There is no single treatment for oppositional defiant disorder (ODD). It commonly involves a combination of training and therapy tailored to the needs of the child and family.
Oppositional defiant disorder (ODD) is a behavior disorder in children. Children with ODD show a persistent pattern of disobedient, uncooperative, and sometimes hostile behavior toward people in authority.
Early intervention can help individuals cope with and manage their symptoms. Receiving treatment allows many to live symptom-free and happy lives.
Treatment should involve a collaborative approach between the child, their parents, their school, and their community. Options range from parent management training to individual therapy, medication, and lifestyle changes.
This article explores different treatment options for children with ODD in further detail.
Therapy is one of the treatment options for children with ODD. We explore the different types that may benefit children with ODD below.
Parent Management Training
Parent management training (PMT) is the primary treatment for ODD. It follows the principles of social learning theory and operant conditioning, the use of positive reinforcements, to promote prosocial behaviors and decrease unwanted behaviors.
PMT helps examine how a caregiver’s behavior inadvertently reinforces undesirable behaviors in the home. It teaches effective parenting behaviors to promote positive interactions and improve the child’s behavior.
Several notable PMT programs include:
- Incredible Years: This program involves 2-hour weekly sessions over
13–16 weeks. During this time, parents watch videos of proper and improper examples of child management. The program also asks them to rehearse approaches and complete weekly activities at home.
- Positive parenting program (Triple P): This offers advice and training programs for parents and children (ages 0 to 16), as well as coping skills and support.
- Defiant teens: Some healthcare professionals
may offera program based on a method by Dr. Russell Barkley and Dr. Arthur Robin outlined in their book, Defiant Teens. There is also a book aimed at parents called Your Defiant Teen.
- Behavioral and emotional skills training (BEST): This training helps parents and caregivers understand the basics of behavior management and apply them consistently and effectively to their children
- Parent-child interaction therapy (PCIT): This training
features coaching sessionsoccurring while the child and parent are at one end of a playroom. The therapist observes from the other end and provides coaching through an in-ear speaker worn by the parent.
Individual therapy can help children manage their anger problems and extreme emotions and alleviate aggressive behaviors.
Therapy can also help them gain the necessary skills to function better and improve their relationship with others. Some types of individual treatments include:
- Cognitive behavioral therapy (CBT): This can help a child identify maladaptive thought patterns that cause inappropriate behavior.
- Dialectical behavior therapy (DBT): DBT believes people engage in problematic and high-risk behaviors to modulate or express extreme emotions. DBT helps teach children healthier ways to manage their intense emotions.
- Social skills training (SST): This helps the child learn how to have more positive interactions with their peers.
An individualized, computer-assisted SST benefited school-aged children with disruptive behavior disorders with peer-related aggression, based on a 2022 study.
A 2021 review on the effectiveness of CBT for children with externalizing behaviors found the therapy effective across individual and group settings.
Children can also have these therapies in a group setting. A 2019 study found that group-based, child-centered CBT is effective for peer-related, aggressive behavior.
Combining these therapies with parent training can further boost each other’s effectiveness. A 2015 study found that CBT based on PMT led to a significant decrease in ODD symptoms.
Family therapy can help family members learn how to relate and communicate better with other members of the family.
Psychosocial interventions like training and therapy are the first-line treatment for ODD.
Doctors reserve medications for ODD symptoms, such as severe aggression and emotional dysregulation, that
The Food and Drugs Administration (FDA) has not yet approved a drug for ODD. Commonly prescribed drugs are antipsychotics, such as risperidone. A doctor
Other drugs that doctors may prescribe a person with ODD include stimulants and atypical stimulants for coexisting attention deficit hyperactivity disorder (ADHD) and antidepressants for coexisting depression.
Collaborative problem-solving (CPS) is a CBT-based intervention introduced by Dr. Ross Green in his book, The Explosive Child.
CPS believes that challenging behaviors arise when the parent’s expectations and demands are beyond the child’s capacity.
It aims to promote a collaborative problem-solving approach where the child and the parent brainstorm possible solutions to problems. It veers away from using punishments and rewards.
School-based interventions can provide a teacher of a child with ODD with
- improve a child’s classroom behavior
- prevent oppositional behavior or its escalation
- facilitate the child’s compliance with rules and social norms
These interventions can also help children with ODD improve their peer relationships and problem-solving skills.
At home, parents can try several behavioral strategies to help children with ODD and build on the positive behaviors they show, such as:
- praising and recognizing specific positive behaviors
- modeling appropriate behavior
- taking a break when conflict is building up
- picking battles and avoiding power struggles
- setting reasonable, age-appropriate limits
- working with other people who deal with the child, including family members, teachers, and coaches
- being sure to set aside time for self-care
- following and enforcing a consistent routine or schedule
Staying healthy and encouraging a child to practice
- staying physically active
- eating a healthy diet
- getting enough sleep
- nourishing relationships with family members
Parenting a child with ODD can be challenging. Resources are available to help parents learn how to cope with the condition.
The American Academy of Child and Adolescent Psychiatry (AACAP)’s resource center offers support and advice for parents of children with ODD.
Parents and caregivers may also ask their pediatricians or family doctor to refer them to a child psychiatrist or mental health specialist. They can diagnose and treat ODD and other coexisting mental conditions.
Below are tools that may help a family find an ODD specialist for their child:
- American Psychological Association’s Psychologist Locator
- AACAP’s Child and Adolescent Psychiatrist Finder
- Association for Behavioral and Cognitive Therapies’s Find a Cognitive Behavioral Therapist tool
Here are some answers to frequently asked questions about ODD.
What is the best medication for oppositional defiance disorder?
There is currently no FDA-approved medication for ODD.
Doctors do not generally give medications for ODD except if the person’s aggressive and disruptive behaviors
Doctors may also give medications to people with ODD if they have another mental health condition, such as ADHD or anxiety disorders. If left untreated, these may worsen a person’s ODD symptoms.
Can oppositional defiant disorder be cured?
ODD is treatable. Most children and adolescents with the condition improve over time, especially if they receive treatment.
About 67% of children with ODD who receive treatment become symptom-free after 3 years. However, studies show that individuals who present with ODD symptoms early in life have less chance of becoming symptom-free later in life.
The treatment of oppositional defiant disorder is multimodal and involves the individual, their family, and their community.
Different therapies and training can help a child manage their emotions and modify their behavior. Medications may also help if these strategies do not work.
Parents and caregivers can also help by practicing lifestyle changes, such as praising positive behaviors, setting appropriate limits, and seeking support from mental health professionals.
A child with ODD can lead a symptom-free and fulfilling life with the right interventions and treatments.