Oppositional Defiant Disorder

25^th June 2026

Oppositional Defiant Disorder (ODD) can significantly impact family functioning and a child’s school and social experiences. It is characterised by persistent patterns of irritability, defiant behaviour, and difficulty with emotional dysregulation, which can place considerable stress on both children and families with underlying anxiety drives these challenging symptoms. ODD is understood to be multifactorial, with contributions from temperament, neurodevelopmental factors, environmental influences, and co-occurring conditions such as anxiety or ADHD [1].

Children with ODD may experience difficulty in managing frustration and emotional responses, which can lead to conflict with parents, teachers, and peers. These challenges can place significant stress on families and disrupt educational functioning. First-line, evidence-based approaches include behavioural interventions, parent management training, and psychological support; however, some children continue to experience persistent emotional and behavioural difficulties despite comprehensive care [1].

An increasing number of families explore medical cannabinoids as a potential adjunctive option when children continue to experience emotional distress, anxiety symptoms, or behavioural dysregulation despite conventional interventions.

How Cannabinoids Can Help

Medical cannabinoids have been explored for their potential role in supporting symptoms such as anxiety, sleep disturbance, and emotional dysregulation, which may co-occur in children with behavioural and neurodevelopmental conditions, including Oppositional Defiant Disorder (ODD). Cannabinoids interact with the endocannabinoid system, which is involved in regulating stress response, emotional processing, reward, and sleep.

ODD is a multifactorial condition characterised by persistent irritability, defiant behaviour, and difficulties with emotional and behavioural regulation, often occurring alongside other neurodevelopmental conditions [1]. Research into cannabinoid use in paediatric behavioural conditions remain in early stages, including preliminary and protocol-level studies exploring its potential role in ODD and related disorders [2].

A small pilot trial in children and adolescents with intellectual disability has shown preliminary evidence that cannabidiol may reduce severe behavioural problems, although findings are limited and require further confirmation [3]. Overall, evidence remains emerging and not yet sufficient to support routine clinical use in ODD.

As such, cannabinoid-based interventions should only be considered within a specialist-guided, comprehensive treatment plan when first-line interventions have not provided sufficient benefit.

Mechanisms of Action

Tetrahydrocannabinol (THC)

THC is one of the primary compounds found in cannabinoids. It works by interacting with cannabinoid receptors as well as other receptors in the brain and nervous system, which are involved in regulating functions such as mood, perception, and sleep. In some individuals, THC may help promote relaxation and support sleep. Responses to THC can vary from person to person and may depend on the dose used.  For this reason, treatment decisions, product selection, and dosing should always be guided by a healthcare professional and reviewed regularly based on individual response.

Cannabidiol (CBD)

CBD is a non-intoxicating compound found in cannabis that does not typically produce a “high.” It interacts with multiple systems in the body involved in mood regulation, stress response, and sleep. Some individuals report benefits such as reduced anxiety-related arousal, improved sense of calm, or better sleep quality; however, responses vary and are not guaranteed.

The mechanisms of CBD are still being researched, and its effects may differ depending on formulation, dose, and co-existing conditions or treatments. CBD should therefore be used under appropriate clinical guidance and monitored for both response and tolerability, particularly when used alongside other medications.

Common Conditions Related to Oppositional Defiant Disorder

• ADHD: ADHD and ODD frequently co-occur, with studies estimating comorbidity in clinical populations at approximately 30–50%. Both conditions may involve behavioural difficulties, school-related challenges, and social impairment, although the underlying symptom profiles differ.
• Anxiety Disorders: Anxiety commonly co-occurs with ODD and may contribute to increased irritability, emotional reactivity, and oppositional behaviour in some children.
• Autism Spectrum Disorder: Some children with autism present with ODD-like oppositional behaviours driven by anxiety and sensory overwhelm.
• Sleep Disturbances: Poor sleep quality is associated with increased emotional dysregulation, irritability, and behavioural difficulties, which may worsen oppositional patterns.
• Learning Difficulties: Academic challenges may contribute to frustration and oppositional responses.
• Depression: Ongoing conflict, social strain, and reduced engagement in enjoyable activities may increase the risk of low mood and depressive symptoms.

Conventional Treatments

• Parent Training Programmes: Evidence-based parent coaching (Parent-Child Interaction Therapy, behavioural management training) helps families manage challenging behaviours.
• School-Based Interventions: Behavioural supports, classroom accommodations and coordination with educators are essential.
• Individual Behavioural Therapy: Helps children develop emotion regulation skills and coping strategies.
• Family Therapy: Addresses family dynamics and communication patterns.
• Medications: SSRIs for anxiety, stimulants if ADHD is present, or other medications for specific symptoms may be considered.
• Lifestyle Interventions: Sleep optimisation, exercise and stress reduction support overall emotional and behavioural functioning.

