his peers. His actions inside and outside the classroom led to him being ostracized. Dmitrov demonstrated difficulties listening when someone is speaking, maintaining friendships, making new friends, and common social rules such as personal space. In addition, Dmitrov’s impulsivity caused by his ADHD led to multiple incidents in the classroom that upset his peers. For example, when it was raining outside one day, Dmitrov was frightened and demonstrated his high anxiety within the classroom. The class was directly affected and many students were scared by the episode. Events where Dmitrov does not uphold the common behavior of his peers directly affect his relationship with them. Once Dmitrov was placed on Concerta, the number of emotional episodes he had decreased demonstrating the positive effects of the stimulant. Similar to Dmitrov’s improvement, stimulant medication treatment has shown to increase children with ADHD’s social understanding as well as improve their self-esteem.
Symptoms of ADHD also affect students’ home lives and familial structure. Many parents may find life with a child with ADHD to be frustrating and overwhelming. The demands of a child with ADHD can be physically exhausting for parents and can create stressful situations at home. Children with ADHD tend to have stressful and confrontational interactions with their parents, making it difficult to establish strong parent-child relationships (Mautone). Also, families of children with ADHD have more difficulty supporting their children’s education (Mautone). Stimulant medication has been shown to improve family functioning due to the decrease of the impact of ADHD’s symptoms on family structure.
Stimulant medication, received by approximately 70 percent of children with ADHD has been proven to alleviate symptoms of the disorder and positively impact multiple areas of the lives of children with ADHD. Stimulant medications help increase children’s attentiveness while reducing their impulsive tendencies. Within the classroom, medication greatly improves student performance. Students such as Dmitrov demonstrate a decrease in their off-task behavior, thus leading to greater levels of academic performance. When placed on a treatement regimine, students with ADHD show greater levels of compliance as well as academic performance. In addition, stimulant treatment has shown to improve children’s self-esteem and strengthen their understanding of social cues. Children who have greater self-esteem and an understanding of how to interact with others are more likely to make and keep friends, which promotes a more positive outlook on his or herself. Home lives, made stressful by supporting the symptoms of ADHD, improve through the decrease of ADHD symptoms. Stimulant medication provides support for children with ADHD extending beyond academic interventions and positively impacts multiple areas of life.
Adderall shortages have been reported a lot on the news lately. Here is a clip from npr.org that shows how essential daily medications can be for some.
People with Attention Deficit Disorder and Oppositional Defiant Disorder should not be treated solely with medical stimulants.
People with Attention Deficit Disorder and Oppositional Defiant Disorder should not be treated solely with medical stimulants. “ADHD is a neurobiological disorder that affects individuals across the lifespan” (help4adhd.org). ADHD and ODD are disorders that affect a person’s lifestyle. Using medical stimulants are not the only treatment options for people with psychological conditions; many find other treatment processes can be just as or more effective as a prescribed medication. The market for ADHD medications has grown dramatically in the past few decades and it is questionable that these numbers are appropriate. The diagnosis for these psychological disorders is a very subjective process, which could in result in the inappropriate prescription of medications. Finally, as with all medications, there are potential negative side effects could be avoided if the individual does not need the medication that was prescribed.
There are different diagnostic traditions in different countries such as the United Kingdom. As a potential result of this, the UK has lower prevalence rates than the United States (Scheffler 451). This could show a potential over diagnosis in the United States and therefore a possibility of over-prescription of stimulants. According to Scheffler, a study on global trends in the market for ADHD medications confirmed that the United States is the largest consumer of ADHD medications by a significant amount. The prescription of stimulant drugs is also dramatically rising globally. “In 1993, thirty-one countries had adopted the use of ADHD medications, by 2003, the number had grown to fifty-five” (Scheffler 451). Many may argue that that is due to an increasing about of diagnosis throughout the ten year span, however it is possible that there is also an over-diagnosis of the disorder. “Although the increase might be leveling off for children, much concern has been raised regarding the potential for over diagnosis of the disorder, the potential for overuse of these medications, and the possibility of diversion and abuse, weighed against their important clinical benefits under conditions of careful diagnosis and treatment monitoring” (Scheffler 455). With an over diagnosis of the disorder, there is a relationship with the overuse of certain medications. Many are fearful that this can increase the abuse of these stimulant medications. There is a potential that prescription stimulants could be given to people without ADHD in order to improve study skills or potentially create euphoric feelings (Scheffler 451).
