Understanding Your Child's Behavior Disorder
Behavior disorders (sometimes referred to as disruptive behavior disorders) are the most common reasons kids are referred for mental health evaluations and treatment. All disruptive behavior is not the same. Behavior disorders include mental health problems which include behaviors and emotional problems that create interpersonal and emotional problems for kids and teens during the course of their development.
The most common behavior disorder in kids is ADHD, which includes inattentive, impulsive, and hyperactive behaviors. ODD (Oppositional Defiant Disorder) is another behavior disorder that includes behaviors disruptive to relationships with others (i.e., angry and resentful oppositional behavior). Conduct Disorder (CD) involves behaviors which violate social norms and expectations.
1. Attention-Deficit / Hyperactivity Disorder (ADHD)—
ADHD, usually first diagnosed in childhood, is characterized by inattention, impulsiveness, and, in some cases, hyperactivity. These symptoms usually occur together; however, one may occur without the other(s).
The symptoms of hyperactivity, when present, are almost always apparent by the age of 7 and may be apparent in preschoolers. Inattention or attention-deficit may not be evident until a youngster faces the expectations of elementary school.
What are the different types of ADHD?
Three major types of ADHD include the following:
- ADHD, inattentive and distractible type- This type of AHD is characterized predominately by inattention and distractibility without hyperactivity.
- ADHD, impulsive/hyperactive type- This, the least common type of ADHD, is characterized by impulsive and hyperactive behaviors without inattention and distractibility.
- ADHD, combined type- This, the most common type of ADHD, is characterized by impulsive and hyperactive behaviors as well as inattention and distractibility.
What causes attention-deficit/hyperactivity disorder?
ADHD is one of the most researched areas in child and adolescent mental health. However, the precise cause of the disorder is still unknown. Available evidence suggests that ADHD is genetic. It is a brain-based biological disorder. Low levels of dopamine (a brain chemical) are found in kids with ADHD. Brain imaging studies using PET scanners (positron emission tomography; a form of brain imaging that makes it possible to observe the human brain at work) show that brain metabolism in kids with ADHD is lower in the areas of the brain that control attention, social judgment, and movement.
Who is affected by attention-deficit/hyperactivity disorder?
Estimates suggest that about 2 million kids (3 percent to 5 percent) have ADHD. Males are two to three times more likely to have ADHD than females.
Many moms and dads of kids with ADHD experienced symptoms of ADHD when they were younger. ADHD is commonly found in siblings within the same family. Most families seek help when their youngster's symptoms begin to interfere with learning and adjustment to the expectations of school and age-appropriate activities.
What are the symptoms of attention-deficit/hyperactivity disorder?
Most symptoms seen in kids with ADHD also occur at times in kids without this disorder. However, in kids with ADHD, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.
The following are the most common symptoms of ADHD. However, each youngster may experience symptoms differently. The three categories of symptoms of ADHD include the following:
Inattention-
o difficulty attending to details
o difficulty listening to others
o easily distracted
o forgetfulness
o poor organizational skills for age
o poor study skills for age
o short attention span for age (difficulty sustaining attention)
Impulsivity-
o has difficulty waiting for his/her turn in school and/or social games
o often interrupts others
o takes frequent risks, and often without thinking before acting
o tends to blurt out answers instead of waiting to be called upon
Hyperactivity-
o fidgets with hands or squirms when in his/her seat; fidgeting excessively
o has difficulty engaging in quiet activities
o has difficulty remaining in his/her seat even when it is expected
o inability to stay on task; shifts from one task to another without bringing any to completion
o loses or forgets things repeatedly and often
o seems to be in constant motion; runs or climbs, at times with no apparent goal except motion
o talks excessively
The symptoms of ADHD may resemble other medical conditions or behavior problems. Furthermore, many of these symptoms may occur in kids and adolescents who do not have ADHD. A key element in diagnosis is that the symptoms must significantly impair adaptive functioning in both home and school environments. Always consult your youngster's doctor for a diagnosis.
How is attention-deficit/hyperactivity disorder diagnosed?
ADHD is the most commonly diagnosed behavior disorder of childhood. A qualified mental health professional usually identifies ADHD in kids. A detailed history of the youngster's behavior from moms and dads and educators, observations of the youngster's behavior, and psycho-educational testing contribute to making the diagnosis of ADHD. Further, because ADHD is a group of symptoms, often diagnosis depends on evaluating results from several different types of evaluations, including physical, neurological, and psychological. Certain tests may be used to rule out other conditions, and some may be used to test intelligence and certain skill sets. Consult your youngster's doctor for more information.
