Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
Homeopathic Management for Children with
Oppositional Defiant Disorder: A Clinical Study
M. Jayakumar, K. L. Babu
Vinayaka Mission’s Research Foundation, Salem, Tamil Nadu, India
Abstract
Introduction:
Oppositional defiant disorder (ODD) is a disruptive behavioural disorder,
characterized by enduring patterns of negativistic, disobedient, and hostile behaviour toward
authority figures, as well as an inability to take responsibility for mistakes, leading to placing
blame on others. Children frequently argue with adults and become easily annoyed by others,
leading to anger, resentment and may have difficulty in the class room. It significantly affects
the mental health and increasing the risk of developing other mental health issues like
depression, anxiety, and substance abuse disorders.
ODD is a rising concern in paediatric mental health. 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
Purpose: This study aims to investigate the behavioural changes in children and its impact on
the mental health in the context of managing of
the oppositional defiant disorder on
complementary medicine through homeopathy medicines.
Methodology:
45 children were diagnosed with Oppositional defiant disorder with the age
between 5 to 15 years. Three children dropped out, resulting in a total of 42 children
completing the study. Pre and Post Assessment was done using Vanderbilt Assessment Scale.
Post assessment was done at 6th, 12th and 18th month.
Results:
Out of 42 cases, 6 (14.28%) cases with mild improvement, 22 (52.38%) cases with
moderate improvement, 10 (23.80%) cases with marked improvement and 4 (9.52%) cases
showed no improvement.
Conclusion:
Individualized homeopathic treatment has shown a positive role for the
management and treatment of disruptive behavioural disorder. F
urther research through
randomized, placebo-
controlled trials is necessary to confirm efficacy and to guide clinical
application more robustly.
Keywords
Mental Health, Oppositional Defiant Disorder, Homeopathy, Psychiatry, Vanderbilt Assessment
Scale.
Address for correspondence:
Dr. M. Jayakumar,
Parimala Illam, Subramaniya Nagar Extension, Suramangalam,
Salem, Tamil Nadu, India (636005)
E-mail: drjayakumar.homoeo@gmail.com
This work is licensed under a Creative Commons Attribution- 4.0 International License
(CC BY 4.0).
©Copyright: Jayakumar et al., 2025
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v
8
i1.
2
66
Submitted for publication: 04
May 2025
Revised: 06 July 2025
Accepted for publication: 15
July 2025
Introduction
Oppositional Defiant Disorder (ODD) is
classified as a disruptive behavioural disorder
characterized by a persistent pattern of
negativistic, defiant, disobedient, and hostile
behaviour directed toward authority figures.
Affected individuals often exhibit a marked
reluctance to accept responsibility for their
actions, frequently attributing blame to others.
Children with ODD commonly engage in frequent
arguments with adults, display heightened
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irritability, and are easily provoked, leading to
expressions of anger and resentment. These
behavioural patterns often interfere with
classroom functioning and peer relationships.
According to the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (DSM-5),
ODD is categorized into three distinct symptom
clusters:
-Angry/Irritable Mood
-Argumentative/Defiant Behaviour
-Vindictiveness.
Homeopathy is a system of individualized
medicine that considers the patient's
psychological and behavioural characteristics as
part of treatment. It is recognized for its non-toxic
nature and potential in chronic behavioural
conditions. The rationale is based on its holistic
effect on emotional regulation and behavioural
symptoms, as supported by earlier case reports
and literature cited in the manuscript (e.g., Gilla
et al., 2023; Kulkarni, 2019).
This study responds to the rising incidence of
behavioural disorders in children and the
limitations of current psychiatric interventions,
including medication-related side effects.
Homeopathy, being non-toxic and holistic in
nature, presents an alternative that could address
both emotional and behavioural symptoms in a
gentle and individualized manner. While existing
research includes case reports and small-scale
studies, there is a lack of structured clinical studies
evaluating homeopathy in ODD. This study aims
to fill that gap.
The scientific justification lies in the potential of
individualized homeopathy to influence
behaviour through constitutional remedies that
match both psychological and physical
symptomatology. Prior clinical observations and
smaller studies have shown promising results, and
this study provides empirical evaluation using
validated psychiatric tools.
LITERATURE SURVEY
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
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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.
ODD affects Mental Health:
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.
Purpose
The purpose of the study is to investigate the
behavioural changes in children and their impact
on the mental health. The study aims to manage
the oppositional defiant disorder on
complementary medicine through homeopathy
medicines.
NEED FOR THE STUDY:
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.
Methodology
Source of data:
This study conducted in patients who reported
to outpatient department, Inpatient department
and peripheral centers of Excel Homeopathy
Medical College and Hospital.
Sample size:
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 Technique:
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
1. Children’s age between 8 and 12 years.
2. Children of both sexes.
Exclusion criteria
1. Patients with active treatment for any
other chronic disease.
2. Patients with Organic Mental Disorders.
Intervention:
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
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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.
Outcome Measures:
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.
Statistical Analysis:
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.
Ethical Considerations and Informed
Consent:
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).
Results
A total of 45 children diagnosed with
Oppositional Defiant Disorder were enrolled. 3
children were dropped out from the treatment in
between the study. Out of 42 children, 28 (66.7%)
were male and 14 (33.3%) were female.
Among the 42 children, 12 (28.57%) were
aged 12, 5 (11.9%) children were under the age
group of 11, 11 (26.19%) children were under the
age group of 10, 8 (19.04%) children were under
the age group of 9, 6 (14.28%) children were
under the age group of 8. Based Vanderbilt
Assessment Scale, 20 (47.61%) children were
moderately ill and 22 (52.38%) children were
mildly ill. (Table 1).