Individuals who take these stimulants risk negative side effects that can accompany stimulant use. Although most of the noted side effects are mild and unintentional, such as dizziness, dry mouth, and restlessness, there is concern about negative cardiovascular effects and suicidal thoughts. (Scheffler 450). These concerns are great enough to consider when deciding whether or not to take these medications.
There are alternate forms of treatment, if the individual chooses not to go in the route of medical prescriptions. Many find that diet and behavioral modifications can show vast improvement in the lifestyle of individuals with ADHD and ODD.
Here is an discussion from www.npr.org on how a change in diet can improve ADHD symptoms:
When deciding what behavioral treatment may be best for an individual, it can be helpful to consider other cases that have similar situations:
Eva S. Levine and Daphine J. Anshel provide a case study, which follows an 8-year-old second grade boy named “Alex” who showed symptoms of Behavioral disinhibition and inattention problems. He was treated used Cognitive Behavioral Therapy with strategies that included parent, teacher, and child focused interventions. Alex was referred by his general education teacher because of disruptive and inattentive behaviors such as leaving his seat and distracting his peers. Because of these behaviors, Alex was socially isolated by his peers.
After parent and teacher interviews, it was concluded that “Alex exhibited chronic and clinically significant symptoms of inattention and hyperactivity-impulsivity” (Levine 300). Alex also reported feelings of sadness and low self esteem. Alex was diagnosed with Combined Type ADHD. Alex’s parents and interventionists agreed that with a treatment plan, Alex’s relationships should improve.
Behavior modification programs were accommodated for Alex’s school and home needs. Alex’s mother and general education teacher received training to focus on antecedents (environmental changes) that shape Alex’s behavior through consequences such as selective attention. Alex was also provided with more extensive supervision both at home and in school in order to improve task-completion. Alex was also given a token economy system in order to increase his motivation and appropriate behaviors. To ensure that the initial symptoms are improving, progress monitoring was necessary. This would help the team determine whether or not the intervention is working and if not, what aspects of the program need to be altered.
The case study of Alex shows that there are successful, non-
treatment methods for students with Attention Deficit Hyperactivity Disorder. Similarly, programs can be devised for students with Oppositional Defiant Disorder.
As a parent of or individual with either of these disorders it is extremely important to consider all treatment options. While the easy route would be to accept a prescription to a stimulant medication, it can be more beneficial for the individual to consider an option that is best for their specific needs. The diagnosis of these psychological disorders is growing more and more prevalent both around the world and in the United States. Special Educators need to be aware of the treatment options for the student populations that they will be working with.
Finding alternative treatment programs for ADHD and ODD is an extremely beneficial way to approach the disorders compared to pharmaceutical treatments. It teaches the students appropriate behaviors without risking any of the negative side effects or concerns of over-diagnosis.
Areas of Future Research, Directions, or Controversies Regarding ADHD and ODD
When researching a particular subject, many more questions and research opportunities arise. Both Attention Deficit Hyperactivity Disorder and Oppositional Defiant Disorder are growing more and more prevalent in our society. As a result, it is important to be constantly evaluating our knowledge on the subject. Throughout our research, many new question had risen that would be not only interesting, but our duty as educators to continue to research.
We came across many questions of the validity of diagnosis for both ADHD and ODD. Many feel that it is a very subjective process and as a result, is extremely dependent on the expertise of the clinician. It would be interesting to research more into this subject to better understand the training that clinicians need to undergo in order to be qualified to diagnose someone with ADHD or ODD. It would also be interesting to see if any research has been done towards creating a more objective diagnostic process. With that in mind, it may be interesting to consider that the questions may not be relevant for different cultures. Should the questions on the diagnosis checklist for ADHD and ODD be altering according to specific cultures? For example, children in some cultures are not expected to make eye contact with adults, so criterion such as “Often argues with adults” or “often actively defies or refuses to comply with adults’ requests or rules” may not be as relevant as they would be for children in other cultures.
In our research w
e evaluated medications from two different viewpoints; children should be given stimulant medications as a form of treatment for ADHD or ODD, or student should not be given these medications. It would be interesting to further this research and evaluate the effectiveness of different medications and dosages. It would also be interesting to learn the method for choosing different medications and dosages. If ADHD or ODD is not quantatively measurable, then how do clinicians determine the dosage? As a future educator, this is less relevant information, but it would be interesting information as a researcher.