Treatment for attention-deficit/hyperactivity disorder:
Specific treatment for attention-deficit/hyperactivity disorder will be determined by your youngster's doctor based on:
- expectations for the course of the condition
- extent of your youngster's symptoms
- your youngster's age, overall health, and medical history
- your youngster's tolerance for specific medications or therapies
- your opinion or preference
Major components of treatment for kids with ADHD include parental support and education in behavioral training, appropriate school placement, and medication. Treatment with a psycho-stimulant is highly effective in most kids with ADHD.
Treatment may include:
Psycho-stimulant medications are used for their ability to balance chemicals in the brain that prohibit the youngster from maintaining attention and controlling impulses. They help "stimulate" or help the brain to focus and may be used to reduce the major characteristics of ADHD, which include the following:
o hyperactivity
o impulsivity
o inattention
Different psycho-stimulant medications that are commonly used to treat ADHD include the following:
o a mixture of amphetamine salts (Adderall)
o atomoxetine (Strattera) - a newer non-stimulant medication
o dextroamphetamine (Dexedrine)
o methylphenidate (Ritalin, Metadate, Concerta)
Psycho-stimulants have been used to treat childhood behavior disorders since the 1930s. They have been widely studied. Stimulants take effect in the body quickly, work for one to four hours, and then leave the body quickly. Recently many long acting stimulant medications have come on the market, lasting 8-9 hours, requiring one daily dosing. Doses of stimulant medications need to be timed to match the youngster's school schedule - to help the youngster pay attention for a longer period of time and improve classroom performance.
The common side effects of stimulants may include, but are not limited to, the following:
- decreased appetite
- headaches
- insomnia
- jitteriness
- rebound activation (when the effect of the stimulant wears off, hyperactive and impulsive behaviors may increase for a short period of time)
- stomach aches
Most side effects of stimulant use are mild, decrease with regular use, and respond to dose changes. Always discuss potential side effects with your youngster's doctor.
Antidepressant medications may also be administered for kids and teens with ADHD to help improve attention while decreasing aggression, anxiety, and/or depression.
Psychosocial treatments- Parenting kids with ADHD may be difficult and can present challenges that create stress within the family. Classes in behavior management skills for moms and dads can help reduce stress for all family members. Training in behavior management skills for moms and dads usually occurs in a group setting which encourages parent-to-parent support.
Behavior management skills may include the following:
- contingent attention (responding to the youngster with positive attention when desired behaviors occur; withholding attention when undesired behaviors occur)
- point systems
- use of "time out"
Educators may also be taught behavior management skills to use in the classroom setting. Training for educators usually includes use of daily behavior reports that communicate in-school behaviors to moms and dads.
Behavior management techniques tend to improve targeted behaviors (e.g., completing school work or keeping the youngster's hands to himself/herself), but are not usually helpful in reducing overall inattention, hyperactivity, or impulsiveness.
Prevention of attention-deficit/hyperactivity disorder:
Preventive measures to reduce the incidence of ADHD in kids are not known at this time. However, early detection and intervention can reduce the severity of symptoms, decrease the interference of behavioral symptoms on school functioning, enhance the youngster's normal growth and development, and improve the quality of life experienced by kids or teens with ADHD.
2. Oppositional Defiant Disorder (ODD)—
Oppositional Defiant Disorder is a behavior disorder, usually diagnosed in childhood that is characterized by uncooperative, defiant, negativistic, irritable, and annoying behaviors toward moms and dads, peers, educators, and other authority figures. Kids and teens with Oppositional Defiant Disorder are more distressing or troubling to others than they are distressed or troubled themselves.
What causes ODD?
While the cause of Oppositional Defiant Disorder is not known, there are two primary theories offered to explain the development of Oppositional Defiant Disorder. A developmental theory suggests that the problems begin when kids are toddlers. Kids and teens that develop Oppositional Defiant Disorder may have had a difficult time learning to separate and become autonomous from the primary person to whom they were emotionally attached.
