(Diagnostic Criteria for Oppisitional Defiant Disorder)
Note: Consider a criterion met only if the behavior is considerably more
frequent than that of most people of the same mental age.
A. A disturbance of at least six months during which at least five of the
following are present;
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses adult requests or rules, e.g., refuses
to do chores at home
(4) often deliberately does things that annoy other people, e.g., grabs
other children's hats
(5) often blames others for his or her own mistakes
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive
(9) often swears or uses obscene language
B. Does not meet the criteria for Conduct Disorder, and does not occur
exclusively during the course of a psychotic disorder, Dysthymia, or a Major
Depressive, Hypomanic, or Manic Episode.
Criteria for severity of Oppositional Defiant Disorder:
Mild: Few, if any, symptoms in excess of those required to make the
diagnosis and only minimal or no impairment in school and social
functioning.
Moderate: Symptoms or functional impairment intermediate between "mild"
and "severe."
Severe: Many symptoms in excess of those required to make the diagnosis
and significant and pervasive impairment in functioning at home and school
and with other adults and peers.
ANXIETY DISORDERS OF CHILDHOOD OR ADOLESCENCE
This subclass includes disorders in which anxiety is the predominant clinical
feature. In the first two categories, Separation Anxiety Disorder and Avoidant
Disorder of Childhood or Adolescence, the anxiety is focused on specific
situations. In the third category, Overanxious Disorder, the anxiety is generalized
to a variety of situations.
Separation Anxiety Disorder
The essential feature of this disorder is excessive anxiety, for at least two weeks,
concerning separation from those to whom the child is attached. When
separation occurs, the child may experience anxiety to the point of panic. The
reaction is beyond that expected for the child's developmental level. Onset of the
disorder is before age 18. The diagnosis is not made if the anxiety occurs
exclusively during the course of a Pervasive Developmental Disorder,
Schizophrenia, or any other psychotic disorder.
Children with Separation Anxiety Disorder are uncomfortable when they
travel independently away from the house or from other familiar areas. They may
refuse to visit or sleep at friends' homes, to go on errands, or to attend camp or
school. (It should be noted that some cases of school refusal are not due to
separation anxiety; in such cases, usually in adolescence, the child actually fears
the school situation because of anxiety about social or academic performance,
whether or not he or she is accompanied by a parent.) Children with Separation
Anxiety Disorder may be unable to stay in a room by themselves, and may
display "clinging" behavior staying close to the parent, "shadowing" the parent
around the house. Physical complaints, such as stomachaches, headaches,
nausea, and vomiting, are common when separation is anticipated or occurs.
Cardiovascular symptoms such as palpitations, dizziness, and faintness are rare
in younger children, but may occur in adolescents.
When separated from significant others to whom they are attached, these
children are often preoccupied with morbid fears that accidents or illness will
befall those to whom they are attached or themselves. They often express fear of
being lost and never being reunited with their parents. The exact nature of the
fantasized mishaps varies. In general, young children have less specific, more
amorphous concerns. As the child becomes older, the fears may become
systematized around identifiable potential dangers. Many children, even some
older ones, do not report fears of definite threats, but only pervasive anxiety
about ill-defined dangers or death. Children also typically exhibit anticipatory
anxiety when separation is threatened or impending; young children experience
distress only when separation actually occurs.
Children with this disorder often have tears of animals, monsters, and
situations that are perceived as presenting danger to the integrity of the family or
themselves. Consequently, they may have exaggerated fears of muggers,
burglars, kidnappers, car accidents, or plane travel. Concerns about dying and
death are common.
These children often have difficulty going to sleep, and may insist that
someone stay with them until they fall asleep. They may make their way to their
parents' bed (or that of another significant person, such as a sibling); if entry to
the parental bedroom is barred, they may sleep outside the parents door.
Nightmares, whose content expresses the child's morbid fears, may occur.
Some children do not experience morbid apprehension about possible harm
befalling them or those close to them, but instead are extremely homesick and
uncomfortable, to the point of misery, or even panic, when away from home.
These children yearn to return home, and are preoccupied with reunion
fantasies. When not with a major attachment figure, children with this disorder
may exhibit recurrent instances of social withdrawal, apathy, sadness, or difficulty
concentrating on work or play. Occasionally, a child may become violent toward a
person who is forcing separation. Children with Separation Anxiety Disorder may
refuse to see relatives or former friends in order to avoid having to account for
their difficulties in, or absence from, school or from other activities that they
avoided.
