Oppositional Defiant Disorder | Diagnosis & Treatments

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. Here at Boston Children's, 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:

  • new 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 more about psychiatric medications for children and adolescents.

Coping and support

In addition to the condition-specific information provided here, Boston Children's offers the following resources for support:

  • Boston Children's Hale Family Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.
  • The Boston Children's Department of Spiritual Care (chaplaincy) is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members — representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian, and United Church of Christ traditions — who will listen to you, pray with you and help you observe your own faith practices during your child's treatment.
  • The Experience Journal was designed by Boston Children's psychiatrist-in-chief, David DeMaso, MD, and members of his team. This online collection features reflections from kids, families and health professionals about dealing with physical illnesses like asthma and diabetes, as well as mental health conditions like ADHD and depression.
  • The Advocating Success for Kids (ASK) Program at Boston Children's provides multidisciplinary evaluation, referral and advocacy services for children under 14 who are experiencing behavioral, emotional, learning or developmental problems, either at home or at school. ASK works with children who receive their primary care either at Boston's Bowdoin Street Community Health Center, Martha Eliot Health Center, Joseph M. Smith Community Health Center, or at Boston Children's Primary Care Center. For more information about ASK, please call 617-355-4690.