Homeopathic Management for Children with Oppositional Defiant Disorder: A Clinical Study

Oppositional and negativistic behaviours, when exhibited in moderation, are considered developmentally normative during early childhood and adolescence. Epidemiological studies in nonclinical populations have reported the presence of such traits in approximately 16% to 22% of school-aged children. Although the onset of ODD can occur as early as three years of age, it is most commonly identified by the age of eight and rarely emerges after early adolescence.

Prevalence estimates for ODD range from 2% to 16%, with higher rates observed in males prior to puberty. Post-pubertal prevalence appears to equalize across sexes. Notably, the incidence of oppositional behaviours tends to decline in individuals over the age of twelve.

The most pronounced manifestation of normative oppositional behaviour typically occurs between 18 and 24 months of age—commonly referred to as the "terrible twos"—as a developmental expression of emerging autonomy. Pathological patterns are suggested when such behaviours persist beyond expected developmental stages, when authority figures respond with excessive rigidity, or when oppositional behaviours occur with a frequency and intensity that significantly exceed normative expectations for the child's developmental level.

Among the diagnostic criteria for ODD, chronic irritability has been identified as the most robust predictor of subsequent psychiatric disorders. In contrast, other features of the disorder may reflect underlying temperamental traits. Children vary in their innate predispositions toward assertiveness, strong will, and preference expression. Parental modelling of extreme or authoritarian behaviour may exacerbate these tendencies, potentially contributing to entrenched oppositional dynamics that extend to interactions with other authority figures. What begins for an infant as an effort to establish self-determination may become transformed into an exaggerated behavioural pattern. In late childhood, environmental trauma, illness, or chronic incapacity, such as mental retardation, can trigger oppositionality as a defence against helplessness, anxiety, and loss of self-esteem. Another normative oppositional stage occurs in adolescence as an expression of the need to separate from the parents and to establish an autonomous identity.

Classic psychoanalytic theory implicates unresolved conflicts as fuelling defiant behaviours targeting authority figures. Behaviourists have observed that in children, oppositionality may be a reinforced, learned behaviour through which a child exerts control over authority figures; for example, if having a temper tantrum when a request or demand is made of the child coerces the parents to withdraw their request, then tantrum behaviour becomes strongly reinforced. In addition, increased parental attention during a tantrum can reinforce the behaviour.

Children diagnosed with ODD frequently engage in argumentative interactions with adults, exhibit frequent temper outbursts, and display persistent irritability, anger, and resentment. These behaviours occur at a frequency and intensity that exceed normative expectations for the child's developmental stage. Affected individuals often defy rules and instructions, intentionally provoke others, and demonstrate a consistent tendency to externalize blame for their own misbehaviour.

While symptoms are most commonly observed in the home environment, they may also manifest in school settings or in interactions with peers and other adults. In some cases, oppositional behaviours are evident across multiple contexts from the onset; in others, they may initially be confined to the home and later generalize. These behaviours are typically most pronounced in interactions with familiar adults or peers, and may not be readily observable in clinical settings. Although children with oppositional defiant disorder may be aware that others disapprove of their behaviour, they may still justify it as a response to unfair or unreasonable circumstances.

ODD often causes greater distress to caregivers, educators, and peers than to the affected child. Chronic oppositionality and irritability frequently disrupt interpersonal relationships and academic performance. Children with ODD are at increased risk of peer rejection, social isolation, and loneliness. Despite possessing average or above-average intellectual abilities, these children may underperform academically due to noncompliance, lack of engagement, and resistance to assistance.

These challenges may contribute to secondary emotional difficulties, including low self-esteem, poor frustration tolerance, depressive symptoms, and frequent temper outbursts. Adolescents who experience social exclusion may resort to substance use as a maladaptive coping strategy. Persistent irritability in childhood is associated with an elevated risk of developing mood disorders during adolescence or adulthood.

Relationship difficulties: Constant conflict with parents, teachers, and peers due to defiant behaviour, making it hard to build and maintain healthy relationships.

Low self-esteem: The negative feedback and consequences of ODD behaviours can lead to feelings of worthlessness and low self-esteem.

Mood disorders: Increased irritability and anger, manifests as symptoms of depression or anxiety.

Social isolation: Difficulty to make friends and maintain social connections.

Increased risk of Conduct disorder: More aggressive and delinquent behaviours, including violence and property damage.

Stress and anxiety: The constant conflict and pressure to control their behaviour can lead to high levels of stress and anxiety.

Oppositional Defiant Disorder (ODD) is a rising concern in pediatric mental health, and current pharmacological treatments often carry risks such as side effects or poor adherence in children. There is a growing global demand for non-drug, integrative approaches that are safe, effective, and culturally acceptable. This study addresses that gap by evaluating individualized homeopathy in a clinical setting.

