Disruptive Behaviour Disorders [These disorders include oppositional defiance disorder (ODD) and conduct disorder (CD)]

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Disruptive Behaviour Disorders [These disorders include oppositional defiance disorder (ODD) and conduct disorder (CD)]

Summary:
– Children and adolescents with disruptive behaviour disorders struggle with:
– School performance;
– Family relationships; &
– Peer Connections.

– These disruptive behaviours (self-control of behaviour & emotions & which manifests in significant conflict with societal norms, authority figures & disrespecting the rights of others) usually intensify over time & negatively impact their daily lives & others around them
– also they typically occur in all settings: school, social, family

– bullying (I.e. engaging in bullying behaviour) can be symptomatic of having one of the disruptive behaviour disorders [& is screened for]

– noted ADHD was previously in this category of disorders but was removed when the new DSM-5 was released in 2013
– ADHD is now a neuro-behavioural disorde

– notwithstanding the above, ODD & ADHD typically have a high co-occurrence

– ADHD children often have an irritable temperament, low frustration & this is exacerbated when coupled with environmtal responses such as harsh parenting or difficult circumstances, a child with ADHD can develop ODD
– often experience frustration & require breaks when operating in a structured environment (therefore handling is very important)

ODD & CD
– it is true to say some disruptive behaviour (not necessarily anti-social) is to be expected as part of “normal” development – however, when it is more prolonged, more pronounced/severe & across all contexts then ODD should be considered
– Defying authority (figure) – Beyond normal childhood rebellion And the testing of limits
– Multiple angry outbursts
– Lying or stealing
– Physically or verbally aggressive
– Destroying property
– Harming animals
[All symptoms occur on the spectrum of severity]

Children who do not have a Disruptive behaviour disorder generally do
– respond to consequences
– They show remorse and
– they do respond to feedback (& Add here to societal norms of behaviour)

Children with disruptive behaviour disorders do not do the above [ & there are frequency, persistence & pervasiveness issues to consider]
– It is worth noting that depression and/or anxiety can mimic some of the symptoms too

Conduct disorder children typically interface with the legal system And still refuse to adhere to societal norms

The therapists contend that: authoritarian styles of parenting &/or over-reaction will not work with children who have disruptive behaviour disorders, & can exacerbate the situation
– feedback
– nurturing
– calling out negative behaviours & not noticing positive behaviour
– we do not wish to minimise the problem – it requires treatment

DSM-5 – this category now also includes impulsive control disorder
– criteria used to specify it needed to be diagnosed in childhood – this has now changed
– note disruptive behaviour disorders can morph into ASPD (Anti-Social Personality Disorder) as an adult, including how they view the world

0DD is typically 8 to 10% of the population
CD is typically 4 to 6% of the population [Conduct disorder is a more severe disorder – Violating the rights of others including harming others threatening others; Being manipulative; lying; stealing things; Harming people/harming animals Often interfacing with the Juvenile Justice System]

It should be noted that disruptive behaviour disorders present differently for males and females
Males
– Fighting, stealing, vandalism, school, discipline problems
[mood]
Females
– substance use early sex or prostitution; Lying; being truant; Self-harming
[Depression / anxiety]

Disruptive mood dysregulation disorder
– moods – sadness; not caring; highly irritable; temper tantrums; anxiety for hours

Differential diagnosis:
1) Anxiety disorders
– GAD (School refusal and truancy issues)
– Social phobia
2) Depression
[Do not know how to express their feelings/acting out behaviour]
3) Substance-abuse

Research about causation:
ODD
– temperament of child
– Environmental factors – harsh parenting/authoritarian style parenting
CD
– emotional regulation / impulsivity
– fMRI (brain areas)
– Genetic vulnerability
– Alcohol dependence or abuse in families
– where family members have mood or learning disorders
– environmental factors too as for ODD
[looking for nature & nurture]

Treatment:
– multi factorial
– individual – problem-solve; frustration tolerance; anger management; how to interact & engage
– family – systems of communication/argument
– parent – strategies for positive reinforcement
– psychotropic medication (only when necessary, while also monitoring side-effects)
[consistency & love – parenting]

Prognosis:
– earlier e onset, the more intervention that is required
– idea to have normalised behaviour all around them (social; school)

Source: Psych Sessions Podcast | Podcast date: 09/12/2016

Tipsheet @ http://psychsessions.com/wp-content/uploads/2016/12/DBD-Tip-Sheet.pdf

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