Oppositional Defiant Disorder Treatment

According to the DSM-5, oppositional defiant disorder (ODD) is a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness that lasts at least 6 months. It typically starts in childhood and manifests in interactions with others (besides siblings).

ODD varies in severity. The DSM-5 features three categories: mild, where symptoms are confined to one setting, such as home, school, or with peers; moderate, where some symptoms are present in two settings; and severe, where some symptoms are present in three or more settings.

Parenting a child or teen with ODD can be really frustrating, confusing, and overwhelming. Fortunately, there are a number of effective treatments, along with valuable tools and techniques.

Psychotherapy is the best way to treat ODD, and medication may be prescribed for aggression or irritability or for co-occurring conditions (e.g., ADHD).

Overall, your child’s specific treatment will depend on several factors, including their age, severity of symptoms, and presence of other disorders.

It’s important to note that ODD isn’t exclusive to kids and teens, and symptoms do continue into adulthood. For example, ODD has been found in clinical adult samples. A 2013 study found that individuals with both ADHD and ODD had greater impairment on measures of ADHD, personality disorders, and substance abuse when compared to adults with ADHD alone.

A 2018 study found links between ODD symptoms and greater social impairment and conflict with authority figures (such as teachers and managers); more frequent thoughts about dropping out of college and arguments with parents; and difficulties in romantic relationships. However, research is only recently starting to explore ODD in adults, and there’s little to no data on effective treatment.

Psychotherapy

Psychotherapy is the main treatment for oppositional defiant disorder (ODD). Parents play a pivotal role in helping to change their child’s behavior. The most commonly used interventions fall under the category of parent management training (PMT).

PMT is based on the work of Gerald Patterson and his colleagues, who viewed ODD as a pattern of learned behavior that’s fostered by negative interactions between children and their parents. PMT interventions use rewards and consistent consequences to shape behavior. Their aim is to foster positive relationships between kids and parents, along with increasing adaptive behaviors and decreasing disruptive behaviors. These are some examples of PMT:

• Parent-child interaction therapy (PCIT) is for kids ages 2 through 7. It includes two phases: The first phase focuses on cultivating warmth in your relationship with your child, and the second phase focuses on learning effective tools to manage your child’s most challenging behaviors. Specifically, you and your child are in a room together with a one-way mirror, while the therapist is in another room and coaches you through a headset. You can learn more about PCIT at their website, and find a provider here.
• Positive parenting program (Triple P) can be used with toddlers and teens. Triple P has multiple levels, which are matched to your child’s problem severity. According to a 2019 chapter in The Clinician’s Guide to Oppositional Defiant Disorder, “Triple P teaches parents 17 core parenting skills (e.g., talking to children, physical affection, attention, setting limits, planned ignoring) to increase positive behaviors and decrease negative ones with use of planned practice activities.” You can learn more on their website, and purchase either a course for toddlers to tweens, or pre-teens and teens.
• Helping the noncompliant child is for 3- to 8-year-olds. It features two phases: differential attention and compliance training. In phase one, parents cultivate a positive relationship with their child, and learn concepts, such as using rewards and ignoring minor inappropriate behavior. In phase two, parents learn to provide clear, concise instructions; use consequences for compliance (e.g., positive attention) and noncompliance (e.g., time out); and apply these skills in different situations (e.g., riding in the car). The intervention is outlined in the book Parenting the Strong-Willed Child by psychologist Rex Forehand.
• The incredible years aims to cultivate a positive bond between parents and kids; increase parents’ abilities to use play to coach their kids on different skills, such as emotional, verbal, and academic skills; decrease harsh discipline; and increase positive discipline strategies, such as ignoring, redirecting, time-out, and problem solving. Learn more at com.
• Defiant teens consists of 18 steps. Steps 1 through 9 teach parents effective strategies for dealing with defiant behavior. Steps 10 through 18 teach parents and teens to communicate and problem solve, while facilitating healthy independence for teens. The intervention is outlined in Russell Barkley’s book for clinicians, Defiant Teens, and in his book for parents, Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship.

Another intervention is collaborative problem solving or collaborative proactive solutions (CPS), which is built on the belief that challenging behavior stems from lagging thinking skills. Thus, it’s best to teach kids the skills they lack. CPS consists of three steps: identifying and understanding the child’s concerns about a specific problem; identifying the parents’ concern about the same problem; and having the child and parent brainstorm solutions together to find one that works well for both. Learn more at CPSConnection.com and ThinkKids.org.

Cognitive behavior therapy (CBT) also can be helpful, particularly for older kids. CBT can help children and teens to regulate their frustration, learn and practice assertive behaviors, and improve social problem-solving skills. Parents can be present during treatment sessions, and learn to be supportive in other ways, such as using praise and rewards for positive behavior. In addition, CBT can help with anxiety and depression (which can co-occur with ODD).

