Evolução clínica de crianças e adolescentes com Transtorno de Oposição Desafiante (TOD) mediante tratamento farmacológico no SUS: perspectiva de pais ou responsáveis

Oppositional Defiant Disorder (ODD) is classified among disruptive, impulse-control and conduct disorders, and is characterised by a persistent pattern of irritable mood, oppositional/defiant behaviour and vindictiveness, especially towards authority figures. Although it may occur in isolation, it is frequently associated with psychiatric and neurodevelopmental comorbidities, including Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). This study aimed to evaluate the perception of parents or caregivers regarding the clinical evolution of children and adolescents under 18 years of age diagnosed with ODD and undergoing pharmacological treatment, with full or partial healthcare linkage to the Brazilian Unified Health System (SUS). This was a cross-sectional study with a predominantly quantitative, exploratory and descriptive approach. Data collection was carried out in person, using a printed questionnaire containing questions related to epidemiological, clinical, diagnostic and therapeutic aspects, administered to 20 parents or caregivers of patients with ODD. The results indicated a predominance of male patients (75%), with a higher frequency in the 11 to 15-year age group (45%). After initially seeking care, 30% of the caregivers reported an interval of 1 to 6 months until diagnosis was obtained, while 35% of the patients received the diagnosis between 9 and 10 years of age. The main comorbidities reported were ADHD (85%) and ASD (20%). In ODD, medication therapy is mainly used for the management of target symptoms and associated comorbidities, especially when these have a significant impact on the patient’s behaviour and functionality. The most frequently used medications were risperidone (70%), aripiprazole (25%) and methylphenidate (25%), followed by melatonin (15%) and, with 10% each, cannabidiol, atomoxetine, fluoxetine, haloperidol, lisdexamfetamine, quetiapine, divalproex sodium and clomipramine. According to the caregivers, 75% of the patients had been using medication for more than two years. Improvement or cessation was reported in frequent arguments with authority figures (45%), physical aggression (40%), defiant behaviour (30%) and sleep disturbances (30%), in addition to positive changes in social interaction (45%). Furthermore, 75% of the patients received medical care through SUS; however, 60% of the caregivers reported purchasing medications with their own financial resources. It is concluded that pharmacotherapy may contribute to the management of target symptoms and comorbidities associated with ODD, but it should be integrated with psychosocial interventions, multidisciplinary follow-up and family support.