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Treatment of Oppositional Defiant Disorder

Andrea Barkoukis, M.A., Natalie Staats Reiss, Ph.D., and Mark Dombeck, Ph.D.

Treatment for ODD is typically similar in design to therapy for treating Conduct Disorder. As is the case with Conduct Disorder, treatment is typically designed to decrease or eliminate as many current problem behaviors as possible (with a bias toward targeting and eliminating behaviors in order of severity; more serious behaviors that have the potential to harm others or cause more negative consequences are targeted first). Therapy also attempts to change affected children's long-term developmental course toward a more positive outcome. There are several different approaches to treating Oppositional Defiant Disorder. Close involvement of the entire family, and recruitment of parents as implementers of the therapy is important for treatment success.

angry mom and sonBehavioral therapy in children with Oppositional Defiant Disorder is based on learning theory. Behavioral therapists essentially set up conditions wherein children can "unlearn" inappropriate behaviors and, in their place, learn new, more appropriate behaviors. After studying the problematic interactions between ODD children and their parents and other authority figures, behavioral therapists help parents to draw up a behavioral contract that specifies in detail, which negative behaviors are to be discouraged, and which positive behaviors are to be rewarded. Methods that will be used for discipline and reward are also specified in detail, so that the entire plan for altering children's behavior is as explicit and transparent as possible. Parents are taught to be consistent in their use of approved reinforcements (rewards) and, as necessary, punishment techniques. By learning to take better and more consistent control over the reward landscape of their children's environment, parents gain more control over how their children behave. Over time, some rewarded behaviors become habitual, and (more usefully) become reinforced by the environment itself (rather than by parent's actions) such that children start engaging in those actions on their own. For example, parents may create conditions which promote their children's completion of homework, which in turn may result in their getting better grades and experiencing a greater mastery of the subject matter being taught, which causes them to want to avoid homework less.

Behavior therapy for Oppositional Defiant and Conduct Disorders necessarily occurs within the context of the family; techniques are taught to all family members, most especially to parents. However, behavioral family therapy is commonly supplemented with individualized therapy for the children themselves. Therapists work directly with disordered children in order to teach them important skills and coping mechanisms (e.g., appropriately expressing feelings such as anger, taking other's perspectives, and appreciating the impact of their own behavior on others). These two therapy strategies complement one another. The family therapy component helps reinforce and maintain gains that occur in individual therapy. This sort of combination of family and individual therapy work is currently thought to be the best way to approach therapy for disobedient children.

Both Conduct Disorder and ODD occur in the context of the family and are heavily influenced by the health of family interactions. Therapists working to treat these disorders may thus recommend marital therapy, or substance abuse treatment to parents and caregivers if they believe such interventions will improve the overall health of family interactions.

Medications have not been proven effective in treating Oppositional Defiant Disorder, so they are generally only used if a child has a co-morbid (co-occurring) disorder that responds to medication, such as Major Depression or ADHD.

 

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