Adolescents with this disorder, especially boys, may deny overconcern about
their mother or their wish to be with her; yet their behavior reflects anxiety about
separation: they are reluctant or unable to leave the home or the parent, and feel
comfortable only in situations in which no separation is demanded.
Although the disorder represents a form of phobia, it is not included among
the Phobic Disorders because it has unique features and is characteristically
associated with childhood.
Associated features. Fear of the dark is common, and some children have
fixed fears that may appear bizarre. For example, they may report that they see
and feel eyes staring at them in the dark, that mythical animals are glaring at
them, or that bloody creatures are reaching for them.
Depressed mood frequently is present, and may become more persistent
over time, justifying an additional diagnosis of Dysthymia or Major
Depression.
Children with this disorder are often described as demanding, intrusive, and
in need of constant attention. They may complain that no one loves them or
cares about them and that they wish they were dead, especially if separation is
enforced. Others are described as unusually conscientious, compliant, and eager
to please.
When no demands for separation are made, children with Separation Anxiety
Disorder typically have no interpersonal difficulties.
Age at onset. The age at onset may be as early as preschool age; by
definition, it is before the age of 18. Onset in adolescence is rare.
Course. Typically there are periods of exacerbation and remission over a
period of several years. In some cases both the anxiety about possible
separation and the avoidance of situations involving separation (e.g., going away
to college) persist for many years.
Impairment. In its severe form, the disorder may be very incapacitating, in
that the child is unable to attend school and function independently in a variety of
areas.
Complications. The child often undergoes elaborate physical examinations
and medical procedures because of numerous somatic complaints. When school
refusal occurs, common complications are academic difficulties and social
avoidance.
Predisposing factors. No specific premorbid personality disturbance is
associated with Separation Anxiety Disorder. In most cases the disorder
develops after some life stress, typically a loss, the death of a relative or pet, an
illness of the child or a relative, or a change in the child's environment, such as a
school change or a move to a new neighborhood.
Children with this disorder tend to come from families that are close-knit and
caring. The etiologic significance of this familial pattern is not clear. Neglected
children are underrepresented among those with Separation Anxiety
Disorder.
Prevalence The disorder is apparently not uncommon.
Sex ratio. The disorder is apparently equally common in males and
females.
Familial pattern. The disorder is apparently more common in first-degree
biologic relatives than in the general population, and may be more frequent in
children of mothers with Panic Disorder.
Differential diagnosis. In early childhood some degree of separation anxiety
is a normal phenomenon, and clinical judgment must be used in distinguishing
this from the clearly excessive reaction to separation seen in Separation Anxiety
Disorder. In Overanxious Disorder, anxiety is not focused on separation. In
Pervasive Developmental Disorders or Schizophrenia, anxiety about
separation may occur, but is viewed as due to these conditions rather than as a
separate disorder. In Major Depression occurring in children, the diagnosis of
Separation Anxiety Disorder should also be made when the criteria for both
disorders are met. Panic Disorder with Agoraphobia is uncommon before age
18, and the fear is of being incapacitated by a panic attack rather than of
separation from parental figures. In some cases of Panic Disorder with
Agoraphobia in adolescents or young adults, however, many of the symptoms of
Separation Anxiety Disorder may be present. In Conduct Disorder, truancy is
common, but the child stays away from the home, and anxiety about separation
is usually not present.
(Diagnostic Criteria for separation Anxiety Disorder)
A. Excessive anxiety concerning separation from those to whom the
child is attached, as evidenced by at least three of the following:
(1) unrealistic and persistent worry about possible harm befalling major
attachment figures or fear that they will leave and not return
(2) unrealistic and persistent worry that an untoward calamitous event will
separate the child from a major attachment figure, e.g., the child will be
lost, kidnapped, killed, or be the victim of an accident
(3) persistent reluctance or refusal to go to school in order to stay with
major attachment figures or at home
(4) persistent reluctance or refusal to go to sleep without being near a
major attachment figure or to go to sleep away from home
(5) persistent avoidance of being alone, including "clinging" to and
"shad-owing" major attachment figures
(6) repeated nightmares involving the theme of separation
(7) complaints of physical symptoms, e.g., headaches, stomachaches,
nausea, or vomiting, on many school days or on other occasions when
anticipating separation from major attachment figures
(8) recurrent signs or complaints of excessive distress in anticipation of
separation from home or major attachment figures, e.g., temper
tantrums or crying, pleading with parents not to leave
(9) recurrent signs of complaints of excessive distress when separated
from home or major attachment figures, e.g., wants to return home,
needs to call parents when they are absent or when child is away from
home
B. Duration of disturbance of at least two weeks.
C. Onset before the age of 18.
D. Occurrence not exclusively during the course of a Pervasive
Developmental Disorder, Schizophrenia, or any other psychotic
disorder.
