Disruptive Behavioral Disorders

Fatima AlHaidarProfessor, Child & Adolescent Psychiatrist

KSU

Oppositional Defiant Disorder

Definition:

Enduring pattern of negativistic, hostile, and defiant behaviors in the absence of serious violations of social norms or of the rights of others.

Epidemiology:

Developmentally normal in early childhood and adolescence ( establish autonomy, identity, & inner standards and control )

Prevalence of 2-16 %

Boys ≥ Girls

Etiology:

Temperamental predisposition Psychological theories … …unresolved conflicts …learned behavior Parental factors Social factors Environmental factors

Clinical features:

Temper outburstsActive refusal to comply with rulesDeliberately annoy othersBlame others for their mistakesPresent at homeCause distress to othersInterpersonal difficultiesPoor school performance

Assessment:

Nature & severitySituation & circumstancesWho are around ?Parental personality and skillsParent- child relationship.Charts

Management:

Parental counseling

Behavioral modification programs

Cognitive behavioral approach

Family therapy

Outcome:

Better prognosis if associated with clear stress

2/3 continues to have the diagnosis during school years

Many children with ODD develop CD in adolescence

Conduct Disorder

Definition:

Enduring set of behaviors, characterized by aggression and violation of the rights of others.

Epidemiology:

Prevalence of 10%

Boys : girls4-12 : 1

Parents with antisocial personality and alcoholism

Socioeconomic factors

Etiology:

Parental factors

Sociocultural factors

Child abuse & maltreatment

CNS dysfunction & damage

Temperament

Clinical features:

Aggression to people & animalsDestruction of property & stealingDeceitfulness or theftSerious violations of rulesPersistent lyingFire settingSexual behaviorFrequent truancyTobacco smoking & other substance abuseHistory of deprivationFamily disharmony

Comorbidity:

ADHD

Depression

Learning disorders

Assessment:

Nature & severity

Circumstances

Family

Management:

Cognitive behavioral therapyProblem-solving skills trainingParent management trainingFamily therapyMedicationCommunity-based centersResidential placementCourt reports

Outcome:

Varies with the nature and extent of antisocial behavior

Poor with parental criminality

Associate with antisocial personality, substance abuse, & mood disorders

Better prognosis with mild form, absence of comrbidity and normal intelligence