What is Oppositional Defiant Disorder (ODD)?

From the Guidelines

Oppositional defiant disorder (ODD) should be treated with a multimodal approach, involving individual and family psychotherapeutic approaches, medication, and sociotherapy, as recommended by the practice parameter for the assessment and treatment of children and adolescents with ODD 1. The treatment of ODD is complex and often demands a comprehensive approach, considering the disorder's impact on social, academic, or occupational functioning. Key aspects of treatment include:

• Individual therapy for the child to develop problem-solving skills and anger management techniques
• Family therapy to address family dysfunction and improve communication
• Parent training programs, such as Parent-Child Interaction Therapy (PCIT) or The Incredible Years, to teach consistent discipline strategies and positive reinforcement techniques
• Medication, such as stimulants or non-stimulants, may be prescribed if comorbid conditions like ADHD are present, with dosages tailored to the individual child's needs, for example, methylphenidate (Ritalin) at 0.3-0.7 mg/kg/dose twice daily or amphetamine salts (Adderall) at 0.1-0.5 mg/kg/dose twice daily 1. It is essential to note that early intervention is crucial, as ODD can progress to conduct disorder if left untreated, and the etiology of ODD is complex, involving a cumulative risk/protective factor model that combines biological, psychological, and social factors 1. The recommended treatment approach is based on the practice parameter for the assessment and treatment of children and adolescents with ODD, which draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD 1.

From the Research

Overview of Oppositional Defiant Disorder

• Oppositional defiant disorder (ODD) is a common clinical condition seen among children and adolescents in behavioral health settings 2.
• ODD can cause significant distress to patients and their caregivers, and familiarity with behavioral treatment programs provides clinicians with tools for managing this condition in clinical settings 2.

Treatment Options for ODD

• Behavioral treatment programs, including Parent Management Training, Parent-Child Interaction Therapy, Collaborative Problem Solving, Incredible Years program, Triple-P Positive Parenting Program, Start Now and Plan program, and Coping Power Program, have been found to be effective in managing ODD 2.
• Parent Management Training (PMT) and Collaborative & Proactive Solutions (CPS) have been compared in a randomized control trial, with both treatments showing superiority over a waitlist control group, but not differing from each other in terms of responder or remitter analyses 3.
• PMT combined with Group-CBT has been compared to PMT only, with results showing long-term effectiveness of both treatments in reducing disruptive behavior problems and harsh parenting strategies, and increasing emotion regulation and social communication skills 4.

Predictors and Moderators of Treatment Outcomes

• Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills have been examined as predictors and moderators of behavioral improvement in children with ODD following treatment with PMT and CPS 5.
• Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline have been found to predict poorer behavioral outcomes following both treatments, while child-responsible attributions have been found to moderate treatment outcome, with CPS being more beneficial for families with higher levels of child-responsible attributions 5.

Family-Based Psychosocial Interventions

• Family-based psychosocial interventions, including family therapy, cognitive-behavioral parent training, and family-based treatment protocols, have been found to be empirically supported treatments for children with ADHD, ODD, and conduct disorder 6.
• Well-researched interventions, such as remote and group-based parent training programs, have been found to relate to improvements in parenting quality, positive parenting, and the child's decreased ADHD and conduct behavioral problems 6.