Step one to treating oppositional defiant disorder (ODD) is detecting and controlling the symptoms of ADHD if they are present. Treatment for ADHD symptoms may include taking a daily stimulant or non-stimulant medication which can sometimes help with oppositional defiant symptoms as well.
Step two is receiving a formal evaluation for other related conditions including anxiety, depression and bipolar disorder – each of which can cause oppositional behavior.
Step three is devising a strategy to treat ODD. The treatment of choice for ODD is a combination of individual and family behavioral therapy. When therapy alone does not resolve symptoms, medication can sometimes help. In addition, lifestyle changes can help some people with mild symptoms to control their explosions.
Treating ODD with Therapy
Counseling for ODD should include both the patient and his or her family members, and it should emphasize strategies that the family can use to cope with defiant behaviors.
Remember, people with ODD are neurologically hard-wired to defeat and thwart people in roles of authority. They have no intention of cooperating in any therapeutic process.
Individual Cognitive-Behavioral Therapy
Individual therapy teaches people with ODD a series of techniques for managing anger, controlling emotions, and solving problems. It can provide positive alternative behaviors to replace defiant ones. This type of therapy works best when it begins early in life, when family and social interactions aren’t ingrained and difficult to change.
Family and Parent Training Programs
Parent- and family-training programs are built on the premise that children behave badly when they realize that doing so gets them what they want. Say your child throws a fit when you ask him to turn off a video game; if you give in even once, he learns that he will sometimes succeed. Parent training teaches caregivers what to do in these stressful, exhausting moments to avoid setting a precedent that will encourage more bad behavior.
Parents learn to change their reactions to a child’s behavior – good and bad. They learn to demonstrate and define their expectations, and then give well-defined rewards and praise when their child behaves accordingly – or consistent consequences when the child doesn’t. Most effective parenting programs are built around these four core principles:
1. Reinforce good behavior with a reward system – like stars on a chart, or extending a special privilege.
2. Discourage negative behavior by ignoring it. Kids often use bad behavior to get attention.
3. Take away a privilege if negative behavior is too serious to ignore.
4. Remove common triggers of bad behavior.
A therapist will also work with a parent and child together to solve specific challenges. The plan should start with a key, narrow behavior – like no swearing. Parents learn how to give instructions in an authoritative way, use time-outs effectively, praise children, and create rewards systems.
The goal is to incrementally teach a child new ways of behaving and to break the cycle of defiance. By focusing on and rewarding desired behaviors, a parent can help their child experience success, which encourages the child to behave that way again.
The three most common types of parent- and family-training programs are:
1. Parent-Child Interaction Therapy (PCIT) – PCIT is a program that looks beyond bad behavior to examine troubled relationships – and how changing them can improve daily life. It helps parents become better at managing their child’s behavior with real-time coaching. It is most effective for children ages two to seven, and is offered in university-based centers and by individual therapists.
Participating family members interact 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) – CPS is a program created by Ross W. Green, Ph.D., for defiant teens who have outgrown time-outs. The program focuses on giving kids the problem-solving skills they lack rather than using a reward-and-punishment system.
The first step in CPS is to identify and understand the child’s concern about a problem (completion of homework or chores), and reassure him that the problem will be resolved by the child and the adult together. The second step is to identify the adult’s concerns about the same problem. The third step invites the child to brainstorm solutions with the adult, and to find a plan that is mutually satisfactory.
3. Vive – This is an intensive family therapy program for parents of older kids with behavioral problems. It uses the principles of parent management training, but involves 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 patterns in the ways they react to each other. This technique is geared toward families in crisis who can devote a substantial amount of time and money. Fees can be up to $3,000 a month.
Treating ODD with Medication
If therapies prove ineffective, medication can sometimes help to “re-wire” oppositional 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 do show signs of improvement with a low dose of atypical neuroleptics – arippirazole (Abilify) and risperidone (Risperidal), for example.
Treating ODD with Lifestyle Changes
Families can use many of the techniques taught in behavioral therapy to improve everyday life with defiant behavior while working to diminish it. These techniques include the following:
• Always build on positives: Praise your child and offer 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 suspect you are about to make the conflict with your child worse, not better.
• Pick your battles: Since a child with ODD has trouble avoiding power struggles, prioritize the demands you put on your child.
• Provide structure: Bad behavior tends to escalate when a child has unsupervised free time and unclear expectations. A daily routine, on the other hand, lets a child know what to expect.
• Position behavioral issues as problems she can 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 avoid being tardy again.
• 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 interact with your child. Look for local support groups and/or parenting classes for parents of difficult children.
• Avoid burnout: Maintain interests other than your child so that managing her behavior doesn’t sap all of 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.