Culture, Medicine, and Psychiatry

, Volume 41, Issue 1, pp 94–110

Innocent or Intentional?: Interpreting Oppositional Defiant Disorder in a Preschool Mental Health Clinic

Original Paper

DOI: 10.1007/s11013-016-9506-7

Cite this article as:
El Ouardani, C.N. Cult Med Psychiatry (2017) 41: 94. doi:10.1007/s11013-016-9506-7


Based on 9 months of ethnographic fieldwork in a U.S. mental health clinic focused on the treatment of preschool-aged children who exhibited extremely disruptive behavior, this article examines the contradictions clinicians faced when trying to identify and attribute “intentionality” to very young children. Disruptive, aggressive behavior is one of the central symptoms involved in a wide-range of childhood psychopathology and the number one reason young children are referred to mental health clinics in the United States. In the clinic where I conducted my research, clinicians were especially interested in diagnosing these children with oppositional defiant disorder (ODD), in order to identify those at risk for more serious mental illness later in the lifecourse. In this article, I look at the different strategies clinicians used in interpreting whether aggressive, defiant behavior was a part of the child’s “self,” a biologically driven symptom of a disease, or a legitimate reaction to problematic social environments. I argue that conceptualizing intentionality as a developmental, interpersonal process may help to make sense of the multiple discourses and practices clinicians used to try to reconcile the contradictions inherent in diagnosing ODD.


Oppositional defiant disorder Intentionality Child mental health Aggressive behavior Diagnosis 

Funding information

Funder NameGrant NumberFunding Note
Irving Harris Foundation

    Copyright information

    © Springer Science+Business Media New York 2016

    Authors and Affiliations

    1. 1.Department of Human DevelopmentCalifornia State University Long BeachLong BeachUSA

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