Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ONGOING

children and adolescents

1st line – behavioural parent training (BPT)

Back
ONGOING
|
children and adolescents
1st line – 

behavioural parent training (BPT)

Refer for BPT (sometimes referred to as parent management training [PMT]), which aims to teach effective and supportive parenting skills, counsel on the effective use of contingencies, and improve parent-child communication, among other components.[53][55][84][85][86][89]

Many effective BPT interventions also include child-directed treatment components. These are typically based on cognitive behavioural therapy (CBT) interventions and may target areas such as emotion-regulation skills, problem-solving skills, or cognitive reframing.[53][90][91]

Specific empirically supported treatments of note include Parent-Child Interaction Therapy (PCIT), Incredible Years, Problem-Solving Skills Training and Parent Management Training, Parent Management Training - Oregon model, and the Triple P Positive Parenting Program. ​Parent-Child Interaction Therapy Opens in new window ​The Incredible Years® Opens in new window ​Triple P Positive Parenting Program Opens in new window[91][92][93][94][95][96]

Most evidence-based interventions for ODD are provided to families by licensed outpatient mental health providers, although some research has examined alternative deliveries.[53][87][88]

Although most validated treatments for ODD focus on early to middle childhood, the principles of management of ODD in children can usually be applied to adolescents.

Plus – child-directed behavioural interventions

Back
ONGOING
|
children and adolescents
Plus – 

child-directed behavioural interventions

Treatment recommended for ALL patients in selected patient group

Refer all children and adolescents with ODD (and their families) for behavioural interventions, which are the first-line treatment modality for the condition.[53][55][84][85][86]

Child-directed interventions are typically based on CBT interventions and may target areas such as emotion-regulation skills and problem-solving skills or cognitive reframing.[53][90][91] Specific empirically supported treatments of note include Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH ADTC), and Coping Power.[90][97][98]

The majority of these interventions have primarily been tested in developed countries such as the US, the UK, and Australia, although some studies also support the use of cognitive behavioural interventions for ODD in developing country settings.[99][100] Although most validated treatments for ODD focus on early to middle childhood, the principles of management of ODD in children can usually be applied to adolescents.

Most evidence-based interventions for ODD are provided to families by licensed outpatient mental health providers, although some research has examined alternative deliveries.[53][87][88]

Plus – management of co-existing conditions

Back
ONGOING
|
children and adolescents
Plus – 

management of co-existing conditions

Treatment recommended for ALL patients in selected patient group

Effective pharmacotherapy for any associated comorbid conditions (e.g., ADHD or conduct disorder) should be considered, which may help to reduce the severity of co-occurring ODD symptoms.[53][55][101][102] However, do not give pharmacotherapy for the routine management of behavioural problems to people with ODD in the absence of comorbidities.​[9][53]

See Attention deficit hyperactivity disorder in children.

Plus – safeguarding

Back
ONGOING
|
children and adolescents
Plus – 

safeguarding

Treatment recommended for ALL patients in selected patient group

A safeguarding assessment should be conducted as part of the management of ODD. It is recommended that this assessment includes positive and negative aspects of parenting, the parent-child relationship, positive and negative adult relationships within the child's family, including domestic violence, and parental wellbeing (covering mental health issues, substance misuse, and criminal behaviour).[53]

Risks that may be faced by the patient (e.g., risk of physical, sexual, and emotional abuse) should be assessed and managed. If required, develop a risk management plan for self-neglect, exploitation by others, self-harm, or harm to others in line with local protocol.[53]

adults

1st line – management of co-existing conditions and consider psychotherapy

Back
ONGOING
|
adults
1st line – 

management of co-existing conditions and consider psychotherapy

Refer adults with ODD to a specialist for consideration of psychotherapeutic interventions.

Evidence for the treatment of adults with ODD is scarce; this may be due to the historical tendency to regard ODD as a childhood disorder. Until validated interventions for adult ODD are available, it is reasonable for clinicians to take inference from evidence-based treatments (EBTs) for ODD in childhood. Specifically, intervention components that target emotion-regulation skills, cognitive reframing, and problem-solving skills should be prioritised. Many treatments used in children and adolescents with ODD - especially those grounded in cognitive behavioural therapy (CBT) (e.g., dialectical behaviour therapy [DBT], acceptance and commitment therapy [ACT]) - would include appropriate components to apply to the treatment of ODD in adulthood.

Effective pharmacotherapy for any associated comorbid conditions (e.g., ADHD or conduct disorder) should be considered, which may help to reduce the severity of co-occurring ODD symptoms. However, do not give pharmacotherapy for the routine management of behavioural problems to adults with ODD in the absence of comorbidities.[9]

See Attention deficit hyperactivity disorder in adults.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer