Management

With methodologically sound RCTs lacking and recommendations based on clinical consensus, the appropriate psychosocial interventions for ODD include parenting training in behavior management techniques: improved parent/child relationship, positive reinforcement, closer supervision, giving more effective commands, time-out, and token economies. Despite the usually chaotic family situation and high emotions involved, the family physician needs to establish a therapeutic alliance with both the child and the family to have the best chance of success (Steiner and Remsing, 2006). Interventions should be family based, targeted to specific concerns, and oriented to problem solving. Traditional individual psychotherapy, unstructured/nondirected family therapy, or short-term treatment is usually not helpful. Psychoactive medications are used to treat comorbid conditions and targeted symptoms but have not demonstrated benefit for ODD alone. Intense and prolonged treatment may be necessary for severe and persistent ODD. One-time crisis interventions (e.g., "scared straight" attempts) are not effective.

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