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| HOME > FOR FAMILIES > DISORDERS > DISRUPTIVE BEHAVIOR DISORDERS | |||
Disruptive Behavior Disorders A dditional information about child and adolescent disruptive behavior disorders is available from:National Institute of Mental Health American Academy of Child & Adolescent Psychiatry: For information on treatments for disruptive behavior disorders that are available through CARE-NET, see Studies.
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What is Oppositional Defiant Disorder (ODD)? Virtually every child is at least occasionally oppositional or defiant. Challenges to adult authority or outright oppositional behavior are certainly expected during different developmental periods, such as toddlerhood or early adolescence. And, of course, there are common circumstances in most children’s lives that may increase their likelihood of being oppositional, such as being hungry, tired, angered, frustrated, stressed, or even confused. Oppositionality takes several forms, but includes being argumentative and disobedient, tantrumming, talking back, and defying adults. Oppositional and defiant behavior can become an ongoing pattern of behavior that characterizes a child’s typical interactions with parents, teachers, and other adults. These behaviors may become frequent and difficult to manage, reflecting negative interactions with others that may transition into angry outbursts and hostility. When they become more frequent and intense than those commonly seen in other children their age, these patterns they may reflect a more serious and clinically significant concern, especially as they cause problems in the child's family, school, peer, and community functioning. Oppositional Defiant Disorder (ODD) is a disruptive behavior disorder that is commonly found in preschool and young school-aged children. The prevalence of this disorder in the general population is estimated to range between 5% and 10%. Children with ODD demonstrate an ongoing pattern of uncooperative, defiant, and angry behavior toward authority figures that seriously interferes with their everyday functioning. The disorder should be diagnosed based on a systematic clinical interview. In accord with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by the American Psychiatric Association (2000), the diagnosis is made if a child exhibits at least 4 of the following 8 symptoms of ODD for at least 6 months continuously:
In general, ODD symptoms are often exhibited across different circumstances and settings, but may be more apparent at home or school. No single cause or clear set of causes of ODD has been reported. However, the patterns may begin early in the child’s life as parents begin to manage their child’s behavior. Some parents also find that their children are very difficult to redirect and discipline. Thus, both child and parental or family factors may play a role in the development of ODD. Children with ODD symptoms may have other disorders, such as attention-deficit hyperactive disorder (ADHD). They may also develop other disorders, such as learning disabilities, mood disorders (depression, bipolar disorder), and anxiety disorders. Some children with ODD may develop a related disruptive behavior disorder called conduct disorder. The majority of effective treatments for ODD include some form of parent training in effective behavior management techniques. This can be conducted individually or in dyadic sessions with the parent and child. Much of this work can be directed towards improving the parent-child relationship, establish ongoing consequences for the child’s behavior, and teach skills to encourage calm and caring time together. Parents may find that they can learn to model self-control, provide clear instructions that are age and developmentally appropriate, fair but firm expectations and discipline, and a balanced approach to consequences that includes both reinforcement and punishment. In addition, children may benefit from participation in individual training in self-management, social, and/or emotion-regulation skills through direct counseling. Family work is encouraged to promote effective problem-solving and communication, especially when patterns of oppositional and defiant behavior occur throughout the family (for example, siblings). Fortunately, the good news is that there is research evidence that shows the benefits of these services. Of course, the challenging nature of ODD requires that both parent and child be aware that they may get easily frustrated. Counselor support can assist the parent and child to learn to be patient as treatment begins in order to change their behaviors that have been developing for many months and in some cases years. What is Conduct Disorder (CD)? Conduct Disorder (CD) is a disruptive behavior disorder (DBD) that is one of the more commonly diagnosed and studied mental health disorders in children and adolescents. An important characteristic of children and adolescents with this disorder is their difficulty in following rules and behaving in a socially acceptable way. These children may exhibit behaviors perceived as “antisocial” or “deviant”. The symptoms of CD make it difficult for a child or adolescent to function successfully with family members, in school or work settings, and with peers. The diagnosis of CD should be based on a comprehensive clinical interview. It is especially helpful to have other information from a variety of sources including teacher, parent, and self-reports on measures that reflect the nature and severity of the child’s behavior problems. In accord with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) by the American Psychiatric Association (2000), the diagnosis is made if the child is found to exhibit at least any 3 of 15 diverse symptoms within the past 12 months. In addition, one of the symptoms must have been present in the past 6 months. Large-scale population studies have found prevalence rates for CD averaging around 7%, with a range from 4 to 10%. The specific symptoms that comprise this disorder are listed below, grouped by their general content: Aggression to people and animals
Destruction of Property
Deceitfulness, lying, or stealing
Serious violations of rules
Many children with a conduct disorder may have another disorder, such as Attention Deficit Hyperactivity Disorder (ADHD), mood disorders, anxiety disorder, PTSD, or substance abuse. Some of these children exhibit other problems that are treatable in their own right, such as learning/achievement problems or thought disorders. Although the DSM-IV stipulates that children diagnosed with CD cannot also be diagnosed with ODD, it is clear that many CD children exhibit the symptoms of ODD as well. In fact, a history of ODD may be one of the primary contributors to CD. CD has been found to be a fairly stable condition, especially if children or parents do not receive intervention. Sometimes, the clinical course of CD may wax and wane over a relatively long time interval. In some cases, CD children may progress toward more serious delinquent behaviors. This progression may include the experience of difficulties across various settings, such as home, school, and work, and difficulties in social relationships. CD is associated with problems adapting to the demands and stress of adolescence and, possibly, adulthood, which may include later involvement in criminal activity.
Many factors may contribute to the emergence of conduct disorder, especially, parent (discord, behavior management problems), family (conflict, limited positive time together and little affection, peer (deviant activities) and other neighborhood/community influences (exposure to crime). The American Academy of Child and Adolescent Psychiatry indicates that other factors may play a role, including brain damage, child abuse, genetic vulnerability, school failure, and traumatic life experiences. Clearly, a broad range of factors may exert a significant influence on the development of children’s behavior problems, highlighting the presence of many potential contributors to this disorder.
CD is one of the most frequent reasons for referral to clinical services, at times reflecting up to three-fourths of the cases seen in outpatient or inpatient treatment settings. Treatment for conduct disorder may require the integration of several interventions and the participation of several individuals, including children, parents, families, and teachers. As a result, treatment may be intensive, challenging, and involve different systems or settings, requiring much energy from all parties involved. An important element of treatment is the development of a positive initial relationship, the identification of clear and important treatment targets or goals, and a focus on maximizing the cooperation and motivation of all involved parties.
In general, a range of useful interventions has been reported for this disorder. Some form of parent training, especially in behavior management principles and methods, represents the most effective treatment approach for this disorder. Several clinical materials and programs have been found to be effective in promoting parent effectiveness and reducing children’s antisocial behavior. Children may benefit from instruction in psychological and behavioral skills, such as anger control, social skills, and problem-solving. These skills have also been effectively taught to the entire family in an effort to enhance positive communication and interactions. Some of these children may require school-based interventions or services from special education. Medication may also be helpful, especially for those children with attention deficit hyperactivity disorder, anxiety disorders, or depressive disorders. Because treatment may be directed towards several individual and family targets, the length of treatment may vary across families. Fortunately, scientific research evidence has shown several of these methods to be effective, especially for treatments that blend several of these intervention components. |
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