abuse, parents that are not involved, and lack of supervision can also contribute to odd. externalizing problems are reported to be more frequent among minority-status youth, a finding that is likely related to economic hardship, limited employment opportunities, and living in high-risk urban neighborhoods. studies have also found that the state of being exposed to violence was a contribution factor for externalizing behaviors to occur. diagnosis for a child or adolescent to qualify for a diagnosis of odd, behaviors must cause considerable distress for the family or interfere significantly with academic or social functioning. interference might take the form of preventing the child or adolescent from learning at school or making friends or placing him or her in harmful situations. these behaviors must also persist for at least six months. effects of odd can be greatly amplified by other disorders in comorbidity such as adhd. other common comorbid disorders include depression and substance use disorders. adults who were diagnosed with odd as children tend to have a higher chance of being diagnosed with other mental illness in their lifetime, as well as being at higher risk of developing social and emotional problems. management approaches to the treatment of odd include parent management training, 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. children with oppositional defiant disorder tend to exhibit problematic behavior that can be very difficult to control. an occupational therapist can recommend family based education referred to as parent management training (pmt) in order to encourage positive parents and child relationships and reduce the child's tantrums and other disruptive behaviors. since odd is a neurological disorder that has biological correlates, an occupational therapist can also provide problem solving training to encourage positive coping skills when difficult situations arise, as well as offer cognitive behavioral therapy. psychopharmacological treatment psychopharmacological treatment is the use of prescribed medication in managing oppositional defiant disorder. prescribed medications to control odd include mood stabilizers, anti-psychotics, and stimulants. in two controlled randomized trials, it was found that between administered lithium and the placebo group, administering lithium decreased aggression in children with conduct disorder in a safe manner. however, a third study found the treatment of lithium over a period of two weeks invalid. other drugs seen in studies include haloperidol, thioridazine, and methylphenidate which also is effective in treating adhd, as it is a common comorbidity. the effectiveness of drug and medication treatment is not well established. effects that can result from taking these medications include hypotension, extrapyramidal symptoms, tardive dyskinesia, obesity, and increase in weight. psychopharmacological treatment is found to be most effective when paired with another treatment plan, such as individual intervention or multimodal intervention. individual interventions individual interventions are focused on child-specific individualized plans. these interventions include anger control/stress inoculation, assertiveness training, a child-focused problem-solving skills training program, and self-monitoring skills. anger control and stress inoculation help prepare the child for possible upsetting situations or events that may cause anger and stress. they include a process of steps the child may go through. assertiveness training educates individuals in keeping a balance between passivity and aggression. it aims to help the child respond in a controlled and fair manner. a child-focused problem-solving skills training program aims to teach the child new skills and cognitive processes that teach how to deal with negative thoughts, feelings, and actions. parent and family treatment according to randomized trials, evidence shows that parent management training is most effective. it has strong influences over a long period of time and in various environments. parent-child interaction training is intended to coach the parents while involving the child. this training has two phases; the first phase is child-directed interaction, where the focus is to teach the child non-directive play skills. the second phase is parent-directed interaction, where the parents are coached on aspects including clear instruction, praise for compliance, and time-out for noncompliance. the parent-child interaction training is best suited for elementary-aged children. parent and family treatment has a low financial cost, which can yield an increase in beneficial results. multimodal intervention multimodal intervention is an effective treatment that looks at different levels including family, peers, school, and neighborhood. it is an intervention that concentrates on multiple risk factors. the focus is on parent training, classroom social skills, and playground behavior programs. the intervention is intensive and addresses barriers to individuals' improvement such as parental substance use or parental marital conflict. an impediment to treatment includes the nature of the disorder itself, whereby treatment is often not complied with and is not continued or adhered to for adequate periods of time. comorbidity oppositional defiant disorder can be described as a term or disorder with a variety of pathways in regard to comorbidity. high importance must be given to the representation of odd as a distinct psychiatric disorder independent of conduct disorder. in the context of oppositional defiant disorder and comorbidity with other disorders, researchers often conclude that odd co-occurs with an attention deficit hyperactivity disorder (adhd), anxiety disorders, emotional disorders as well as mood disorders. those mood disorders can be linked to major depression or bipolar disorder. indirect consequences of odd can also be related or associated with a later mental disorder. for instance, conduct disorder is often studied in connection with odd. strong comorbidity can be observed within those two disorders, but an even higher connection with adhd in relation to odd can be seen. for instance, children or adolescents who have odd with coexisting adhd will usually be more aggressive and have more of the negative behavioral symptoms of odd, which can inhibit them from having a successful academic life. this will be reflected in their academic path as students. other conditions that can be predicted in children or people with odd are learning disorders in which the person has significant impairments with academics and language disorders, in which problems can be observed related to language production and/or comprehension.