Disruptive Behavioural Disorder

Learning Objectives

By the end of this session you will be able to:

This session uses self assessments that help you check what you have learnt. You do not have to use them.  Discuss your answer within your group and click on the instructional button to see the answer

Chapter 1 (and only)

Why is it important to understand about oppositional defiant disorder (ODD) and conduct disorder (CD)?

  • Children may have difficulty in their learning at school such as their academic performance They also face difficulty with family relationships, authority figures such as teachers and friends
  • They have shorter attention span and and they are not able to speak well

These disorders cause great distress for the children and young people concerned. They lead to great difficulties in their families. 

ODD/CD impair people’s ability to learn; they also affect the learning of other children around them. 

Question: How might these disorders affect children?

Understanding ODD & CD

Temporary behavioural difficulties are common in childhood. It is important to distinguish between those and the children and young people who suffer from these disorders 

Some people mistakenly regard these disorders as character flaws rather than psychiatric disorders. The children are seen as ‘bad’ or ‘nasty’.

Characteristic

Examples of the behaviours on which the diagnosis is based include:

Excessive levels of fighting or bullying

Cruelty to other people or animals

Severe destructiveness to property

Fire-setting

Stealing

Repeated lying

Truancy from school and running away from home

Unusually frequent and severe temper tantrums

Disobedience

  • - repetitive and persistent patterns of aggressive behaviour - disruptive behaviour towards authority figures - destruction of property - significant deceit or theft - serious violation of rules, e.g. truancy, breaking curfews or running away
  • - listening to instruction - completing task - adhering to authority figure - friendly toward peers & famillies

Disruptive Behaviour Disorders involve behaviours more severe than ordinary childhood mischief

or teenage rebellion.

Name some of the characteristics.

 

Key terms in ODD & CD

ODD usually occurs in younger children. It is primarily characterised by markedly , , behaviour that does not include delinquent acts or the more extreme forms of aggressive or dissocial behaviour.

What causes Oppositional Defiant Disorder?

How is Oppositional Defiant Disorder treated?

  • There is no single treatment for all children and adolescents with Oppositional Defiant Disorder (ODD). The most effective treatment plan will be individualized to the needs of each child and family. Specific treatment modalities may be helpful for a particular child, depending on his or her age, the severity of the presenting problems, and the goals, resources, and circumstances of the family. Treatment must be delivered for an adequate duration (usually several months or longer) and may require multiple episodes either continuously or as periodic "booster" sessions. Treatment will often include both individual therapy and family therapy. It may also include work with the child's teacher or school. Treatment may also include the use of medication, although medication alone would rarely be considered an adequate or appropriate intervention for children with ODD.
  • Child will outgrow themselves with no intervention needed.

True or False !?

  • Maltreatment of children increases the risk, as does institutional upbringing or children being transferred to foster care
  • ODD and CD is hereditary
  • Locality and socio-economic status (SES) show a strong relationship with rates of ODD and CD
  • Stealing, lying, truancy, and cruelty to animals are some examples of behaviours on which a diagnosis is based
  • Family poverty is not related to increased ODD/CD

How family function and parenting style can also pose risks for developing ODD/CD.

  • Harsh inconsistent discipline Low warmth and involvement High levels of parental criticism Family poverty is related to increased ODD/CD because poverty compromises/influences parenting style.
  • the opposite of all above :)

Others

Session Key Points


  • ODD and CD are important because they cause much distress to children and families, they can impair the child’s learning and psychosocial development, they can persist and be linked to poor mental health in adulthood; they are also financially and socially costly to society. Moreover there is evidence that management and treatment can have a positive influence on their development
  • The main features of ODD involve persistent defiant, headstrong, argumentative and spiteful behaviour, anger and irritability/tantrums as well as anger and irritability(ODD); in CD these include a persistent pattern of breaking societal norms, including aggression, destruction, theft, and other serious violations of rules
  • Both are commonly comorbid with other neurodevelopmental and psychiatric disorders
  • Causes may be psychosocial (socio-economic, poor family mental health and parenting practices, maltreatment), genetic (especially in the more serious manifestations or when ADHD is also present) or related to pregnancy risks
  • In taking a history, it is important to obtain careful accounts of specific incidents, their severity, pervasiveness and consequences, school and intellectual performance, parental attitudes and rearing practices and to interview children and observe parent child interactions
  • The main differential diagnoses are ADHD, adjustment disorders, depression and anxiety disorders, autism and subcultural antisocial behaviour


References

  1. (2016). Retrieved 31 October 2016, from https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/odd/odd_resource_center_odd_guide.pdf
  2. Greene, R., Biederman, J., Zerwas, S., Monuteaux, M., Goring, J., & Faraone, S. (2002). Psychiatric Comorbidity, Family Dysfunction, and Social Impairment in Referred Youth With Oppositional Defiant Disorder. American Journal Of Psychiatry, 159(7), 1214-1224. http://dx.doi.org/10.1176/appi.ajp.159.7.1214
  3. Matthys, W., Vanderschuren, L., Schutter, D., & Lochman, J. (2012). Impaired Neurocognitive Functions Affect Social Learning Processes in Oppositional Defiant Disorder and Conduct Disorder: Implications for Interventions. Clinical Child And Family Psychology Review, 15(3), 234-246. http://dx.doi.org/10.1007/s10567-012-0118-7
  4. del Valle, P., Kelley, S., & Seoanes, J. (2001). The “oppositional defiant” and “conduct disorder” child: A brief review of etiology, assessment, and treatment. Behavioral Development Bulletin, 10(1), 36-41. http://dx.doi.org/10.1037/h0100481
  5. khean, K. (2001). Behavioural Disorders in Childhood: A Singapore Perspective. Ann Acad Med Singapore, 3(2), 1-9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11379413