People with Asperger’s usually collect labels like ADHD, anxiety disorders, or bipolar disorder before they’re diagnosed with AS. The label that annoys me is Oppositional Defiant Disorder. Is there a difference between people whose Asperger’s-related behavior is misunderstood and ODD? I find that ODD is sometimes simply a description of behavior without a cause.
Insurers ask for diagnoses based on ICD 10, the “handbook” of diagnoses. One of the official ICD 10 descriptions of AS is that it’s a “neuropsychiatric disorder whose major manifestations is an inability to interact socially; other features include poor verbal and motor skills, single mindedness, and social withdrawal.”
ICD 10 describes ODD as a behavior disorder and a psychopathological disorder. It’s described as a “recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures.” The criteria include “frequent occurrence of at least four of the following behaviors: losing temper, arguing with adults, actively defying or refusing to comply with requests or rules of adults, deliberately annoying others, blaming others for own mistakes, and being easily annoyed, angry or resentful.”
ICD 10 is right in my experience in describing those with Asperger’s Syndrome as “single minded.” This is a real strength when doing tasks, following rules and being honest. However, single mindedness can also include inflexibility or even severe rigidity in sticking to a point of view.
When an inflexible demand is made of an inflexible person, you have rigidity meeting rigidity. That’s not going to work. For people with AS, what’s being perceived as oppositional, hostile or rule breaking is actually more about having a fixed way of viewing the world.
Especially when rules or demands seem illogical or unfair, those with AS can dig in and stand their ground. Many with AS and NLD also have concrete or literal thinking, which adds to the mix of misunderstanding and “rule breaking.”
I worked with a boy who could not understand why he couldn’t rock back in his chair in the classroom. The angle was slight and posed no real danger to himself or anyone else. The teacher insisted on the ‘four chair legs on the ground” rule.
When this boy wouldn’t comply and argued, he was sent to the principal’s office. The class, meanwhile, went to recess. The principal was busy, so he told the boy to wait there a minute. The boy sat for one minute (he watched the clock) and then went to recess.
It seemed to the teacher and the principal that this boy was just seeing how far he could push them. That makes sense, unless you understand this boy.
This boy often got in trouble for doing things that seemed OK to him. He was acting in ways that made logical sense from his perspective. His understanding frequently missed social norms or nuance.
His teachers tried to set limits using consequences, assuming he understood why he was in trouble. He concluded that no matter what he did, the people at the school didn’t like him. He was annoyed and resentful. They concluded he was ODD.
In any setting where inflexibility is the norm and there isn’t an understanding of divergent or concrete thinking, it’s not surprising that the AS individuals are seen as oppositional and given the ODD label.
The problem is that the ODD label misrepresents the thought process of the person doing the opposing. Since ODD behavior is seen as willful disobedience, the response usually is punishment instead of clarification, collaboration and education. The ODD label is usually pejorative; the person is seen as a “bad actor” and there is a halo effect of how he or she is seen and treated.
This boy worked with me after this incident at school, and we explored what had happened. I let him know I understood his view that his chair wasn’t making a lot of difference. I then wondered what the class might be like if everyone was doing something different with his or her chair at once. It might be pretty distracting. So it made a little sense that there was a need to keep the class distraction-free.
ICD 10 mentions language problems with AS. This problem is usually with pragmatic language skills. Those with AS often miss the meaning of figurative and inferred language. “Wait a minute” doesn’t mean wait a minute; that’s figurative language and the real message (wait until I get back) is inferred. It would have been much clearer for the principal to speak directly, which would be, “Wait here until I get back.”
I find that schools and families often are given an AS diagnosis without really knowing how that translates into everyday behavior. As a result, they don’t understand the thought process and the need to be clear.