The "bad attitude" characteristic of Oppositional Defiant Disorder is viewed as a continuation of the normal developmental issues that were not adequately resolved during the toddler years. Learning theory suggests, however, that the negativistic characteristics of Oppositional Defiant Disorder are learned attitudes, reflecting the effects of negative reinforcement techniques used by moms and dads and authority figures. The use of negative reinforcement by moms and dads is viewed as increasing the rate and intensity of oppositional behaviors in the youngster as it achieves the desired attention, time, concern, and interaction with moms and dads or authority figures.
Who is affected by ODD?
Behavior disorders, as a category, are, by far, the most common reason for referrals to mental health services for kids and teens. ODD is reported to affect 20 percent of the school-age population. Oppositional Defiant Disorder is more common in males than in females.
What are the symptoms of ODD?
Most symptoms seen in kids and teens with ODD also occur at times in kids without this disorder, especially around the ages or two or three, or during the teenage years. Many kids (especially when they are tired, hungry, or upset) tend to disobey, argue with moms and dads, or defy authority. However, in kids and teens with ODD, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.
Symptoms of ODD may include:
- always questioning rules; refusal to follow rules
- behavior intended to annoy or upset others, including grown-ups
- blaming others for his/her misbehavior or mistakes
- easily annoyed by others
- excessive arguments with authority figures
- frequent temper tantrums
- frequently has an angry attitude
- refusal to comply with adult requests
- seeking revenge
- speaking harshly, or unkindly
The symptoms of Oppositional Defiant Disorder may resemble other medical conditions or behavior problems. Always consult your youngster's doctor for a diagnosis.
How is ODD diagnosed?
Moms and dads, educators, and other authority figures in child and adolescent settings often identify the youngster or teen with Oppositional Defiant Disorder. However, a youngster psychiatrist or a qualified mental health professional usually diagnoses Oppositional Defiant Disorder in kids and teens. A detailed history of the youngster's behavior from moms and dads and educators, clinical observations of the youngster's behavior, and, sometimes, psychological testing contribute to the diagnosis. Moms and dads who note symptoms of Oppositional Defiant Disorder in their youngster or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.
Further, ODD often coexists with other mental health disorders, including mood disorders, anxiety disorders, conduct disorder, and attention-deficit/hyperactivity disorder, increasing the need for early diagnosis and treatment. Consult your youngster's doctor for more information.
Treatment for ODD:
Specific treatment for kids with ODD will be determined by your youngster's doctor based on:
- expectations for the course of the condition
- extent of your youngster's symptoms
- your youngster's age, overall health, and medical history
- your youngster's tolerance for specific medications or therapies
- your opinion or preference
Treatment may include:
• Family therapy is often focused on making changes within the family system (e.g., improving communication skills and family interactions). Parenting kids with Oppositional Defiant Disorder can be very difficult and trying for moms and dads. Moms and dads need support and understanding as well as help in developing more effective parenting approaches.
• Individual psychotherapy for Oppositional Defiant Disorder often uses cognitive-behavioral approaches to improve problem solving skills, communication skills, impulse control, and anger management skills.
• While not considered effective in treating Oppositional Defiant Disorder, medication may be used if other symptoms or disorders are present and responsive to medication.
• Peer group therapy is often focused on developing social skills and interpersonal skills.
Prevention of ODD in childhood:
Some experts believe that a developmental sequence of experiences occurs in the development of ODD. This sequence may start with ineffective parenting practices, followed by difficulty with other authority figures and poor peer interactions. These experiences compound and continue, and oppositional and defiant behaviors develop into a pattern of behavior. Early detection and intervention into negative family and social experiences may be helpful in disrupting the sequence of experiences leading to more oppositional and defiant behaviors.
Early detection and intervention with more effective communication skills, parenting skills, conflict resolution skills, and anger management skills can disrupt the pattern of negative behaviors and decrease the interference of oppositional and defiant behaviors in interpersonal relationships with adults and peers, and school and social adjustment. The goal of early intervention is to enhance the youngster's normal growth and development, and improve the quality of life experienced by kids or teens with ODD.
3. Conduct Disorder (CD)—
Conduct Disorder is a behavior disorder, sometimes diagnosed in childhood, that is characterized by antisocial behaviors which violate the rights of others and age-appropriate social standards and rules. Antisocial behaviors may include irresponsibility, delinquent behaviors (e.g., truancy or running away), violating the rights of others (e.g., theft), and/or physical aggression toward others (e.g., assault or rape). These behaviors sometimes occur together; however, one or several may occur without the other(s).