Page 9
Adoption World Main Site
(Diagnostic Criteria for Oppisitional Defiant Disorder)
Note: Consider a criterion met only if the behavior is considerably more frequent than that of most people of the same mental age.
A. A disturbance of at least six months during which at least five of the following are present;
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses adult requests or rules, e.g., refuses to do chores at home
(4) often deliberately does things that annoy other people, e.g., grabs other children's hats
(5) often blames others for his or her own mistakes
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive
(9) often swears or uses obscene language
B. Does not meet the criteria for Conduct Disorder, and does not occur exclusively during the course of a psychotic disorder, Dysthymia, or a Major Depressive, Hypomanic, or Manic Episode.
Criteria for severity of Oppositional Defiant Disorder:
Mild: Few, if any, symptoms in excess of those required to make the diagnosis and only minimal or no impairment in school and social functioning.
Moderate: Symptoms or functional impairment intermediate between "mild" and "severe."
Severe: Many symptoms in excess of those required to make the diagnosis and significant and pervasive impairment in functioning at home and school and with other adults and peers.
ANXIETY DISORDERS OF CHILDHOOD OR ADOLESCENCE
This subclass includes disorders in which anxiety is the predominant clinical feature. In the first two categories, Separation Anxiety Disorder and Avoidant Disorder of Childhood or Adolescence, the anxiety is focused on specific situations. In the third category, Overanxious Disorder, the anxiety is generalized to a variety of situations.
Separation Anxiety Disorder
The essential feature of this disorder is excessive anxiety, for at least two weeks, concerning separation from those to whom the child is attached. When separation occurs, the child may experience anxiety to the point of panic. The reaction is beyond that expected for the child's developmental level. Onset of the disorder is before age 18. The diagnosis is not made if the anxiety occurs exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or any other psychotic disorder.
Children with Separation Anxiety Disorder are uncomfortable when they travel independently away from the house or from other familiar areas. They may refuse to visit or sleep at friends' homes, to go on errands, or to attend camp or school. (It should be noted that some cases of school refusal are not due to separation anxiety; in such cases, usually in adolescence, the child actually fears the school situation because of anxiety about social or academic performance, whether or not he or she is accompanied by a parent.) Children with Separation Anxiety Disorder may be unable to stay in a room by themselves, and may display "clinging" behavior staying close to the parent, "shadowing" the parent around the house. Physical complaints, such as stomachaches, headaches, nausea, and vomiting, are common when separation is anticipated or occurs. Cardiovascular symptoms such as palpitations, dizziness, and faintness are rare in younger children, but may occur in adolescents.
When separated from significant others to whom they are attached, these children are often preoccupied with morbid fears that accidents or illness will befall those to whom they are attached or themselves. They often express fear of being lost and never being reunited with their parents. The exact nature of the fantasized mishaps varies. In general, young children have less specific, more amorphous concerns. As the child becomes older, the fears may become systematized around identifiable potential dangers. Many children, even some older ones, do not report fears of definite threats, but only pervasive anxiety about ill-defined dangers or death. Children also typically exhibit anticipatory anxiety when separation is threatened or impending; young children experience distress only when separation actually occurs.
Children with this disorder often have tears of animals, monsters, and situations that are perceived as presenting danger to the integrity of the family or themselves. Consequently, they may have exaggerated fears of muggers, burglars, kidnappers, car accidents, or plane travel. Concerns about dying and death are common.
These children often have difficulty going to sleep, and may insist that someone stay with them until they fall asleep. They may make their way to their parents' bed (or that of another significant person, such as a sibling); if entry to the parental bedroom is barred, they may sleep outside the parents door. Nightmares, whose content expresses the child's morbid fears, may occur.
Some children do not experience morbid apprehension about possible harm befalling them or those close to them, but instead are extremely homesick and uncomfortable, to the point of misery, or even panic, when away from home. These children yearn to return home, and are preoccupied with reunion fantasies. When not with a major attachment figure, children with this disorder may exhibit recurrent instances of social withdrawal, apathy, sadness, or difficulty concentrating on work or play. Occasionally, a child may become violent toward a person who is forcing separation. Children with Separation Anxiety Disorder may refuse to see relatives or former friends in order to avoid having to account for their difficulties in, or absence from, school or from other activities that they avoided.