Before schools (and parents, and families) label behavior problems as ODD, they need to explore the thinking of the child involved. Though certain explanations of behavior might seem intuitive to the parent or teacher, this behavior might not be intuitive to the child with AS or NLD. Ideally, once the teachers and parents “get it,” they’ll be better able to be helpful and provide meaningful explanations and valuable insight instead of creating a negative experience. This takes time, but it’s well worth it.
by Marcia Eckerd, PhD
This article originally appeared on PsychCentral.com as “Do People With Asperger’s/NLD Really Have ODD (Oppositional Defiant Disorder)?“. All rights reserved. Reprinted here with permission.
Dr. Marcia Eckerd has been in practice as a licensed psychologist since 1985. I am on the CT ASD Advisory Council and the Clinical Advisory Committee of the Aspergers/Autism Association of New England, as well the professional advisory board of Smart Kids with LD. Aspergers101 is honored to offered the knowledge and experience of Dr. Eckerd through her informative blogs!
Literal thinking is not a sign of oppositional defiant disorder usually. But people with Asperger’s are more in touch with reality than the rest of the population. Also people with ODD are vindictive and want to get back at others.
Another difference between ODD and Asperger’s is that people with Asperger’s get annoyed by people and those with
ODD go out of their way to annoy others. Many signs of AS are caused by anxiety but nobody knows what causes Oppositional Defiant Disorder.
Merry Christmas! My teen nephew has been diagnosed with ODD after years of no treatment/intervention at all. In the past year, he’s has a bit of psychiatric/psychological treatment, but is now refusing all treatment–leading to his current diagnosis. I’m no expert, but I’ve long suspected AS. He has bouts of aggression that seem to come out of nowhere, is very argumentative, and seems to enjoy pushing people’s buttons and being vindictive–ever since he was little. He is socially and physically awkward, shows no interest in his physical appearance, wears a winter jacket in stifling hot weather (even indoors), and prefers to be alone, reading or playing video games. He rarely takes off his headphones, even where they’re not plugged into anything. He’s become much more socially withdrawn in recent years. He’s very structured, needs to know what’s coming, and reacts negatively to unexpected changes. He is also a very literal thinker, although he often seems to be very aware of this and enjoys using it against people (sometimes playfully, sometimes not). For example, if you were to tell him to “wait a minute”, he would do so, as described in the example above, but then laugh at his cleverness and rub it in your face that you only told him to wait a minute. In other words–he often understands nuances, but takes advantage of literal interpretations (does that make sense?)
I am so glad to have found this article…for the past 4 years I have been fighting, trying to change my sons diagnosis fromODD to AS… my son while sharing many symptoms of ODD is not mean, resentful, hateful or vindictive. He is very unruly and is now being sent off to a school for children with behavioral problems and not AS…i am so beside myself with trying to get my son the help he actually needs…
My son has been diagnosed with ADHD, ODD, anxiety, and depression. I’m a nurse and feel that maybe he actually has AS. His symptoms overlap so much. Can this be possible? He is so fixated on certain things and completely ignores others. Same with rules. Please help.
This was a great explanation!!!
Dr. Eckrd, thank you for this insightful article. I have a 13 year old son in 7th grade with an AS diagnosis. As of late ( a year or so) I have seen an increase in his anger, defiance and argumentativeness. It is hard to get through the day without arguments and raised voices. Hi teachers have reported problems in school having to do with meltdowns ( in his case making loud noises of displeasure) about assignments, homework, tests etc. He will yell “this is not faird!”and strom out of the classroom. He is also doing “mischievous” things that are disrupting. Any time he is told “no”,or “I am sorry you can not” it causes him to immediately get angry and yell. Anything that takes away time from his preferred activity is met with an automatic “no!”. When met with a problem (for example computer glitch) we have a very hard time helping him as he get very impatient and pushes us away (figuratively speaking). “No! This is not how you fix it!” he wants help but does not know how to receive it. It is exhausting. We are exhausted. Teachers are exhausted. I am having an IEP meeting next week and I honestly do not know what to do/say/advise the educators. Thankfully, his school seems to be opened to suggestions but I am very concerned all teachers will not be on board since they have many kids to deal with. Follow up question: have you seen any evidence of CBD oil helping with anxiety/ having calming effect on the child? Thank you for your time!
