DEAR READER: All children and teens have moments when they can be difficult, moody and/or argumentative. This is perfectly normal. However, when tantrums, arguing and angry or disruptive behaviors (especially toward the parent/guardian and other authority figures) become regular occurrences, ODD may be the reason.

Symptoms are hard to distinguish from normal behaviors of strong-willed or emotional people. In fact, the symptoms of ODD are the same as behaviors expected during certain stages of a child’s development. When these behaviors become persistent, are clearly disruptive to the family, home or school, and have lasted at least six months, ODD must be considered.

Negativity, defiance, hostility toward authority figures and disobedience are common with ODD and lead to temper tantrums, academic problems, anger, resentment, argumentative, spiteful or vindictive behavior with adults and aggressiveness toward peers. There may be deliberate annoyance of others, blaming others for mistakes, difficulty maintaining friendships, easy annoyance, acting irritably and refusal to comply with adult rules or requests. ODD often accompanies other problems, such as depression, anxiety and attention deficit/hyperactivity disorder (ADHD).

There is no clear cause, but it is thought that is it likely the result of a combination of inherited and environmental factors.

Possible risk factors include having a parent with a mood or substance-abuse disorder; exposure to violence; lack of supervision; being abused or neglected; having parents with a severely troubled marriage; family financial problems; inconsistent or harsh discipline; lack of positive parental involvement; parents with a history of ADHD, ODD or conduct issues; and family instability, such as multiple moves, school changes or the use of childcare providers.

Diagnosis is not made through blood or other physical testing. A child must meet certain criteria set by the American Psychiatric Association. In order to have a positive diagnosis, the child must show a pattern of abnormal behavior for six or more months (as compared to what is typical for the child’s peers) and meet at least four of the eight criteria. The behavior must also cause significant problems at work, home or school; must occur on its own rather than as part of another mental disorder; and must not meet the diagnostic criteria for conduct disorder or antisocial personality disorder (in those over age 18).

Treatment of ODD typically involves several types of psychotherapy and training for the child and parents. Medication to treat any associated conditions, such as ADHD, may also be used. Individual and family therapy can help the child manage anger and express feelings, as well as helping the family understand how the child is feeling and provide a safe, neutral environment to discuss concerns, and learn how to cope and work together. Parent-child interaction therapy (PCIT) teaches parents how to interact with their children in order to bring out their best behavior without stressing the parent and straining the (likely) already tenuous relationship. Training may include social-skills training, which teach the child how to interact with others in a positive manner; parent training similar to PCIT; and cognitive problem-solving training, which aids the child in identifying patterns that lead to behavioral problems and thus change them.

I believe the best approach to the situation is for your entire family to seek out some or all of the treatment options I’ve detailed. In this way, everyone can come to understand what is happening and how best to handle problems when they arise.

DEAR READER: Cluster headaches can occur every day or over a period of weeks or months. They can occur during a particular season, only to reappear the following year during the same time period. They can strike quickly, without warning, and appear all on the same side of the head. They may be present at the same time on successive evenings, and sufferers can almost set their clocks and calendars by their occurrence. They often occur during the night and appear to most commonly affect middle-aged men.

Symptoms can include a drooping eyelid, stuffy or runny nose, sweating, flushing, tearing, nausea and sensitivity to light.

There is no cure for cluster headaches. The goal is to reduce the severity of pain and shorten the duration of each episode. Treatment focuses on prevention and commonly includes injectible Imitrex except for those people diagnosed with uncontrolled hypertension or ischemic heart disease. In those two instances, Octreotide would be a better choice for control. Beyond that, dihydroergotamine might be used, but is only given in a physician’s office or hospital setting. Xylocaine as a nasal drop remains another choice.

In otherwise healthy people, oxygen, lithium, verapamil and older antidepressants known as tricyclic antidepressants may be beneficial.

Cluster headaches are vascular in nature. Researchers are unsure precisely what causes ADD; however, some considerations include heredity, exposure to high lead levels, brain injuries, nutrition, cigarette smoking and/or alcohol use during pregnancy. Therefore, my interpretation is there is no direct link between ADD and cluster headaches.

In terms of recommending a medication, I believe your son’s best bet is what is prescribed by his physician who knows his complete history. Research remains ongoing and new developments are always on the horizon. Additional information can be obtained through the National Headache Foundation at www.headaches.org.

To give you related information, I am sending you a copy of my Health Report “Headaches”. Other readers who would like a copy should send a self-addressed, stamped No. 10 envelope and a $2 check or money order to Newsletter, PO Box 167, Wickliffe, OH 44092-0167. Be sure to mention the title or print out an order form from my website www.AskDrGottMD.com.