Adolescents with this disorder, especially boys, may deny overconcern about their mother or their wish to be with her; yet their behavior reflects anxiety about separation: they are reluctant or unable to leave the home or the parent, and feel comfortable only in situations in which no separation is demanded.
Although the disorder represents a form of phobia, it is not included among the Phobic Disorders because it has unique features and is characteristically associated with childhood.
Associated features. Fear of the dark is common, and some children have fixed fears that may appear bizarre. For example, they may report that they see and feel eyes staring at them in the dark, that mythical animals are glaring at them, or that bloody creatures are reaching for them.
Depressed mood frequently is present, and may become more persistent over time, justifying an additional diagnosis of Dysthymia or Major Depression.
Children with this disorder are often described as demanding, intrusive, and in need of constant attention. They may complain that no one loves them or cares about them and that they wish they were dead, especially if separation is enforced. Others are described as unusually conscientious, compliant, and eager to please.
When no demands for separation are made, children with Separation Anxiety Disorder typically have no interpersonal difficulties.
Age at onset. The age at onset may be as early as preschool age; by definition, it is before the age of 18. Onset in adolescence is rare.
Course. Typically there are periods of exacerbation and remission over a period of several years. In some cases both the anxiety about possible separation and the avoidance of situations involving separation (e.g., going away to college) persist for many years.
Impairment. In its severe form, the disorder may be very incapacitating, in that the child is unable to attend school and function independently in a variety of areas.
Complications. The child often undergoes elaborate physical examinations and medical procedures because of numerous somatic complaints. When school refusal occurs, common complications are academic difficulties and social avoidance.
Predisposing factors. No specific premorbid personality disturbance is associated with Separation Anxiety Disorder. In most cases the disorder develops after some life stress, typically a loss, the death of a relative or pet, an illness of the child or a relative, or a change in the child's environment, such as a school change or a move to a new neighborhood.
Children with this disorder tend to come from families that are close-knit and caring. The etiologic significance of this familial pattern is not clear. Neglected children are underrepresented among those with Separation Anxiety Disorder.
Prevalence The disorder is apparently not uncommon.
Sex ratio. The disorder is apparently equally common in males and females.
Familial pattern. The disorder is apparently more common in first-degree biologic relatives than in the general population, and may be more frequent in children of mothers with Panic Disorder.
Differential diagnosis. In early childhood some degree of separation anxiety is a normal phenomenon, and clinical judgment must be used in distinguishing this from the clearly excessive reaction to separation seen in Separation Anxiety Disorder. In Overanxious Disorder, anxiety is not focused on separation. In Pervasive Developmental Disorders or Schizophrenia, anxiety about separation may occur, but is viewed as due to these conditions rather than as a separate disorder. In Major Depression occurring in children, the diagnosis of Separation Anxiety Disorder should also be made when the criteria for both disorders are met. Panic Disorder with Agoraphobia is uncommon before age 18, and the fear is of being incapacitated by a panic attack rather than of separation from parental figures. In some cases of Panic Disorder with Agoraphobia in adolescents or young adults, however, many of the symptoms of Separation Anxiety Disorder may be present. In Conduct Disorder, truancy is common, but the child stays away from the home, and anxiety about separation is usually not present.
(Diagnostic Criteria for separation Anxiety Disorder)
A. Excessive anxiety concerning separation from those to whom the child is attached, as evidenced by at least three of the following:
(1) unrealistic and persistent worry about possible harm befalling major attachment figures or fear that they will leave and not return
(2) unrealistic and persistent worry that an untoward calamitous event will separate the child from a major attachment figure, e.g., the child will be lost, kidnapped, killed, or be the victim of an accident
(3) persistent reluctance or refusal to go to school in order to stay with major attachment figures or at home
(4) persistent reluctance or refusal to go to sleep without being near a major attachment figure or to go to sleep away from home
(5) persistent avoidance of being alone, including "clinging" to and "shad-owing" major attachment figures
(6) repeated nightmares involving the theme of separation
(7) complaints of physical symptoms, e.g., headaches, stomachaches, nausea, or vomiting, on many school days or on other occasions when anticipating separation from major attachment figures
(8) recurrent signs or complaints of excessive distress in anticipation of separation from home or major attachment figures, e.g., temper tantrums or crying, pleading with parents not to leave
(9) recurrent signs of complaints of excessive distress when separated from home or major attachment figures, e.g., wants to return home, needs to call parents when they are absent or when child is away from home
B. Duration of disturbance of at least two weeks.
C. Onset before the age of 18.
D. Occurrence not exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or any other psychotic disorder.