Treatment for oppositional defiant disorder (ODD) includes psychotherapy and medication. Treatment also includes addressing related conditions, including anxiety, depression, and bipolar disorder – each of which can cause oppositional behavior and exacerbate ODD. Many people use behavior modification techniques to manage ODD symptoms. In severe cases, a child may need to see a family therapist trained in childhood behavior problems.
Counseling should involve both the child and family, with an emphasis on ways to cope with such behavior. Often, a therapist will recommend parent-management or family training as the treatment of choice for ODD. Your doctor may also suggest parental counseling to learn more productive ways of responding to your child’s behaviors.
Remember that children and adolescents with moderate to severe ODD are neurologically hard-wired to defeat and thwart people in roles of authority. They have no intention of cooperating in any therapeutic process. Consequently, when children fail to respond to the types of interventions listed above, other medication must be used to “re-wire” ODD behaviors. No medications are FDA-approved for the treatment of ODD in the U.S. Nonetheless, clinical experience has shown that the majority of children and adolescents with ODD improve rapidly with a low dose of atypical neuroleptics – arippirazole (Abilify) and risperidone (Risperidal), for example. When medication alone does not work, consider behavior therapy and family training.
Behavior therapy is a series of techniques meant to improve parenting skills and a child’s behavior; it fills in the behavior gaps that medication can’t address. It gives kids positive alternative behaviors to replace defiant ones. The American Psychological Association recommends this as the first line of treatment for children diagnosed with ADhD before the age of 5. In fact, it works best when it is started early in a child’s life, when parent-child interactions aren’t ingrained and are easier to change.
Successfully implementing behavior therapy at home is hard work. It means changing the way you and your child interact, and maintaining those changes over time. Improvements may not be apparent for weeks or months. But, it will be worth it when a child’s behavior changes for the long term.
All behavior programs operate on the same premise: Parents and other adults in the child’s life set clear expectations for their child’s behavior. They praise and reward positive behavior and discourage negative behavior. This establishes predictability and routines, and increases the positive attention directed at your child. A behavior therapy regimen can be developed by a pediatrician, school psychologist, or another mental health worker.
Family and Parent Training Programs
Parent- and family-training programs are based on the premise that bad behavior results when children realize they can get what they want by behaving badly. Say your child throws a fit when you ask him to turn off the video game; if you give in even some of the time, he learns that he will sometimes succeed. The goal of parent training is to break this cycle and help parents discipline children more effectively.
Parents are taught to change their reactions to a child’s behavior – good and bad. They learn to show their child what they expect, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when they don’t. Therapists will also work with a parent and child together to solve specific challenges. Sometimes this involves ignoring minor bad behavior. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.
Three types of parent and family training programs are:
1. Parent-Child Interaction Therapy (PCIT) – This helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven. The family interacts while listening to advice from therapists behind a one-way mirror, so the child associates the parenting skills with her parent, not the therapist.
2. Collaborative Problem Solving (CPS) - A program for defiant teens who are too big and strong to be put in a time out. The program focuses on giving kids problem-solving skills they lack rather than a reward-and-punishment system.
3. Vive - An intensive family therapy program for parents of older kids with behavioral problems. It uses two separate therapists: a “mentor” for the struggling teen, and a “coach” for the parents. The program can help kids become more reflective about problems, and help families recognize patters in ways of reacting to each other.
Some children benefit from social skills training that allows them to interact more effectively with peers so that school becomes less of a battle ground.
Alternative Treatments for ODD
Parent-management training – in which parents learn to change the way they react to their child’s behavior — is highly effective in treating ODD. Between weekly sessions, the parents practice what they’ve learned from the therapist and report back on progress. Parents set up a system for giving praise and rewards when a child cooperates, and clear consequences when he misbehaves. Strategies include the following:
• Always build on positives: Give the child praise and positive reinforcement when he shows flexibility or cooperation. Recognize the “little victories” with enthusiasm.
• Learn to control yourself: Take a time-out or break if you are about to make the conflict with your child worse, not better.
• Pick your battles: Since the child with ODD has trouble avoiding power struggles, prioritize the things you want your child to do.
• Provide structure: Bad behavior is more apt to occur when kids have unsupervised free time. A daily routine can let them know what to expect.
• Position behavioral issues as problems to solve: Explain to your child that ignoring an alarm clock doesn’t help her get to school on time, and ask what she can do to get ready without being tardy.
• Set up reasonable, age-appropriate limits and enforce consequences consistently: Resist the temptation to rescue the child from naturally occurring consequences.
• Don’t go it alone: Work with and get support from the other adults (teachers, coaches, and spouse) who deal with your child. Look for area support groups and/or parenting classes for parents of difficult children.
• Avoid burnout: Maintain interests other than your child with ODD, so that managing your child doesn’t take all your time and energy. Manage your own stress with exercise and relaxation. Use respite care as needed.
Additionally, supplements may improve certain symptoms of ODD. Be sure to consult with a physician before trying any of the alternative therapies below.
• Omega-3 Fatty Acids to regulate mood and emotions
• Vitamin E to help absorb Omega-3s
• Melatonin to help normalize sleep patterns
• Zinc to help neutralize brain chemicals that can lead to hyperactivity and impulsivity
For adults, reading about ODD can be an asset. Taking Charge of Anger, a book by W. Robert Nay, Ph.D., gives practical advice that may benefit an adult with the condition.