Treatment for ODD

While ODD can't be cured per se, it can be effectively controlled to the point that the child's behavior is well within the norm for his age group. In fact, you may be relieved to know that treatment has been proven effective in a number of programs. Typically, treatment can be divided into pharmacological treatment (medications), and strategies and changes in the child's environment.

Pharmacological Treatment

Medication for behavioral problems can suppress symptoms. It can't obliterate an illness by killing offending bacteria like the medications you give your child when she's sick. If you decide to try medication, take the time to explain this concept to your spouse and anyone else sharing childcare: it's important to avoid skipping a dosage because the problem behaviors aren't suppressed once the medication is out of the bloodstream.

There isn't a single medication that's prescribed across the board for ODD. A clinician who evaluates your child will probably write a prescription designed to suppress the most disruptive behaviors your child displays.

If your child has aggressive behaviors, drugs that suppress aggression, like olanzapine, quetiapine, and risperidone (marketed as Zyprexa, Seroquel, and Risperdal, respectively) may be effective. Lithium carbonate and carbamazepine may also be effective. Also, if your child's aggression can be described as rage or lack of impulse control, anticonvulsants can be prescribed; these are car-bamazepine and divalproex (Tegretol and Epival, respectively).

Depression is often treated with the antidepressants bupropion, imipramine, and nortriptyline (marketed as Wellbutrin, Tofranil, and Pamelor, respectively). Just because a prescription is written for a child does not mean that the FDA has approved its use for children. At present, many antidepressants are prescribed for children, but only fluoxetine (Prozac) has been approved for use in children. If a doctor or psychologist suggests a different antidepressant, ask why.

If your child also has ADHD, Ritalin may be prescribed. Ritalin is a household name because it is extremely effective at helping kids to focus on their tasks and get their work done, and so has been widely prescribed. Though it won't directly affect ODD, it can help with your child's overall behavioral problems. Be aware that a pediatrician can prescribe Ritalin or any other psychophar-maceutical based on a short doctor's visit. That's not ideal — a child with ODD needs her parent to have an extended talk with a mental/behavioral health professional, like a therapist, psychologist, or psychiatrist, so that all behaviors are carefully considered and medication, if any, is prescribed accurately.

Alert

Prescriptions should be written by a child psychiatrist because there are very few drugs approved for use in children, and their side effects are significant. Therapists and psychologists cannot prescribe medications; pediatricians can, but don't have the experience or the time that psychiatrists have to accurately diagnosis and prescribe medications.

Some parents who are hesitant to trust the FDA or the pharmaceutical industry may be tempted to seek alternative medications, such as dietary supplements, vitamins, naturopathy, hormones, and so on. It is strongly recommended that you do not give your child any type of medication, including alternative medications, without a clinician's consent, and that you disclose all medications to the clinician on the first visit. It's important to understand that overthe-counter remedies often have not been tested for side effects, and though some alternative products include natural ingredients, they can include them in doses much higher than what's found in nature, and can have unintended, possibly dangerous side effects.

Therapy and Training

In all likelihood, in order to best help you and your child create a more peaceful and loving home, you will personally need to attend some therapy sessions. This doesn't mean that you are the source of the problem or that your parenting will be scrutinized and judged. It just means that of all people in the world, you are in the best position to help your child by changing her environment and helping her reduce ODD behaviors, so the therapist needs to talk to you.

At some point, the therapist may also wish to have sessions that include your child, or are private with your child. This can be especially effective at treating comorbidities like anxiety and depression, and teens may benefit from private sessions in which they can disclose and deal with related issues they may not want to share with their parents.

Essential

One thing you can do immediately, is to verbally praise your child for the small stuff. Catch your child being good — even a little bit — and recognize it without sarcasm and backhanded compliments. While you're waiting for your therapist to give you more instruction, you can implement simple praise, and it will improve your relationship with your child.

In general, you can expect that a therapist will work with you to set up a program for dealing with defiant behavior that uses a system of rewards for positive behavior, trains your child to think through consequences of defiant behavior, and minimizes punishment. If you think that praising your child for the smallest progress would be condescending and unproductive, you're not alone. Most parents would like to see some cooperation, pronto, and even a little retribution. However, programs that focus on praise and reward have been scientifically proven to be much more effective at helping kids with ODD than traditional punishment.

While the programs a therapist gives you closely mirror what follows in the rest of this book, remember that if your child has been diagnosed with ODD, self-help won't be enough on its own. The support and expertise of a therapist will be crucial in ensuring your program works and any glitches are corrected.

Low-Cost Options

Ideally, you will be able to find professional help for your child. However, the reality is that many insurance companies don't pay enough to cover mental health treatment, if they cover it at all. If you do not have access to affordable health care coverage, you may be able to qualify for low-cost health care coverage through Medicaid or your state's insurance programs. To find out if you and your children qualify, visit www.CoverageForAll.org. If that doesn't work, and you have a therapist in mind, ask if she has a sliding fee scale or can work out some kind of other arrangement. Some therapists take pro bono cases.

You may also ask your child's school what type of counseling services they provide. If your child has a disability or mental health diagnosis and goes to a public school, she may qualify for special education benefits that could include the mental health treatment she needs. You won't know if you don't ask, so call the school and see what services are provided or where they can refer you for more help.

You can also call your county's mental health office and see if any low-cost services are provided. And finally, if you live in an area with a college or university where graduate or professional level psychology is taught, investigate to find out whether they offer clinics where graduate students render treatment under supervision by expert therapists. Sessions like this usually cost about ten to twenty dollars each.

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