Dealing with ODD (Oppositional Defiant Disorder)

ODD, or oppositional defiant disorder, is a heartbreaking problem for parents of kids with ADHD.  It is difficult to treat and even more difficult to live with a child who is defiant, angry, and purposefully annoying, especially once they start to get into trouble with others or get suspended from school.  However, there is hope.  Much research has gone into treating ODD in the past 20 years and results are promising.

Medication:  Yes and No
Many children with ODD  see significant improvement with ADHD medications so it is worth a trial of medication if your child also carries the diagnosis of ADHD.  However, medications rarely treat ODD that is leftover after treatment for ADHD.  Some doctors will prescribe sedatives or antipsychotics to children who are aggressive.  However, this should always occur with family and/or individual counseling, not in place of it.

Counseling is Essential
Many children with ODD will not get completely better with medication alone.  Talk therapy is the cornerstone of treatment.   There are several kinds of therapy which may need to take place at once.
Family/parent therapy.  Teaches the parent how to respond to the child's negative behaviors in ways that do not escalate the negative behaviors and which hopefully motivate positive behaviors.  Two very different methods of therapy which have proven effective are the parent management therapy (including the Kazdin method) and the collaborative problem solving (Explosive Child) method.

School based interventions.  This includes accommodations based on the child's ODD and in school support services.  School gives children many opportunities for social interactions.  Working with the school can turn it into a behavioral training ground.

Individual therapy.  Usually focuses on cognitive restructuring and teaching of social skills as they pertain to handling what the child perceives as negative situations.   For example, a child with ODD might think, "The teacher is yelling at me.  He's against me."  But the therapist teaches them to think, "The teacher is trying to get my my attention.  If I answer quickly, he'll stop making so much noise."

It is important to realize that the effectiveness of counseling depends heavily on how well you and your child are able to bond with your therapist.  It doesn't mean that you need to like them, but it does mean that you feel your are being listened to, that you feel willing to try what they suggest at home, and that you understand what you are being asked to do.

Set a Time Table
Counseling should result in a significant improvement of symptoms within 6 to 12 months.   If things aren't improving at all by that point in time, you should consider a different form of therapy or a different provider.    Some children may require intensive management in a day hospital or residential setting, others just need a provider who meshes better with their personality.


References:
American Academy of Child and Adolescent Psychiatry. "ODD: A Guide for Families." (2009): n. pag. EAACAP ODD Resource Center. American Academy of Child and Adolescent Psychiatry. Web. 12 Apr. 2016.
Riley, Margaret, Sana Ahmed, and Amy Locke. "Common Questions About Oppositional Defiant Disorder." American Family Physician 93.7 (2016): 586-91. Print.

This article is part of a series on ODD including Diagnosis, Treatment, and Prevention.