What is the best medication for Oppositional Defiant Disorder (ODD)?

From the Guidelines

There is no single "best" medication for Oppositional Defiant Disorder (ODD) as treatment typically involves a combination of behavioral therapy and, in some cases, medication to address specific symptoms or co-occurring conditions. Medications are not FDA-approved specifically for ODD but may be prescribed to target associated symptoms like aggression, impulsivity, or mood issues. Some key points to consider in the treatment of ODD include:

• Stimulants such as methylphenidate (Ritalin, Concerta) or amphetamine-based medications (Adderall) are often used when ADHD co-occurs with ODD, typically starting at low doses and adjusting based on response 1.
• For severe aggression or mood instability, atypical antipsychotics like risperidone (0.25-3mg daily) or aripiprazole (2-15mg daily) might be considered, as they have shown promise in reducing irritability and aggression in youth with intellectual disability and disruptive behavior disorders 1.
• Mood stabilizers or antidepressants may be appropriate if mood disorders are present.
• Medication should always be part of a comprehensive treatment plan that includes parent training, individual therapy (particularly cognitive-behavioral therapy), and school interventions.
• The most effective approach addresses the underlying causes of defiant behavior while teaching children more appropriate ways to express themselves and manage emotions, as supported by the most recent guidelines and studies 1. It's essential to develop an individualized treatment plan based on the specific clinical situation, considering the age of the child, severity of presenting problems, and goals, resources, and circumstances of the parents 1. Given the complexity of ODD and its frequent comorbidity with other psychiatric conditions, a multimodal treatment approach is often necessary, combining individual psychotherapy, family psychotherapy, pharmacotherapy, and ecological interventions 1. The treatment plan should be delivered for an adequate duration and may require multiple episodes, either continuously or as periodic booster sessions, reinforcing previous skills or improvements 1. Ultimately, the goal of treatment is to improve the child's functioning and quality of life, while also reducing the risk of progression to more severe disorders, such as conduct disorder or substance abuse 1.

From the Research

Treatment Options for Oppositional Defiant Disorder

The treatment of oppositional defiant disorder (ODD) often involves a combination of behavioral therapy and medication. According to 2, behavioral therapy for the child and family members can improve symptoms of ODD.

Medications Used to Treat ODD

• Risperidone: An atypical antipsychotic that has been shown to be effective in managing disruptive behavior disorders, including ODD 3.
• Psychostimulants: Such as those used to treat attention-deficit/hyperactivity disorder (ADHD), may also be efficacious in the treatment of ODD, particularly when ODD is comorbid with ADHD 4, 5.
• Atomoxetine: A non-stimulant medication used to treat ADHD, may also be effective in treating ODD associated with ADHD 5.
• Mood regulators, alpha(2)-agonists, and antidepressants: May be used as second-line agents in the treatment of ODD and its comorbidities 5.

Behavioral Treatment Programs

• Parent Management Training: An evidence-based treatment program that has been shown to be effective in managing ODD 6.
• Parent-Child Interaction Therapy: A therapy that aims to improve the relationship between the parent and child, and reduce symptoms of ODD 6.
• Collaborative Problem Solving: A psychological intervention that aims to develop a child's skills in tolerating frustration, being flexible, and avoiding emotional overreaction 4, 6.
• Incredible Years program: A treatment program that focuses on teaching parents and children skills to manage behavior and improve relationships 6.
• Triple-P Positive Parenting Program: A program that provides parents with skills and strategies to manage their child's behavior 6.
• Start Now and Plan program: A program that aims to help children develop self-regulation skills and reduce symptoms of ODD 6.
• Coping Power Program: A program that focuses on teaching children skills to manage their emotions and behaviors 6.