What Are the Treatments for Oppositional Defiance Disorder?

Oppositional Defiant Disorder (ODD) is a psychiatric diagnosis given to children and teens who demonstrate a pattern of angry and hostile behavior. The strength and length of ODD behavior is quite different from the typical "terrible two's" or the challenge of teens striving to learn independence. These difficult behaviors result in family trauma and an individual who is unsuccessful in daily endeavors and relationships. The long-term effects of untreated ODD have a significant impact as it develops into an ongoing spiral of struggle.

Symptoms of ODD

• At first glance, the symptoms that define ODD may be shrugged off as typical misbehavior: arguing with adults, actively defiant or refusing to comply, deliberately annoying others, touchy or easily annoyed, angry and resentful, spiteful and vindictive and frequently blaming others for their mistakes. The key criteria---those that set ODD apart---are that at least four of the symptoms must be evident, the negative behavior manifests for at least six months, and the behaviors must occur more frequently than what would be observed in other children of the same age and developmental stage.

Diagnosis and Treatment

• If parents find that their best efforts and standard discipline techniques don't help, then the sooner they consult a qualified professional the better. Diagnosing and treating ODD as early as possible translates into a better outcome. Less time will be spent in negative, unproductive interaction with children who must be managed differently. The professional consulted will talk to the child, parents and teachers to get a complete picture of behavioral issues. They must also rule out other disorders that may be responsible for the symptoms, such as ADHD, learning disabilities, mood and anxiety disorders. If a diagnosis of ODD is made then treatment focuses primarily on therapy and training. Medication may be prescribed but medication without therapy will not adequately manage and remediate ODD.

Psychosocial Treatment

• Therapy for ODD includes one, or any combination, of the following: parent training, individual therapy, family therapy, cognitive behavioral therapy and social skills training. Parent training programs teach parents how to manage the difficult behavior, recognize the positive, and learn new methods of discipline. Individual therapy helps the person with ODD learn to recognize triggers and manage her behavior. Cognitive behavioral therapy (CBT) focuses on teaching how to recognize the negative thoughts that lead to misperception and self-defeating behaviors, and how to respond appropriately to difficult situations. Social skills training is implemented when the person with ODD needs to learn how to relate to peers and how to repair relationships. As the name implies, family therapy involves all members of the family. It is used to teach about ODD, provide a safe environment for the discussion of feelings and issues, and help the family learn to communicate while navigating hurtful behaviors.

Medications

• Medications alone are not sufficient to treat ODD but they can be used for specific symptoms or conditions. Stimulant medications may be prescribed if the person with ODD is also diagnosed with ADHD. Anti-anxiety or anti-depressant medications treat underlying anxiety or depression. Severe symptoms of rage or aggression can be helped with antipsychotic medications. But there isn't one medication that specifically targets ODD.

The Long Haul

• Treatment for ODD lasts for at least three months. Depending on the child's age, the severity of symptoms and coexisting disorders, treatment may last for many years. This is a long process that requires commitment and hard work not only from the person with ODD, but also from the parents and other adults who have a significant role in the child's life. Parents need to learn a new arsenal of behavior management and discipline techniques. They also need to be prepared to offer support, patience, and unconditional love in the face of extreme behavioral challenges. These behaviors can be difficult to change but 67 percent of those who receive consistent treatment will be free of symptoms after three years.