There were 14 different remedies prescribed
during the course of the study, taking into
account the remedy changes that occurred at 6,
12 and 18 months of follow up.
The most frequently used and effective
medicines were Calcarea carbonicumonicum
(21.42%), Lycopodium (11.9%), Natrum
muriaticum (11.9%), Silicea (9.52%), Nux vomica
(7.14%), Medorrhinum (7.14%), Calcarea
phosphoricum (4.76%), Staphysagria (4.76%),
Sulphur (4.76%), Hyoscyamus (4.76%),
Stramonium (4.76%), Baryta carb (2.38%),
Tarentula (2.38%) and Tuberculinum (2.38%).
(Table 2)
Out of 42 cases, 10 (23.80%) cases showed
marked improvement, 22 (52.38%) cases
showed moderate improvement, 6 (14.28%)
cases showed mild improvement and 4 (9.52%)
cases showed no improvement. (Table 3).
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Table 1: Baseline Profile
Variables
No. of Cases
Percentage
Mean±SD
Gender
Male
28
66.66
Female
14
33.33
Age Group (in years)
10±1.58
12
12
28.57
11
5
11.90
10
11
26.19
9
8
19.04
8
6
14.28
Intensity of Disease
21±1.41
Mild (VAS Score 12-
30)
22
52.38
Moderate (VAS
Score 31-50)
20
47.61
Table 2: Medicines prescribed during the study
Percentage
21.42
11.90
11.90
9.52
7.14
7.14
4.76
4.76
4.76
4.76
4.76
2.38
2.38
2.38
Table 3: Clinical outcome categories of Children Post-Treatment
Percentage
23.80
52.38
14.28
9.52
Table 4: Anova: Single Factor
SUMMARY
Groups
Count
Sum
Average
Variance
Column 1
42
1286
30.6190476
73.1684088
Column 2
42
651
15.5
16.1585366
ANOVA
Source of Variation Between Groups Within Groups Total
SS
4800.297619
3662.404762
8462.702381
Df
1
82
83
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MS 4800.297619 44.66347271
F 107.477035
P-value 1.41097E-16
F crit 3.957388322
Table 5: t-Test: Paired Two Sample for Means
Variable 1
Variable 2
Mean
30.61904762
15.5
Variance
73.16840883
16.15853659
Observations
42
42
Pearson Correlation
0.855461823
Hypothesized Mean
Difference 0
Df
41
t Stat
17.74253616
P(T<=t) one-tail
3.79802E-21
t Critical one-tail
1.682878002
P(T<=t) two-tail
7.59604E-21
t Critical two-tail
2.01954097
The t-test was carried out before and after
treatment values showed a statistically significant
difference between before and after scores. The
mean difference is 30.61, variance is 73.16, t =
17.74; P < 0.000001. (Table 5).
Discussion
Homeopathy has shown potential as a useful
approach in the treatment of oppositional defiant
disorder over the years. The number of patients
taken for the study was 42. The patients were
observed for the period of 6 – 18 months. All the
patients were treated with constitutional remedies
in this study.
The findings of this study demonstrate
measurable behavioral improvements in children
diagnosed with Oppositional Defiant Disorder
(ODD) following individualized homeopathic
treatment. These results are consistent with prior
case series and observational studies, such as
those by Gilla et al. (2023) and Kulkarni (2019),
which reported significant behavioral stabilization
in pediatric cases managed with homeopathic
remedies.
In particular, the frequent prescription of
Calcarea carbonicumonicum aligns with its
known applicability in children with irritability,
stubbornness, and hypersensitivity—key features
of ODD. Studies by Justina Steefan et al. (2023)
and Moorthi et al. (2022) have similarly noted the
role of constitutional remedies in supporting
emotional regulation in children.
While the clinical significance of the
improvements observed (e.g., reduction in
Vanderbilt scores) is encouraging, the absence of
a control group necessitates cautious
interpretation. Without a placebo group or
comparator therapy, it is not possible to
definitively attribute these improvements solely to
the homeopathic treatment.
Limitations and Future Directions:
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
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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.
Strengths of the study:
This study may contribute to improving
behavioral patterns in children using
individualized homeopathic treatment.
Practical Value
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).
Conclusions
This preliminary clinical study suggests that
individualized homeopathic management may
contribute to behavioral improvement in children
with Oppositional Defiant Disorder. The positive
changes observed in the Vanderbilt Assessment
Scores support further exploration of this
treatment modality. However, given the
observational design, absence of a control
group, and potential confounding factors, the
findings must be interpreted cautiously. Further
research through randomized, placebo-
controlled trials is necessary to confirm efficacy
and to guide clinical application more robustly.
Acknowledgments
We extend our sincere gratitude to the staff
and administration of Excel Homeopathy Medical
College and Hospital for their continuous support
during the course of this study. We also
acknowledge the valuable contributions of the
faculty, clinical staff and interns who assisted in
patient follow-up and data collection.
Special thanks to the children and their
parents/guardians who participated in the study
with trust and cooperation. Their willingness to
engage in this research made the work possible.
We also appreciate the guidance provided
by the Institutional Ethics Committee for ensuring
the ethical integrity of the project.
Funding Statement
The authors declare that this research did not
receive any specific grant from funding agencies
in the public, commercial, or not-for-profit
sectors. All expenses related to the study and
publication were personally covered by the
authors.
Conflict of interest
The authors declare no conflict of interest.
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