There’s obviously no simple answer. There’s no research on the use of CBD oil for anxiety that I know of and certainly not in children. It would be hard to get that research approved! So I can’t give you anything evidence- based. I personally haven’t had any experience with adults using it, since it’s illegal in CT. I understand that the “high” properties are removed, but I don’t know if that means there is no impact on child or adolescent development.
It seems like your son’s increased irritability might coincide with hormones and his transition to adolescence, which can be a trigger for behavior issues and mood disorders. So there may be a biological component to it in addition to any environmental stressors (curriculum or social environment of school more difficult, some stressor at home).
If he’s willing, meditation can be a useful tool for self calming. Regular daily practice actually causes structural change in the brain to be more stress resilient. Headspace is a good app. He can use his meditation techniques during the day.
Some kids benefit from sensory tools like pressure – you might consider that.
I’ve had some really impressive results for two kids with poor emotional regulation with Neurobiofeedback, which is approved by the American Pediatric Association as a treatment for ADHD.
If his over-responsiveness is extreme and very disruptive at home and school, a consultation with a child psychiatrist would be a good idea.
I have been teaching elementary students for the past 20 years and have had my share of experiences with students who have been diagnosed as ADHD, AS, ODD, and ADD. I am teaching a 6th-grade female who has been diagnosed with AS and has been at the same school since kindergarten. I am wondering what are some of the best methods for teaching a student who is defiant towards adults and school work in general? Again, I have exhausted all of my tools in the tool belt because the majority of students I have had with these labels are boys. Is there a difference in with boys and girls and how the display AS or ADD? Should a 6th-grade student still be shouting at adults who are trying to teach her? Would love some answers…
What suggestions do you have for parents with children exactly as you described above and the school district is not in the clarification, collabrative and education mindset?
You’re describing a challenging situation. It would be helpful to have a professional diagnosis for your child, if you don’t already, and to go through the special education process. In my state, a parent can request a PPT meeting to review the plan for a child and to decide if an individual education plan (IEP) is needed, if the child qualifies for one. It could be helpful to have the professional present, and if you can afford it, a special education advocate who knows the laws protecting your child. You can request (if you don’t already have) teacher reported behaviors, and the professional can clarify those behaviors in the light of the diagnosis and presentation of your child. Hopefully, with the behaviors reframed as secondary to a disability, there will be more interest in clarifying and collaborating in addressing the behaviors.
I am curious about diagnoses of Aspergers. My 9 year old son was given a diagnoses of “developmental delay when he was 4”. I was told often kids just don’t have a definitive diagnoses. Being his Mother,no saw his behaviors and reactions in many settings, and I asked about Aspergers as a possibility. I was told that was no longer a diagnoses, and because my son looked for validation when playing with toys, he didn’t fit within the autism spectrum. In addition, they also stated he did however have many characteristics consistent with autism. I am not seeking any particular diagnoses, just guidance on how to best serve my child. Without knowing how he works, it is hard for me to work with him.
I have a Son who’s 40 and I think he’s has Aspergers he’s always been obsessed with games and has literal thinking black and white no Gray area he also constantly interrupting conversations and everything he says is based on facts he’s also often has what I can only describe as having a melt down and that he’s always right . I have 6 grandchildren 4 are on the spectrum so have 14 years first hand experience
It certainly sounds possible, we often see parents diagnosed after children. I’m assuming your son isn’t exploring this for himself and he’s doing well enough to function as an adult. In my experience we grandparents do our best by giving our support unless asked for help or advice.
I enjoyed reading your article and gained a lot of insight into the difference between ODD and Asperger/Autism. As a district wide Behavior Consultant, I often find myself defending student’s behavior because “I understand”. Unfortunately, It is difficult to help others “see” the big picture. Can you give me some resources to help educate teachers in regards to your topic and suggestions for teaching replacement behaviors? I believe the key is to teach students how to be flexible thinkers, but I don’t have good researched based methods to do this. Any and all help is greatly appreciated!!
