Gifted Issues Discussion homepage Forums Twice Exceptional PDD-NOS/ODD/Depression Diagnosis in 6-year-old

I have gotten so much out of reading this board and I am hoping someone may have some advice/ideas/support for a dear friend of mine who is not too active on-line.

She had her HG DS6 evaluated by a professional who specializes in gifted children. She knew he had quite a bit of asynchronus development (grade appropriate in math, but reads at a 5th grade level) as well as some behavioral issues at school (difficulties making transitions could result in explosive outbursts).

Today the psychiatrist presented her with a diagnosis of PDD-NOS, ODD and perhaps some depression. The doctor recommended, among other things, Occupational Therapy, Social Skills Group and Speech Therapy (for learning how to better communicate his thoughts and feelings).

As you might imagine, she feels a bit overwhelmed.

I was wondering if any of you might have had any experience with these diagnoses or therapies. Or a link to any earlier discussions on such topics. My search did not turn up anything (though I'm not convinced I did it correctly ). I will happily pass along any replies, either posted here or through pm.

I appreciate your help. As I mentioned, she is one of my closest friends, and while I will support her in every way I can, I do not have any specific experience in this area.

Thanks for any/all help!

Irish Eyes

I do have experience with those diagnoses. I do not know her DS of course, but I find it pretty difficult to diagnose any 6yo with ODD. I am not saying you can't or that I haven't. That diagnosis could very well be accurate and I have never met the child...but it is tough to tell at that age whether there are other factors causing a child to be that oppositional. A lot of kids that age are oppositional and behaviors could be related to PDD-NOS and difficulty expressing himself causing him to act out more. Depression easily goes along with ODD and PDD-NOS. Chances are that depression will go away when he is able to communicate things better...as could the ODD as well. Sometimes psychiatrists diagnose without thinking through what all those diagnoses will do to a parent, and how overwhelming it all can be for parents. Remember that they are categories that they feel the child fits into and that unfortunately due to insurances there has to be a diagnosis in order to treat and for the child to get services they need. Hopefully some of those diagnoses will go away in time and the child will be happier and more successful at school and at home. I wish your friend and her son the best of luck.

Thanks, shellymos. I really appreciate your insight.

Has you friend read the Misdiagnosis and Dual Diagnoses of Gifted Children and Adults book? I would highly recommend it as it explains how gifted children can often have traits of many disorders but truly not meet the clinical criteria for diagnosis.

My own DS6 was recently havign major behavior issues and underwent a neuropyschological evaluation and it was recommended that I read this book prior to the appt...I would highly recommend it to all parents with gifted children. My DS6 does have a lot of characteristics of ODD but the neuropsychologist and I sat and looked at each of the diagnostic criteria--she told me that it would be almost impossible to diagnose a 6 year old with ODD due to the length of time these behaviors would have had to be persistent. The child would also have to exhibit these behavior in ALL circumstances...(home, school, sports, etc.). I hope your friend and her son find some answers...

Thanks, crisc.

I will certainly pass that book recommendation along. I will probably even read it, myself. It never hurts to be educated when dealing with kids like all of ours.

Is the actual title, "Misdiagnosis and Dual Diagnoses of Gifted Children and Adults"?

Has she considered getting another opinion? For me ODD would be an immediate sign to RUN and see somebody else for a second opinion. It is really a controversial diagnosis for a child that young and it seems especially inappropriate when it is suggested the child is having other difficulties with sensory regulation and speech which could be causing him to be oppositional.

That's a good point, passthepotatoes. I don't know if she is considering a second opinion. Couldn't hurt, right?

I should clarify, that I spend quite a bit of time with her ds6 and I was quite surprised the doctor's recommendations included speech therapy. He is a very verbal kid - speaks clearly - and has a large vocabulary. But I guess the doctor thought a speech therapist could help him learn to express his feelings better. Has anyone else heard of a speech therapist being recommended for this?

This can be a tricky area. I suspect they would get further with the social skills group. Was therapy with a psychologist also suggested?

I'm also wondering if he's gotten a good exam from a pediatrician who is aware of these concerns. Quite a few things can cause oppositional behavior and sensory problems - sleep disorders, anemia, tonsils, allergies, etc.

Does your friend feel like what she heard is accurate? If she's not feeling really settled with it that's a strong reason to get a second opinion.

Hi. We are dealing with VERY similar issues with our DD6. She also has a disparity in reading/writing (reading middle school level), math probably mid 2nd grade level (she'll start 1st in a few weeks).

Webb's book (yes, that is the full title) specifically says, if I recall correctly, that ODD should NOT be diagnosed that early, in fact, I think he uses 14 as a cut off date. Our dd's therapist has suggested Intermittent Explosive Disorder) and other scary POSSIBLE Dx. We are NOT ready to have a psychiatrist see her yet. We don't want her to be misdiagnosed. This type of misdiagnosis is MUCH more common in gifted kids.

I think it is very important for your friend to read the book, and take it with her to the therapist. This is what we are going to do with ours. We are taking it a day at a time. Part of our process is to have her re-evaluated.

That is a good book that was recommended it. I bought it and lent it to a psychologist that I worked with...and she left that position with the book and unfortunately I never got it back. May have to order it again.