Many disagree with whether or not educators should be able to know the medications and dosages that their student’s are taking. It would be interesting to research both perspectives of this argument and be able to come up with our own educated opinions on the matter.
What this Means for Teachers and Schools
Whether or not a student is being medically treated for
either ADHD or ODD, it is imperative that both special educators and general education teachers are aware of academic and behavioral strategies that can support students with these
disorders. Many districts are making the effort to educate their teachers specific instructional strategies that can be successful for particular disorders. For example, Suffolk Public Schools in Suffolk, VA provides an extensive website available to parents and teachers that details classroom strategies and accommodations for children with ODD. This information can be found here:
Teachers should collaborate with parents and ensure that there are consistent expectations for the child both in school and at home. Students with ADHD and ODD should be provided with a structured environment, and yet be allowed certain freedoms and choices. Teachers and schools should constantly be educating themselves with up-to-date evidence based strategies that will help teach students with ADHD and ODD.
Teachers and schools also need to be aware of the legal rights that their students with disabilities have; including the right to accomodations within the classroom. Accommodations for students with ADHD or ODD might include frequent breaks that can be known as "Chill Passes," where they can take a sensory walk around the school or meet with the school psychologist.
Finally, it is imperative that schools consider transition services for their students with disabilities. This involves specifically outlining the students strengths and weaknesses and creating a plan that supports the student beyond graduation. Students with ADHD and ODD should have been receiving interventions throughout their schooling on appropriate behaviors in society. For transition students, interventionists will want to work on detailing behaviors in environments that the specific student may find themselves in after graduation.
Remember: These are disorders, but
Your students can be anything they aspire to be!
Here's a list of celebrities that live with ADHD from www.parenting.com.
Justin Timberlake (singer, songwriter, actor)
Jamie Oliver (star chef)
Will Smith (actor, singer)
Michael Phelps (olympic medalist)
Jim Carrey (actor)
Howie Mandel (host Deal or No Deal)
Terry Bradshaw (former NFL quarterback)
James Carville (political consultant and commentator)
Paul Orfalea (founder of Kinko's)
David Neeleman (founder of Jetblue Airways)
Bruce Jenner (olympic medalist)
What to Learn More? Check Out These Additional Resources
Attention Deficit / Hyperactivity Disorder
This comprehensive website through the Center for Disease Control and Prevention provides information about symptoms of ADHD, treatment options, research, as well as recommendations for parents and teachers of children with ADHD. Useful data and statistics are provided. The website is easy to navigate and very informative.
ADHD In School: A Resource For Teachers
ADHD In School provides useful information concerning specific behavioral and instructional strategies that teachers can use to most efficiently teach students with ADHD. Suggested strategies and interventions are divided into elementary and secondary school level. The website includes information about strategies parents can use at home as well.
Living with ADHD
CHADD.org is a comprehensive website for children and adults with attention deficit disorder. The website provides a brief history of the disability along with their mission statement “CHADD improves the lives of people affected by ADHD.” It also details the causes, symptoms, evaluation, treatment, and disorders that may coexist with ADHD, such as behavioral or mood disorders and Specific Learning Disabilities. The website connects those who are affected by ADHD to support groups such as local CHADD chapters and online communities. It also provides information on relevant conferences to learn more about ADHD.
Where to Find Help
help4adhd.org is another helpful resource that provides information about ADHD including diagnosis and treatments, advice for dealing with the legal system, insurance, and public benefits programs. It also discusses educational issues such as student rights, college and financial aid, as well as information for teachers. The website provides an extensive amount of information about living with ADHD, understanding that it is a disorder that lasts across the lifespan. It provides information on parenting, relationships and social skills, workplace issues, money management, and much more.
Legal Help and Advice
The Special Needs Alliance (SNA) is a national and not for profit organization comprised of attorneys that work with disability and public benefits law. They advocate for individuals with disabilities and their families. SNA supports families by working on Specials Needs Trusts and Wills, guardianship, and medical malpractice settlements. SNA also supports it’s clients by determine the public benefits that are available to them and works with the individuals with disabilities and their families to help them understand their rights and the opportunities that are available to them.
Additional Information on ODD
Unfortunately, credible information on living with ODD and working with students that have ODD is currently limited on the Internet. This website has a section that provides brief information on the causes, symptoms, assessing, and treatment.
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