Oppositional Defiant Disorder or budding Sociopath?

Sounds a little harsh doesn't it? I'm really not suggesting that little Timmy who refuses to eat his green beans or clean his room, or do his homework may have more deeper, darker tendencies. It is just that this is only one of the confusing diagnoses that we are up against in practice daily. Whose child isn't oppositional from time to time? Mine were and if I may say so still are although they are adults now. I have to say I am not a big fan of labels. I think the real issues are the symptoms. How do we treat the symptoms that are being described, usually by the parents and the school system. I also realize we have to have disorders titled as "something" so there is some consistency out there among practitioners to stay within the agreed upon standard of care. I just think sometimes we get too hung up on what something is actually called. I wonder daily where these "behaviors" are coming from. Too much freedom, too little freedom, no boundaries, no fear? I don't know about the rest of the world but I had a healthy fear as a child, and as a teen of stepping over that line and I worried about the consequences of my behavior. I see that missing somehow today. Consequences seems to be just a spelling word anymore. Respect for authority too often is just something from the past. Quite frankly I find this frightening and sad at the same time. I have parents bring children for evaluation who just want them "fixed" and they want a label. What is wrong with my kid? Let's label it then we can tell the school system that they are "ADHD", or "Oppositional Defiant" or they have "Conduct Disorder" and that resolves it. Not so fast. It just doesn't work that way. I am more concerned with why and where these behaviors are coming from. I believe that there isn't a lot of thought anymore going into this. Since Oppositional Defiant Disorder is the subject, let's look at the criteria to meet this diagnosis per the DSM-IV, which is the holy grail of mental health labels. For a child to meet this diagnosis he or she for at least the past six months has to show defiant, hostile, negative behavior. To be more specific, four or more of the following may apply. 1.) losing temper 2) arguing with adults 3.) defying or refusing to carry out the rules or requests of adults 4.) deliberately doing things to annoy others 5.) blaming others for their own mistakes or behaviors 5.) being touchy or easily annoyed by others 6.) angry and resentful 7.) spiteful and vindictive. The qualifier is that these symptoms have to cause clinically significant distress or impair work, school or social functioning. I think more time needs to be spent trying to figure out where this anger, hostility, and defiance is really coming from. Not that I am advocating psychoanalysis for each and every child. Just a little detective work goes a long way. We do use medications frequently in practice now because if a child is at the point of receiving this diagnosis it already is causing significant impairment in their education, their home life and their social interactions with others. I do defend the use of medication for these kids because I have seen it work and once the child is less angry, less hostile, and less defiant then other treatments become more effective. Things like anger management, behavioral plans,and individual counseling that help them learn new coping skills. Sometimes these kids are just depressed and these behaviors have developed as their way of saying "look at me, because something is wrong in my world." To steal a title from a recent movie, "It's complicated."