I understand it can be very difficult to convince teachers (and administration)to understand that behavior is secondary to a disability and not oppositional. This is very important not only for appropriate responding, but legally there is supposed to be a different disciplinary standard for behaviors due to a disability. I suggest showing them the diagnostic criteria for Asperger’s and for ODD as well as my article. If you need links for those you can email me directly, eckwestoff@gmail.com. As or teaching flexibility, that is a challenge. I find Ross Greene’s collaborative problem solving approach most useful. Usually these kids are most often met with “Don’t” or “Stop” and feel misunderstood. Step one is to ask the student for his or her perspective and really hear it. Ask questions and clarify so the student feels understood. Then you can share, “I really get it that you feel that …, “ and introduce another idea “Could it be that…”. You’re not looking for agreement, but baby steps toward understanding that there might be another way of seeing something. I often find it’s best to introduce something logical, like “I get your response, it makes sense, but are you getting the result you want?” You might look at my blogs on Psych Central – there’s a few on talking with AS kids.
I understand it can be very difficult to convince teachers (and administration)to understand that behavior is secondary to a disability and not oppositional. This is very important not only for appropriate responding, but legally there is supposed to be a different disciplinary standard for behaviors due to a disability. I suggest showing them the diagnostic criteria for Asperger’s and for ODD as well as my article. If you need links for those you can email me directly, eckwestoff@gmail.com. As or teaching flexibility, that is a challenge. I find Ross Greene’s collaborative problem solving approach most useful. Usually these kids are most often met with “Don’t” or “Stop” and feel misunderstood. Step one is to ask the student for his or her perspective and really hear it. Ask questions and clarify so the student feels understood. Then you can share, “I really get it that you feel that …, “ and introduce another idea “Could it be that…”. You’re not looking for agreement, but baby steps toward understanding that there might be another way of seeing something. I often find it’s best to introduce something logical, like “I get your response, it makes sense, but are you getting the result you want?” You might look at my blogs on Psych Central – http://blogs.psychcentral.com/aspergers-nld/ -there’s a few on talking with AS kids.
Great article! I will share this with many people that don’t understand my son…. they think it all behavioral but never look deeper than that!
THANK YOU
It is possible for a child to be both autistic and odd. One in ten are diagnosed with both.
My point is that often the ODD diagnosis is simply a way of describing behavior; if behavior that is noncompliant is not understood to be due to something else, it’s assumed to be an ODD. The presence of an autistic spectrum disorder provides a likely explanation for the noncompliant behavior.
If behavior that is noncompliant is not understood to be due to something else, it’s assumed to be an ODD. The presence of an autistic spectrum disorder provides a likely explanation for the noncompliant behavior. To me, often the ODD diagnosis in addition to the ASD diagnosis is simply saying someone isn’t doing what’s wanted again.
Thank you for clarifying more distinctly the difference of these two disorders, specifically Aspergers. This was very beneficial to me. IDEA was a wonderful rule, but fails to be as beneficial as intended without the proper education of disorders for educators.
Comment “Since ODD behavior is seen as willful disobedience” then how is it a ‘Disorder’?
Thank you for increasing awareness of HFASD. Your explaination of ODD versus Aspergers in relation to figurative language interpretation is appreciated.
Great post! I agree about the many incorrect diagnoses that kids often get before the correct ASD diagnosis. Here’s my 2-minute public radio Perspectives essay: http://ww2.kqed.org/perspectives/2016/04/04/autism-spectrum/
The problem begins with the words “neuropsychiatric disorder.” The co-morbid issues of anxiety, ADHD, and more are explainable on NeuroSPECT, not in a “psychiatric” way, but in an objective functional manner. The day we start recognizing and addressing the underlying medical issues (complex immune, complex viral) that we can, will be a major step forward for all (patients, individuals, and their families). Good luck / mjg
I’m well aware of the controversy over the psychiatric labeling of AS, and I’m not trying to weigh in on that. Here i’m talking about the diagnoses given to children parentheses and sometimes adults parentheses that I feel lead to an appropriate treatment.