Multisystemic therapy (MST) is an intensive home-based family- and community-based intervention for 12- to 17-year-olds whose severe behavioral problems place them at risk for being taken out of their home. MST lasts 3 to 5 months.

According to a 2016 article in the Journal of Clinical Child and Adolescent Psychology, “MST identifies the individual, family, peer, school, and community factors that are linked directly or indirectly with each youth’s disruptive behavior. MST then implements an individualized treatment plan for each family that can incorporate interventions from empirically-supported, pragmatic, problem-focused treatments, including select strategies from family, behavioral, and cognitive-behavioral therapy protocols.” Learn more at this website.

When your child has ODD, it’s critical to work with a therapist. Try to find a therapist who specializes in working with children and teens (and someone you feel comfortable with). Don’t hesitate to interview a variety of therapists (if possible). Ask them about the types of interventions they specialize in, and how they’d go about helping your child.

Medications

Currently, there’s no medication approved by the U.S. Food and Drug Administration (FDA) for treating oppositional defiant disorder (ODD). However, doctors may prescribe medication “off label” to help with irritability and aggression.

According to a 2015 article in Current Treatment Options in Pediatrics, “Medications should only be used as adjunctive treatments for severe or treatment-resistant children.”

Research has found that the atypical antipsychotics risperidone (Risperdal) and aripiprazole (Abilify) can reduce irritability and aggression. They’re frequently prescribed for kids with ODD who are at risk of being removed from their school or home.

Atypical antipsychotics can cause metabolic side effects and extrapyramidal symptoms (e.g., muscle contractions, involuntary movements). The same 2015 article noted that children “should be routinely monitored for involuntary movements utilizing a tool such as the Abnormal Involuntary Movement Scale (AIMS).”

ODD commonly co-occurs with attention deficit hyperactivity disorder (ADHD), so your child might be prescribed a stimulant or non-stimulant medication, such as methylphenidate (Ritalin) or atomoxetine (Strattera). For some kids and teens, taking medication for ADHD can also reduce problematic behavior. Learn more about medications for ADHD in this LifeHelper treatment article.

According to the 2015 article, there’s a trend toward adding an atypical antipsychotic to a stimulant medication when individuals don’t respond to one medication and have severe aggression. Some research has found this strategy to be “somewhat efficacious.” The authors stressed the importance of seeing a child psychiatrist. This is especially critical when children need multiple medications.

Self-Help Strategies for ODD

Check out online resources. You can find a slew of online resources on parenting. For example, ParentingCheckup.org includes a variety of helpful videos for preventing and responding to challenging behavior. The Centers for Disease Control and Prevention has general information on parenting toddlers and preschoolers.

Find parenting books that resonate with you. There are many books that help with behavioral problems, some of which directly address oppositional defiant disorder (ODD). The key is to find an approach that resonates with you. Also, if you’re working with a therapist, ask them for a recommendation. In addition to the books already mentioned (in the Psychotherapy section), here are other titles to check out:

• The Explosive Child
• 1-2-3 Magic
• SOS Help for Parents
• Raising Your Spirited Child
• Setting Limits with Your Strong-Willed Child
• The Kazdin Method for Parenting the Defiant Child

Seek out support. Connect with other parents who have kids with ODD. This not only reminds you that you’re not alone, but it also helps in exchanging valuable tools and techniques. This closed Facebook group has almost forty thousand members.   Regulate your own emotions. When your child is lashing out, it feels impossible to remain calm. It’s all-too easy to become angry and fly off the handle yourself. However, it’s not helpful when you’re trying to thoughtfully discipline your child and model healthy emotion regulation. To calm yourself during less-than calm interactions, take a break and practice a deep breathing technique. Or find other techniques that work better for you.

Be clear. Let your child know exactly what constitutes a desired and an undesired behavior. Let them know the specific consequences for disruptive behavior.

Try this 3-step technique. According to an article on ADDitudemag.com, when asking your child to do something, ODD experts suggest being calm. If your child doesn’t respond in 2 minutes, gently say, “I’m asking you a second time. Do you know what I’m asking you to do—and the consequences if you don’t? Please make a smart decision.” If you have to repeat yourself a third time, enact the consequence (e.g., “no TV or video games for an hour”). When creating consequences, make sure they matter to your child.

Be consistent. Similarly, make sure that the consequences you set up are realistic, and you can consistently reinforce them. Make sure that you’re able to follow through on the limits and boundaries you set. Also, make sure that everyone is on board, including your partner, parents, babysitters, teachers, and anyone else who cares for your child.

Take care of yourself. Having a child with ODD can be stressful. Though your time is likely limited, try to carve out moments to engage in activities that bring you joy, fulfillment, and calm. And don’t hesitate to see your own therapist.