Psychosocial Treatments
One of the key factors in the development and maintenance of the negative behaviors associated with ODD symptoms is reinforcement, whether intentional or not, of the unwanted behaviors. The most effective way of treating disruptive behavior disorders is behavioral therapies. Behavioral therapy for children and adolescents focuses primarily on how to prevent problematic thoughts or behaviors from accidentally getting reinforced unknowingly within a young person's environment.
Positive reinforcement often unintentionally contributes to an increase in the frequency of ODD behaviors. Behavior therapies can be applied to a wide range of psychological symptoms among children, adolescents, and adults with ODD. Behavior therapists encourage children and adolescents to try new behaviors and not to allow unwanted reinforcement to dictate the ways in which they act. Furthermore, therapists may work with parents to discontinue ways in which they are unintentionally reinforcing unwanted behaviors. An example of how positive reinforcement can occur is when the patient is rewarded with attention when performing ODD behaviors. Attention is reinforcing itself and the reinforcing attention could be accidentally given, ironically, when trying to create a negative consequence to their behavior. Positive Punishment occurs when the patient is inadvertently punished by aversive stimuli for not performing the ODD behaviors (of revenge, dis-cooperation, and frequent anger). These aversive stimuli that punish patients for not performing ODD behaviors can include: humiliation, isolation, not being told the reason of rules (e.g. being told "the reason you should is because I said so"), not having opinions taken seriously, as well as "being pushed around."
Researchers have found that the use of positive reinforcement and praise for appropriate behaviors are two key elements in effective interventions. If the majority of interactions with the child are focused around correcting their negative behaviors, a cycle of negative interactions is created, where the child expects attention after misbehaving. On the contrary, positive reinforcement and praise not only builds a child's self-esteem but also serves to strengthen the bond between a child and their caregiver. To accomplish this the positive reinforcement should occur immediately after a child has exhibited an appropriate behavior. The behaviors outlined for the child to be reinforced should be easy to evaluate and have very clear and easy to understand instructions. The type of reinforcement used should always depend on the child and should be developed together with both the family and the therapist.
Other approaches to the treatment of ODD include parent training programs, individual psychotherapy, family therapy, cognitive behavioral therapy, and social skills training. According to the American Academy of Child and Adolescent Psychiatry, treatments for ODD are tailored specifically to the individual child, and different treatment techniques are applied for pre-schoolers and adolescents. There are several preventative programs which have had a positive effect on those who are at high risk for ODD. Both home visitation and programs such as Head Start have shown some effectiveness in preschool children. Social skills training, parent management training, and anger management programs have been used as prevention programs for school-age children at risk for ODD. For adolescents at risk for ODD, cognitive interventions, vocational training, and academic tutoring have shown preventative effectiveness.
An approach developed by Russell Barkley uses a parent training model and begins by focusing on positive approaches to increase compliant behaviours.
Non-profit organizations such as the Mayo Clinic and the American Academy of Child & Adolescent Psychiatry (AACAP) provide information and resource centers to the public through their respective websites regarding ODD, including tests and diagnosis, treatments and drugs, as well as advice on preparation for an initial meeting with a physician regarding concerns.
Read more about this topic: Oppositional Defiant Disorder