I went through this with my son when he was in the 4th grade. At the time he was taking Concerta and Prozac. The doctor and I both thought it was just his symptoms worsening and put him on Abilify. When it was all said and done it was the Concerta causing the problem. He is 12 now, no symptoms of ODD and he is taking Prozac for anxiety and Focalin for ADD. You might want to consider stopping the Concerta. Vyvanse works really well for ADHD and ODD. He took that for several years but developed stomach problems because of it. I am also a nurse of 17 years.