This study conducted in patients who reported to outpatient department, Inpatient department and peripheral centers of Excel Homeopathy Medical College and Hospital.

The sample size will be 42 children who have ODD. The total number of enrolled participants was 45, out of which 3 children dropped out, leaving 42 participants who completed the study. Sample size will be determined by using study literature of sources and the calculation was based on precision rate.

Sampling refers to the process by which a researcher selects participants from a population. In this study Purposive Sampling technique will be used to select samples from the population.

Inclusion criteria

• Children's age between 8 and 12 years.

• Children of both sexes.

Exclusion criteria

• Patients with active treatment for any other chronic disease.

• Patients with Organic Mental Disorders.

A structured case history was obtained for each participant using a standardized pro forma developed for the study. Therapeutic management was guided by the principles of classical homeopathy, with a sample size comprising 42 children diagnosed with ODD. Data collection adhered to the documentation protocols of Excel Homeopathy Medical College and Hospital.

For each case, a comprehensive symptom totality was constructed, incorporating personality assessments and individualized characteristics. Remedies were selected based on references to the Homeopathic Materia Medica and various repertories. An individualized treatment plan was formulated in accordance with Standardized Case Record (SCR) guidelines. Participants were monitored over a minimum follow-up period of 18 months, and outcomes were analyzed to derive clinical inferences.

The study employed a clinical observational design without a control group, as it was intended as a preliminary investigation into the feasibility and potential efficacy of homeopathic interventions for ODD. Participants received treatment on both outpatient and inpatient bases. Diagnostic conclusions were primarily based on clinical history and physical examination findings; additional investigations were not uniformly conducted.

The remedy selection process has been elaborated. Remedies were chosen based on detailed individual case histories following classical homeopathic principles. Potencies ranged from 200C to 1M, and were administered based on clinical response. Repetition followed the principle of minimum dose, typically at intervals of 15 to 30 days, adjusted per case. No concomitant therapy such as allopathic treatment or any other treatment was used. Subjects, who were on other therapy already, were asked to discontinue the same. Placebo was used selectively in a small number of cases where either symptom clarity was lacking or during the follow-up phase when repetition of the remedy was not indicated. However, since this was not a placebo-controlled study, this mention has been clarified and reworded to avoid confusion. If the patient's condition becomes severe or deteriorated, it was referred to conventional or other treatment.

The NICHQ Vanderbilt Assessment Scale, the most widely used rating scale in psychiatry containing of symptoms 8 items rated 0 (Never) to 3 (Very often) and academic performance 8 items rated 1 (Excellent) to 5 (Problematic), was used to verify the status at the baseline and each follow-up visits. The result was analyzed on the basis of changes in NICHQ Vanderbilt Assessment Scores. Changes was calculated by using formula and the changes were graded as Marked improvement, Moderate improvement and Mild improvement.

In Inferential statistics, Independent Students ‘t’-test will be used to test the comparison between group of continuous variables outcome. Paired ‘t’ test will be used to compare the within group pre and post-test. ANOVA will be used to compare the repeated measurements.

The written informed consent was obtained from all parents or legal guardians, and age-appropriate verbal assent was sought from participating children. The study protocol was approved by the Institutional Ethics Committee, and this procedure followed the guidelines laid out for pediatric research.

Trail Registration: Clinical Trial Registry India (CTRI/2022/09/046020).

This study has several important limitations. First, it lacked a control or placebo group, which limits the ability to draw causal inferences. The observed improvements may have been influenced by placebo effects, natural developmental progress, or external psychosocial changes. Second, the absence of blinding may have introduced bias in the administration and interpretation of the Vanderbilt Assessment Scale. Third, while individualization is a key feature of homeopathy, the variability in remedies and potencies complicates reproducibility. Lastly, no follow-up was done beyond 18 months to assess long-term effects or relapse. Future studies should incorporate randomized controlled designs, longer follow-up, and standardized treatment protocols to validate these findings.

This study may contribute to improving behavioral patterns in children using individualized homeopathic treatment.

This research offers substantial practical value by addressing a socially and clinically significant issue—Oppositional Defiant Disorder in children. The study's findings suggest that individualized homeopathic treatment may serve as an effective complementary approach for managing ODD symptoms, particularly in settings where conventional psychiatric care is limited or poses concerns related to medication safety.

By supporting alternative models of care, this work contributes to easing the burden on families, educators, and healthcare providers dealing with disruptive childhood behaviors. It promotes a more inclusive understanding of mental health interventions that are affordable, minimally invasive, and potentially scalable across diverse populations. The study also contributes to the field of Global Mental Health by supporting the World Health Organization's call for community-based, culturally sensitive mental health services (World Health Organization, 2013).