Clinical Evidence

Anxiety Reduction, Emotional Regulation and Anger Management

Research suggests that cannabidiol (CBD) has been studied for its potential effects on anxiety symptoms in a range of conditions, including anxiety-related disorders [4]. Early studies have also explored cannabinoids in children and adolescents with severe neurodevelopmental and behavioural difficulties, although this research is still limited and does not specifically focus on Oppositional Defiant Disorder [3].

In children with ODD, difficulties with emotional regulation and anger are generally understood as part of a broader pattern involving multiple factors rather than a single cause [1]. Anxiety and emotional distress may occur alongside ODD in some children and can contribute to increased emotional sensitivity and reactivity. However, these relationships are complex, and oppositional behaviour cannot be explained by anxiety alone.

Some research reviews suggest that CBD may have calming effects on anxiety in certain contexts, but the overall evidence is still early, varies between studies, and is not specific to children with ODD [4]. While there is interest in how anxiety management may support overall emotional wellbeing, there is currently no direct evidence that cannabinoid-based treatments reduce oppositional behaviour in ODD [5,6].

Sleep Quality

A 2019 critical review of clinical studies on cannabinoids and sleep found that the evidence is mixed, with some studies reporting possible improvements in sleep outcomes, while others show limited or inconsistent effects depending on the population, formulation, and dose [5]. Overall, findings remain preliminary and not conclusive.

In paediatric neurodevelopmental research, a phase-2 open-label trial of cannabidiol in children and adolescents with autism spectrum disorder found that sleep-related effects were variable, with some participants experiencing increased sleep duration and sedation, alongside improvements in certain behavioural domains such as irritability and anxiety-related behaviours [6]. However, sleep outcomes were not a primary therapeutic target, and responses differed across individuals.

Sleep disturbances are common in children with behavioural and neurodevelopmental conditions, including Oppositional Defiant Disorder (ODD), and may be associated with increased irritability, emotional reactivity, and reduced behavioural regulation.

Better sleep supports overall emotional and behavioural functioning, including mood stability, frustration tolerance, and the ability to manage daily demands. However, there is currently no direct evidence that cannabinoid-based treatments improve sleep specifically in children with ODD.

Benefits of Cannabinoids

• Emotional and behavioural symptoms: Cannabinoids have been explored for their potential effects on symptoms such as anxiety, emotional dysregulation and irritability, which may co-occur in children with behavioural and neurodevelopmental conditions. However, these effects are not specific to ODD and remain based on early and limited evidence ([1]; [3]).
• Fewer Side Effects: Cannabinoid-based treatments, particularly CBD-dominant formulations, generally have fewer side effects, with reported effects including less impact on appetite, weight, and fewer stimulant-like effects.
• Sleep Support: Some medications used in children with behavioural difficulties may affect sleep. Cannabinoids have been explored for their potential effects on sleep, with some early studies suggesting possible improvements in certain cases; however, the evidence remains limited and more research is needed.
• Support for Co-occurring Symptoms: Cannabinoids have been studied for their potential role in a range of co-occurring symptoms such as anxiety, emotional dysregulation, irritability, and sleep difficulties. Rather than targeting ODD directly, interest lies in whether they may influence associated symptom domains in some individuals.
• Potential Impact on Behavioural Functioning: By potentially supporting co-occurring emotional and behavioural symptoms, cannabinoids may have an indirect role in improving overall functioning in some children. However, evidence for direct effects on oppositional behaviour remains limited.
• Complementary to Behavioural Therapy: Cannabinoids are not a replacement for behavioural interventions but may, in some cases, be considered alongside established approaches such as parent training and behavioural therapy within a specialist-supervised treatment plan.

Side effects of CBD

CBD is generally well-tolerated. Most common side effects are mild to moderate and include diarrhea, nausea, appetite changes, somnolence, and fatigue. Liver enzyme elevation may occur, particularly when combined with valproate. Serious adverse effects are rare. Monitor liver function tests at baseline and periodically, especially in patients with hepatic impairment or taking hepatotoxic medications.

Drug Interactions

CBD may interact with other medications, and some medications may also affect CBD levels in the body. These interactions can occur through shared liver enzyme pathways, including CYP3A4 and CYP2C9.