What causes CD?
The conditions that contribute to the development of CD are considered to be multi-factorial, with many factors contributing to the cause. Neuro-psychological testing has shown that kids and teens with CD seem to have impairment in the frontal lobe of the brain that interferes with their ability to plan, avoid harm, and learn from negative experiences. Childhood temperament is considered to have a genetic basis. Kids or teens that are considered to have a difficult temperament are more likely to develop behavior problems.
Kids or teens from disadvantaged, dysfunctional, and disorganized home environments are more likely to develop CD. Social problems and peer group rejection have been found to contribute to delinquency. Low socioeconomic status has been associated with CD. Kids and teens exhibiting delinquent and aggressive behaviors have distinctive cognitive and psychological profiles when compared to kids with other mental health problems and control groups. All of the possible contributing factors influence how kids and teens interact with other people.
Who is affected by CD?
Approximately 1 percent to 4 percent of kids (ages nine to 17 years old) have CD. The disorder is more common in males than in females. Kids and teens with CD often have other psychiatric problems as well that may be a contributing factor to the development of the conduct disorder. The prevalence of CD has increased over recent decades. Aggressive behavior is the reason for one-third to one-half of the referrals made to youngster and teen mental health services.
What are the symptoms of CD?
Most symptoms seen in kids with CD also occur at times in kids without this disorder. However, in kids with conduct disorder, these symptoms occur more frequently and interfere with learning, school adjustment, and, sometimes, with the youngster's relationships with others.
The following are the most common symptoms of conduct disorder. However, each youngster may experience symptoms differently. The four main groups of behaviors include the following:
Aggressive conduct causes or threatens physical harm to others and may include the following:
- bullying
- cruelty to others or animals
- forcing someone into sexual activity, rape, molestation
- intimidating behavior
- physical fights
- use of a weapon(s)
Destructive conduct may include the following:
- arson
- vandalism; intentional destruction to property
Deceitful behavior may include the following:
- delinquency
- lying
- shoplifting
- theft
Violation of ordinary rules of conduct or age-appropriate norms may include the following:
- mischief
- pranks
- running away
- truancy (failure to attend school)
- very early sexual activity
The symptoms of CD may resemble other medical conditions or behavioral problems. Always consult your youngster's doctor for a diagnosis.
How is CD diagnosed?
A youngster psychiatrist or a qualified mental health professional usually diagnoses CD in kids and teens. A detailed history of the youngster's behavior from moms and dads and educators, observations of the youngster's behavior, and, sometimes, psychological testing contribute to the diagnosis. Moms and dads who note symptoms of CD in their youngster or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.
Further, CD often coexists with other mental health disorders, including mood disorders, anxiety disorders, post-traumatic stress disorder, substance abuse, attention-deficit/hyperactivity disorder, and learning disorders, increasing the need for early diagnosis and treatment. Consult your youngster's doctor for more information.
Treatment for CD:
Specific treatment for kids with CD will be determined by your youngster's doctor based on:
- expectations for the course of the condition
- extent of your youngster's symptoms
- your youngster's age, overall health, and medical history
- your youngster's tolerance for specific medications or therapies
- your opinion or preference
Treatment may include:
• Peer group therapy is often focused on developing social skills and interpersonal skills.
• While not considered effective in treating conduct disorder, medication may be used if other symptoms or disorders are present and responsive to medication.
• Family therapy is often focused on making changes within the family system (e.g., improving communication skills and family interactions).
• The goal of cognitive-behavioral therapy is to improve problem solving skills, communication skills, impulse control, and anger management skills.
Prevention of CD in childhood:
As with ODD (Oppositional Defiant Disorder), some experts believe that a developmental sequence of experiences occurs in the development of conduct disorder. This sequence may start with ineffective parenting practices, followed by academic failure, and poor peer interactions. These experiences then often lead to depressed mood and involvement in a deviant peer group.
Other experts, however, believe that many factors, including youngster abuse, genetic susceptibility, history of academic failure, brain damage, and/or a traumatic experience influence the expression of conduct disorder. Early detection and intervention into negative family and social experiences may be helpful in disrupting the development of the sequence of experiences that lead to more disruptive and aggressive behaviors.
==> Help for Parents with Defiant Children and Teens
