All young children can be naughty, defiant and impulsive from time to time, which is perfectly normal. However, some children have extremely difficult and challenging behaviors that are outside the norm for their age.
The most common disruptive behavior disorders include oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). These three behavioral disorders share some common symptoms, so diagnosis can be difficult and time consuming. A child or adolescent may have two or even all three disorders at the same time. Other exacerbating factors can include emotional problems, mood disorders, family difficulties and substance abuse.
Oppositional defiant disorder
Around one in ten children under the age of 12 years are thought to have oppositional defiant disorder (ODD), with boys outnumbering girls by two to one. Some of the typical behaviors of a child with ODD include:
Easily angered, annoyed or irritated
Frequent temper tantrums
Argues frequently with adults, particularly the most familiar adults in their lives, such as parents
Refuses to obey rules
Seems to deliberately try to annoy or aggravate others
Low self-esteem
Low frustration threshold
Seeks to blame others for any misfortunes or misdeeds.
Conduct disorder
Children with conduct disorder (CD) are often judged as ‘bad kids’ because of their delinquent behavior and refusal to accept rules. Around five per cent of 10 year olds are thought to have CD, with boys outnumbering girls by four to one. Around one-third of children with CD also have attention deficit hyperactivity disorder (ADHD).
Some of the typical behaviors of a child with CD may include:
Frequent refusal to obey parents or other authority figures
Repeated truancy
Tendency to use drugs, including cigarettes and alcohol, at a very early age
Lack of empathy for others
Being aggressive to animals and other people or showing sadistic behaviours including bullying and physical or sexual abuse
Keenness to start physical fights
Using weapons in physical fights
Frequent lying
Criminal behavior such as stealing, deliberately lighting fires, breaking into houses and vandalism
A tendency to run away from home
Suicidal tendencies – although these are more rare.
Attention deficit hyperactivity disorder
Around two to five per cent of children are thought to have attention deficit hyperactivity disorder (ADHD), with boys outnumbering girls by three to one. The characteristics of ADHD can include:
Inattention – difficulty concentrating, forgetting instructions, moving from one task to another without completing anything.
Impulsivity – talking over the top of others, having a ‘short fuse’, being accident-prone.
Overactivity – constant restlessness and fidgeting.
Risk factors
The causes of ODD, CD and ADHD are unknown but some of the risk factors include:
Gender – boys are much more likely than girls to suffer from behavioral disorders. It is unclear if the cause is genetic or linked to socialization experiences.
Gestation and birth – difficult pregnancies, premature birth and low birth weight may contribute in some cases to the child’s anti-social behavior later in life.
Temperament – children who are difficult to manage, temperamental or aggressive from an early age are more likely to develop behavioral disorders later in life.
Family life – behavioral disorders are more likely in dysfunctional families. For example, a child is at increased risk in families where domestic violence, poverty, poor parenting skills or substance abuse are a problem.
Learning difficulties – such as problems with reading and writing.
Intellectual disabilities – children with intellectual disabilities are twice as likely to have behavioral disorders.
Brain activity – studies have shown that areas of the brain that control attention appear to be less active in children with ADHD.
Diagnosis
Disruptive behavioral disorders are complicated and may include many different factors working in combination. For example, a child who exhibits the delinquent behaviors of CD may also have ADHD, anxiety, depression, a drug use problem and a difficult home life.
Diagnosis methods may include:
Diagnosis by a specialist service, which may include a pediatrician, psychologist or child psychiatrist
In-depth interviews with the parents, child and teachers
Behavior check lists or standardized questionnaires.
A diagnosis is made if the child’s behavior meets the criteria for disruptive behavior disorders in the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association.
It is important to rule out acute stressors that might be disrupting the child’s behavior. For example, a sick parent or victimizing by other children might be responsible for sudden changes in a child’s typical behavior and these factors have to be considered initially.
Treatment Untreated children with behavioral disorders may grow up to be dysfunctional adults. Generally, the earlier the intervention, the better the outcome is likely to be. A large study in the United States, conducted for the National Institute of Mental Health and the Office of School Education Programs, showed that carefully designed medication management and behavioral treatment for ADHD improved all measures of behavior in school and at home.
Treatment is usually multi-faceted and depends on the particular disorder and factors contributing to it, but may include:
Parental education – for example, teaching parents how to communicate with and manage their children.
Functional family therapy – the entire family is helped to improve communication and problem-solving skills.
Cognitive behavioral therapy – to help the child to control their thoughts and behavior.
Social training – the child is taught important social skills, such as how to have a conversation or play cooperatively with others.
Anger management – the child is taught how to recognize the signs of their growing frustration and given a range of coping skills designed to defuse their anger and aggressive behavior. Relaxation techniques and stress management skills are also taught.
Support for associated problems – for example, a child with a learning difficulty will benefit from professional support.
Encouragement – many children with behavioral disorders experience repeated failures at school and in their interactions with others. Encouraging the child to excel in their particular talents (such as sport) can help to build self-esteem.