As a result, levels of either CBD or certain medications may increase or decrease, which may affect therapeutic response and the risk of side effects. This may be particularly relevant for certain cardiovascular, psychiatric, and anticonvulsant medications.

The extent of interaction varies depending on the specific medication, cannabinoid formulation, and individual patient metabolism.

Conclusion

For children with Oppositional Defiant Disorder (ODD) who experience significant emotional dysregulation, anxiety, sleep difficulties, or behavioural distress despite comprehensive behavioural and family interventions, medical cannabinoids may offer potential adjunctive symptom support in selected cases. Current evidence suggests that CBD-based formulations have been explored for their potential effects on anxiety and emotional regulation; however, findings remain preliminary and not specific to ODD. Cannabinoid therapy should be integrated with, not replace, evidence-based behavioural approaches and parent training. By ensuring specialist medical and psychological oversight and coordinated care with parents and educators, AKOS BIO can responsibly provide families access to cannabinoid-based therapies within a structured care framework, with the aim of supporting co-occurring symptoms and contributing to improved overall quality of life for both children and their families.

How to Access AKOS BIO Cannabinoid Therapy

If you are interested in exploring cannabinoid-based treatment as part of your therapeutic plan, discuss this option with your treating healthcare provider. They can help determine whether cannabinoid therapy may be be appropriate for your individual circumstances.

Alternatively, if you would like to explore AKOS BIO’s pharmaceutical-grade cannabinoid products, you can book a consultation with an independent prescribing healthcare practitioner via the AKOS BIO website.

AKOS BIO provides pharmaceutical-grade cannabinoid products and educational resources to support patients and healthcare professionals. Prescribing decisions are made independently by qualified healthcare practitioners.

In South Africa, AKOS BIO doctors will apply for your Section 21 licence (SAHPRA) on your behalf if medical cannabinoids are appropriate for your condition. The permit is valid for six months and can be renewed if treatment is effective.

For more information or to book a consultation:

Website: [www.akos-bio.com](https://www.akos-bio.com)

WhatsApp: 066 269 1108

References

[1] Ghosh, A., Ray, A., & Basu, A. (2017). Oppositional defiant disorder: Current insight. Psychology Research and Behavior Management, Volume 10, 353–367. https://doi.org/10.2147/PRBM.S120582

[2] Mansell, H., Quinn, D., Kelly, L. E., Szafron, M., & Alcorn, J. (2021). Pharmacokinetics and perceptions of children and young adults using cannabis for attention-deficit/hyperactivity disorder and oppositional defiant disorder: Protocol for a mixed methods proof-of-concept study. JMIR Research Protocols, 10(10), e31281. https://doi.org/10.2196/31281

[3] Efron, D., Freeman, J. L., Cranswick, N., Payne, J. M., Mulraney, M., Prakash, C., Lee, K. J., Taylor, K., & Williams, K. (2021). A pilot randomised placebo-controlled trial of cannabidiol to reduce severe behavioural problems in children and adolescents with intellectual disability. British Journal of Clinical Pharmacology, 87(2), 436–446. https://doi.org/10.1111/bcp.14399

[4] Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015). Cannabidiol as a potential treatment for anxiety disorders. Neurotherapeutics, 12(4), 825-836. https://doi.org/10.1007/s13311-015-0387-1

[5] Kuhathasan, N., Dufort, A., MacKillop, J., Gottschalk, R., Minuzzi, L., & Frey, B. N. (2019). The use of cannabinoids for sleep: A critical review on clinical trials. Experimental and Clinical Psychopharmacology, 27(4), 383-401. https://doi.org/10.1037/pha0000285

[6] Lawson, J., Robinson, L., Conlon, G. R., Shalev, R. A., Cervantes, P. E., Yoncheva, Y., Hirsch, G. S., Troxel, A. B., Friedman, D., Devinsky, O., & Castellanos, F. X. (2026). A Phase-2 Open-Label Trial of Cannabidiol to Treat Core and Associated Symptoms of Autism in Children and Adolescents Without Intellectual Disability. Journal of Child and Adolescent Psychopharmacology, 36(6), 350–358. https://doi.org/10.1177/10445463261452514

[7] Nachnani, R., Knehans, A., Neighbors, J. D., Kocis, P. T., Lee, T., Tegeler, K., Trite, T., Raup-Konsavage, W. M., & Vrana, K. E. (2024). Systematic review of drug-drug interactions of delta-9-tetrahydrocannabinol, cannabidiol, and Cannabis. Frontiers in Pharmacology, 15, 1282831. https://doi.org/10.3389/fphar.2024.1282831