Will Anything Solve My Child’s Defiance and ODD?
“I’ve tried every reward, every consequence, and nothing makes a difference. How do I help change my child’s oppositional behavior?” Dr. William Dodson recommends a three-pronged approach.
Children and adolescents with oppositional defiant disorder (ODD) will suffer huge negative consequences rather than comply with the demands of authority figures, including their parents. They don’t need to win every argument; they just want to defeat the authority figure through unceasing disobedience and disrespect.
Parents of these defiant kids end up feeling powerless and frustrated after years of failed attempts at implementing rewards and consequences. None of the traditional, logical parenting models seem to work, and that feels maddening.
Here are three steps for turning things around; parents should follow them in this order.
1. Treat your child’s ADHD.
When ADHD is adequately treated with stimulant medications, the systems driving ODD decrease by about 50. This makes the symptoms of ODD, including oppositional behavior, much more manageable. The ODD is still there, but it’s milder.
2. Try a low-dose, atypical neuroleptic.
The FDA has approved no medications with an indication for treating ODD in the United States. Atypical neuroleptics are primarily used to address mood disorders. However, some studies have found success treating ODD with:
When these medications work on ODD, they work very dramatically and quickly. After three or four days of treatment, I received a phone call from a mother who said, “Doctor, someone has come and taken my child. They left another kid here who looks exactly like him, only he’s nice to me, and does what I ask.”
That is the level of response to expect. If you don’t get it with the first medication you try, move on to the next neuroleptic. Try all of them before giving up on treatment with medication; the trial-and-error is worth it in the end.
Worried about the side effects of these medications? Write down a list of risks associated with treatment versus those associated with not treating the child. How does ODD impact this child, the family unit, the caregivers, the educators?
Most of the common side effects are very mild – like sedation – and none of them are permanent. When you stop giving your child the medication, the side effects subside quickly.
3. Use a proven therapy.
Therapy is very difficult to implement for a child or adolescent who is actively trying to defeat you.
When symptoms are lessened with medication, the therapeutic methods described in these three books may help provide structure for and teach skills to difficult children:
For childhood onset:
- The Explosive Child by Ross W. Greene Ph.D.
For adolescent onset:
- Your Defiant Teen by Russell Barkley, Ph.D. and Arthur L. Robin
- Controlling the Difficult Adolescent: The REST Program by David B. Stein
Almost always, parents will need coaching from a child behavioral expert, who can help them practice and implement the behavioral techniques that will help their child learn to live with other people.
This advice came from “Manage ODD Now: Important Strategies for Treating Oppositional Defiant Disorder in Kids, Adults, and Families,” an June 2013 ADDitude webinar lead by William Dodson, M.D., that is now available for free replay here.
William Dodson, M.D., is a member of ADDitude’s ADHD Medical Review Panel.