Mischievous toddler or something worse?
Lately, Alfi’s fun-loving nature seems to have been getting out of hand. His parents are becoming concerned, and have reported that Alfi regularly cows the family dog into a corner, throwing blocks and toys at him despite growls and eventual whimpering, and has taken to chasing his twin sister around with a plastic sword despite her repeated requests for him to stop. Whenever his sister tells on him, Alfi lies to avoid getting into trouble. His daycare supervisor reports that he continues to steal toys from other kids even after multiple timeouts and discussions about proper sharing. Alfi is four years old. Is he just being an extra mischievous preschooler, or exhibiting symptoms of Oppositional Defiant Disorder (ODD)?
ODD is one of two types of disruptive behaviour disorders, the other being Conduct Disorder (CD). According to Children’s Mental Health Ontario, ODD is defined as “a type of behaviour problem in which children are openly hostile, uncooperative, and irritable … Their home life, school life, and peer relationships are seriously affected because of the way they think and behave”. DSM-5 diagnostic criteria for ODD include “a pattern of angry/irritable mood, argumentative/defiant behaviour, or vindictiveness lasting at least 6 months” (American Psychiatric Association [APA], 2013). This is supposed to be evidenced by the presence of at least four symptoms, which range from often losing one’s temper, being touchy or easily annoyed, to often deliberately annoying others, and blaming others for one’s mistakes or misbehaviour, among others. The four symptoms also must be “exhibited during interaction with at least one individual who is not a sibling” (APA, 2013).
However, toddlers and preschoolers are often easily annoyed, uncooperative, and throw tantrums when they don’t get what they want, as seen below with “Little Peter”:
First-time parents may sometimes be taken aback at the excessive “terribleness” of the twos (and often threes for that matter!), but before leaping to any conclusions about what constitutes a serious problem, it is important to recognize that a certain level of tantrum throwing, authority testing, and overall defiance is normative during this developmental phase. Here again, we’re brought back to the ever-present question of, “What is normal?” That is why the DSM-5 includes a note with its diagnostic criteria, specifying that symptoms for children under 5 years old have to be occurring more frequently than for children 5 years and older (almost daily for six months, versus at least once a week for six months). It also means that, as a clinician, one must have a strong grasp of the behaviours characteristic of each developmental stage. As for any disorder, ODD diagnoses are not as simple as ticking off and tallying boxes on a symptom checklist, especially when it comes to toddlers.
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