Oppositional Defiant Disorder (ODD) is thought to be caused by a combination of biological, psychological, and social factors. ODD tends to occur in families with a history of Attention Deficit Hyperactivity Disorder (ADHD), substance use disorders, or mood disorders such as depression or bipolar disorder. Brain imaging studies have also suggested that children with ODD may have subtle differences in the part of the brain responsible for reasoning, judgment and impulse control. Psychological studies have also demonstrated that children who display aggressive behavior have trouble accurately identifying and interpreting social cues from peers. Specifically, aggressive children tend to see hostile intent in neutral situations. They also generate fewer solutions to problems and expect to be rewarded for their aggressive responses. Lack of structure or parental supervision, inconsistent discipline practices, and exposure to abuse or community violence have also been identified as factors which may contribute to the development of ODD.
For many children, Oppositional Defiant Disorder does improve over time. Follow up studies have shown that the signs and symptoms of ODD resolve within 3 years in approximately 67% of children diagnosed with the disorder. However, research has also shown that approximately 30% of children with ODD eventually develop conduct disorder. The risk is 3 times greater for children who were initially diagnosed at a very young (e.g., preschool) age. Preschool children with ODD are also likely to exhibit additional disorders several years later, including ADHD, anxiety or mood disorders. Overall, approximately 10% of children diagnosed with ODD will eventually develop a more lasting personality disorder, such as Anti-Social Personality Disorder.
There is no single treatment for all children and adolescents with Oppositional Defiant Disorder (ODD). The most effective treatment plan will be individualized to the needs of each child and family. Specific treatment modalities may be helpful for a particular child, depending on his or her age, the severity of the presenting problems, and the goals, resources, and circumstances of the family. Treatment must be delivered for an adequate duration (usually several months or longer) and may require multiple episodes either continuously or as periodic "booster" sessions. Treatment will often include both individual therapy and family therapy. It may also include work with the child's teacher or school. Treatment may also include the use of medication, although medication alone would rarely be considered an adequate or appropriate intervention for children with ODD.
Two types of evidenced-based treatments for children with ODD are individual approaches in the form of problem-solving skills training and family interventions in the form of parent management training. Individual approaches should be specific to the child's problems, behaviorally-based, geared to the child’s age, and focused on helping the child acquire new problem-solving skills. Family interventions include training in effective discipline techniques and age-appropriate supervision.
With preschool children, the emphasis is usually placed on parent education and training. For school-age children, school-based interventions, family-based treatment, and individual therapy are often used in combination. For adolescents, individual therapy is often used in conjunction with family intervention.
Throughout all ages, medication may be a useful component of treatment to help address specific symptoms or to treat co-existing conditions (e.g., depression, ADHD, or anxiety disorders), although there is no single medication which specifically treats ODD. There is also limited research data on the safety and efficacy of medications in the treatment of ODD. Parents should discuss the potential risks and benefits of specific medications with their child’s physician. In general, medications should be started only after an appropriate baseline of symptoms or behaviors has been obtained.
For preschool children, there is some evidence that programs such as Head Start and home visitation to high risk families can have a positive impact in areas related to Oppositional Defiant Disorder (ODD). In school–age children, parent management, social skills training, conflict resolution and anger management programs have all been utilized with varying degrees of success. For adolescents, psycho-educational programs, including cognitive interventions and skills training, vocational training, and academic preparations appear to reduce the disruptive behaviors usually associated with ODD.
A number of school-based prevention programs have also produced promising results. The focus of the school programs ranges from bullying prevention to interventions aimed at reducing anti-social behavior and helping children resist negative peer group influences. However, there is some evidence that group treatment can also have negative effects on outcome, especially among children and adolescents who are already showing signs and symptoms of difficulties.