How is oppositional defiant disorder diagnosed?
At Boston Children’s Hospital, a mental health clinician (typically a child and adolescent psychiatrist, child psychologist, or psychiatric social worker) will make the diagnosis following a comprehensive psychiatric assessment with you and your child. During the assessment, you will be asked to talk about your child’s behavioral problems and to give an overview of your child’s family history, medical history, school life, and social interactions.
Your child’s mental health clinician will help explain the disorder and answer any questions you or your child may have. The next step is developing a mutually agreed-upon treatment plan that works for you, your child and your family.
How is oppositional defiant disorder treated at Boston Children's?
ODD is typically treated with one or a combination of the following methods:
Parenting guidance and modification
Your involvement as a parent is crucial to the treatment of your child's oppositional defiant disorder. We've learned that the best approach to ODD is helping parents learn and use effective parenting strategies; anticipate and prepare for problematic behavior; manage and respond to outbursts and tantrums; and implement structure and consistency in the child's life and daily routine.
Parenting modification strategies taught at Boston Children's focus on:
- developing a warm, loving relationship between parent and child
- providing a predictable, structured household environment
- setting clear and simple household rules
- consistently praising and rewarding positive behaviors (such as getting ready for school and bed on time)
- consistently ignoring annoying behaviors (such as whining or badgering), followed by praise when the annoying behavior ceases
- consistently delivering consequences (such as “time-outs” or loss of privileges) for dangerous or destructive behaviors (such as physical aggression or destroying possessions)
Social-emotional skills training
Strengthening the impact of the parenting modification techniques you are learning, therapy for ODD will also focus on providing social-emotional skills training for your child. Through the course of therapy sessions with the clinician, your child will learn:
- skills for identifying and managing feelings
- how to get along better with others
- strategies for making good decisions that are based on thinking rather than feeling
Psychiatric medication
In addition to therapy, your clinician may recommend medication to treat your child's oppositional defiant disorder. There currently are no drugs prescribed specifically for ODD, but certain symptoms of the disorder, when found in conjunction with another disorder, can respond very well to medication in conjunction with psychotherapy (which is also referred to as "talk therapy").
Drugs that may be prescribed to treat ODD symptoms include:
Stimulants for ADHD
- methylphenidate (Ritalin)
- dextroamphetamine (Dexedrine)
Antidepressants for depression or anxiety
- escitalopram (Lexapro)
- fluoxetine (Prozac)
Other medications that may help decrease disruptive behaviors
- guanfacine (Tenex)
- clonidine (Catapres)
- risperidone (Risperdal)
- aripiprazole (Abilify)
Boston Children's Department of Psychiatry and Behavioral Sciences has a specialized Psychopharmacology Clinic to help determine whether psychiatric medication might be a useful addition to a child's treatment plan, but we never prescribe medication as a standalone treatment. Medication, when prescribed, is always part of a two-step approach in conjunction with talk therapy.
Learn about psychiatric medications for children and adolescents.
How we approach oppositional defiant disorder
Boston Children’s has a long history of pioneering important advances in behavioral and mental health for children, adolescents, and families. Our clinicians are committed to evidence-based treatments — therapies that have been tested and proven effective through careful scientific analysis, both here at our hospital and at other top health centers around the world.
At the same time, we practice medicine that’s patient-focused and family centered. We never lose sight of the fact that your child is, first and foremost, an individual — not merely a patient — and we include your family at every stage of the treatment process.
Here at Boston Children’s, our clinicians use several techniques to treat oppositional defiant disorder, including:
- first clarifying if there are other co-existing underlying disorders
- parenting modification strategies
- social and emotional skills training for children
- in some cases, the addition of medication to the therapy plan
Working with your clinician, you can make a difference for your child by learning and using new:
- communication skills
- parenting skills
- conflict resolution skills
- anger management skills
Oppositional defiant disorder: Reviewed by David R. DeMaso, MD
© Boston Children’s Hospital, 2012
