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Treatments and drugs
By Mayo Clinic staffTreating oppositional defiant disorder generally involves several types of psychotherapy and training for your child — as well as for you and your co-parent. Treatment often lasts several months or longer.
If your child has co-existing conditions, particularly ADHD, medications may help significantly improve symptoms. However, medications alone generally aren't used for ODD unless another disorder co-exists.
The cornerstones of treatment for ODD usually include:
- Individual and family therapy. Individual counseling for your child may help him or her learn to manage anger and express his or her feelings more healthfully. Family counseling may help improve your communication and relationships, and help members of your family learn how to work together.
- Parent-child interaction therapy (PCIT). During PCIT, therapists coach parents while they interact with their children. In one approach, the therapist sits behind a one-way mirror and, using an "ear bug" audio device, guides parents through strategies that reinforce their children's positive behavior. As a result, parents learn more-effective parenting techniques, the quality of the parent-child relationship improves and problem behaviors decrease.
- Cognitive problem-solving training. This type of therapy is aimed at helping your child identify and change through patterns that are leading to behavior problems. Collaborative problem-solving — in which you and your child work together to come up with solutions that work for both of you — can help improve ODD-related problems.
- Social skills training. Your child also might benefit from therapy that will help him or her learn how to interact more positively and effectively with peers.
- Parent training. A mental health provider with experience treating ODD may help you develop skills that will allow you to parent in a way that's more positive and less frustrating for you and your child. In some cases, your child may participate in this type of training with you, so that everyone in your family develops shared goals for how to handle problems.
As part of parent training, you may learn how to:
- Give effective timeouts
- Avoid power struggles
- Remain calm and unemotional in the face of opposition, or take your own timeout, if necessary
- Recognize and praise your child's good behaviors and positive characteristics
- Offer acceptable choices to your child, giving him or her a certain amount of control
- Establish a schedule for the family that includes specific meals that will be eaten at home together, and specific activities one or both parents will do with the child
- Limit consequences to those that can be consistently reinforced and if possible, last for a limited amount of time
Although some parent management techniques may seem like common sense, learning to use them in the face of opposition isn't easy, especially if there are other stressors at home. Learning these skills will require consistent practice and patience.
Most important in treatment is for you to show consistent, unconditional love and acceptance of your child — even during difficult and disruptive situations. Don't be too hard on yourself. This process can be tough for even the most patient parents.
- Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed Oct. 25, 2011.
- Nurcombe B. Oppositional defiant disorder and conduct disorder. In: Ebert MH, et al, eds. Current Diagnosis and Treatment: Psychiatry. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=3290408. Accessed Oct. 25, 2011.
- Disruptive behavioral disorders. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/pediatrics/mental_disorders_in_children_and_adolescents/disruptive_behavioral_disorders.html#v1106068. Accessed Oct. 25, 2011.
- Hamilton SS. Oppositional defiant disorder. American Family Physician. 2008;78:861.
- Children with oppositional defiant disorder. American Academy of Child and Adolescent Psychiatry. http://www.aacap.org/cs/root/facts_for_families/children_with_oppositional_defiant_disorder. Accessed Oct. 25, 2011.
- Steiner H. Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry. 2007;46:126.
- Loeber R, et al. Perspectives on oppositional defiant, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry. 2009;50:133.
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