Why I don’t Diagnose Oppositional Defiant Disorder (Part 4 of 4)

by James Wiley, MD, FAAP — @adddoc

As we wrap up this series on why oppositional defiant disorder is often misdiagnosed, let’s talk about depression. 

“She doesn’t care about anything.”

“He’s lazy! Every day instead of doing homework or studying he goes straight to bed.”

“She is so grumpy and cries at the drop of a hat.”

“She won’t even try in school.  When pushed she gets very angry and says the meanest things.”

“He skips school or falls asleep in class half the time.”

“Every time I ask her to do something she argues or tells me she is too tired.”

“She can’t make up her mind about anything until we ask her to do something and then she won’t do it.”

Does any of this sound like common rhetoric in your household? Depressed kids seem apathetic and don’t see the use in doing most anything constructive. They tend to withdraw from people or activities that they previously enjoyed.  They sleep a lot but are often tired ‘all the time’.  They are labeled lazy or emotional.

Recently, one of my college-aged patients with well managed ADHD failed out of college because on many days she was too depressed to get out bed and go to class.  When she got behind she started feeling even more worthless and guilty, which deepened the depression to the point that she became suicidal when contemplating telling her parents about her failure.

While many times treating the ADHD will reduce anxiety and depression, sometimes a depressive disorder can be the primary cause of this type of behavior. If your child shows any kind of symptoms of depression, I urge you to contact your provider.