Treatment of Childhood Oppositional Defiant Disorder

Current Treatment Options in Pediatrics, Apr 2015

Oppositional defiant disorder (ODD) is a common behavioral disorder of childhood which can be described as a learned pattern of behavior reinforced by caregivers’ responses. Behavioral modification for ODD, particularly in preschool and school-aged children, should primarily focus on teaching caregivers to reinforce positive behaviors, discourage negative behaviors, and ultimately interrupt the cycle of argumentativeness and deliberate attention-seeking behavior. Unfortunately, children who are referred for behavioral therapy for ODD often do not receive evidence-based treatments that target the root cause of the disorder. There is some role for the use of psychopharmacology in the treatment of ODD, though primarily in the treatment of underlying and comorbid disorders. The core symptoms of ODD are not amenable to pharmacotherapy, and behavioral modification is the mainstay of intervention. Attention-deficit hyperactivity disorder (ADHD) frequently occurs with ODD. Poor impulse control is a core feature of ADHD, and appropriate use of stimulant and/or non-stimulant ADHD medications can help children with ODD make better behavioral choices and be more successful with behavior modification programs. There is some evidence for the effectiveness of atypical antipsychotics in disruptive behavior disorders (DBDs), but the target symptoms of explosive and aggressive behaviors are seen only in children with more severe ODD who progress to conduct disorder (CD). Pediatric providers should understand the evidence-based behavioral interventions and targeted psychiatric medications that will achieve the best outcomes for children with ODD.

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Treatment of Childhood Oppositional Defiant Disorder

Curr Treat Options Peds Treatment of Childhood Oppositional Defiant Disorder Bradley S. Hood Marilisa G. Elrod 1 David B. DeWine 0 0 Pediatric Psychology & Psychiatry Service, Mary Bridge Children's, 1220 Division Ave. , Tacoma, WA 98403 , USA 1 Department of Developmental-Behavioral Pediatrics, Madigan Army Medical Center, Joint Base Lewis McChord , Tacoma, WA 98431 , USA Oppositional defiant disorder I Attention-deficit hyperactivity disorder I Parent management training I; Disruptive behavior disorders - Opinion statement Oppositional defiant disorder (ODD) is a common behavioral disorder of childhood which can be described as a learned pattern of behavior reinforced by caregivers’ responses. Behavioral modification for ODD, particularly in preschool and school-aged children, should primarily focus on teaching caregivers to reinforce positive behaviors, discourage negative behaviors, and ultimately interrupt the cycle of argumentativeness and deliberate attention-seeking behavior. Unfortunately, children who are referred for behavioral therapy for ODD often do not receive evidence-based treatments that target the root cause of the disorder. There is some role for the use of psychopharmacology in the treatment of ODD, though primarily in the treatment of underlying and comorbid disorders. The core symptoms of ODD are not amenable to pharmacotherapy, and behavioral modification is the mainstay of intervention. Attention-deficit hyperactivity disorder (ADHD) frequently occurs with ODD. Poor impulse control is a core feature of ADHD, and appropriate use of stimulant and/or non-stimulant ADHD medications can help children with ODD make better behavioral choices and be more successful with behavior modification programs. There is some evidence for the effectiveness of atypical antipsychotics in disruptive behavior disorders (DBDs), but the target symptoms of explosive and aggressive behaviors are seen only in children with more severe ODD who progress to conduct disorder (CD). Pediatric providers should understand the evidence-based behavioral interventions and targeted psychiatric medications that will achieve the best outcomes for children with ODD. Case You are seeing a previously healthy 4-year-old William in your office for behavior problems at preschool and at home. This is the third preschool he has attended after having been asked to leave his prior two for out of control behavior. His mother reports that he refuses to comply with her directions and will argue with her when confronted. He frequently is involved in physical altercations in his preschool class. He tells his teacher at school and his mother that they are Bstupid^ and that he hates them. His mother has brought William in today because she feels that she is at her Bwit’s end^ and his teacher thinks Bhe needs to be medicated.^ Vanderbilt scales from his mother and teacher indicate attention-deficit hyperactivity disorder, combined inattentive, and hyperactive type. You note that the oppositional defiant disorder (ODD) screen is Introduction positive for both mother and teacher. On further discussion, his mother states that she and William’s father are divorced and that they differ significantly in their parenting styles. She admits she has mostly Bgiven up^ on correcting her son’s behavior, but his father is extremely strict and Bon him all the time.^ You discuss the importance of consistent parenting with the mother and recommend that the child and both parents establish care with a mental health professional for Parent Management Training (PMT). You also provide recommendations for parenting books. You discuss with William’s mother that you would consider starting a stimulant attention-deficit hyperactivity disorder (ADHD) medication if behavioral interventions do not improve his functioning and plan to see him back in 3 months. ODD is a pattern of negative behavior and interaction characterized by an angry or irritable mood, argumentative or defiant behavior, and vindictiveness. In the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition (DSM-5), it is contained in the Disruptive, Impulse-Control, and Conduct Disorders section, grouped with intermittent explosive disorder, conduct disorder (CD), antisocial personality disorder, pyromania, and kleptomania [ 1 ]. According to DSM-5 diagnostic criteria, symptoms must last at least 6 months and be exhibited during interaction with a non-sibling as evidenced by at least four symptoms from any of following: loses temper, is touchy or easily annoyed, is angry and resentful, argues with authority figures, actively defies or refuses to comply with requests from authority figures or with rules, deliberately annoys others, blames others for his or her mistakes or misbehavior, or has been spiteful or vindictive at least twice within the past 6 months. These must be seen often and more frequently than would be typically observed in children of comparable age and dev (...truncated)


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Bradley S. Hood MD, Marilisa G. Elrod MD, PhD, David B. DeWine PhD. Treatment of Childhood Oppositional Defiant Disorder, Current Treatment Options in Pediatrics, 2015, pp. 155-167, Volume 1, Issue 2, DOI: 10.1007/s40746-015-0015-7