By Steve Waksman, Ph.D.
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Approximately 10-16% of all children display
a recurrent pattern of negative and defiant behavior referred
to as oppositional defiant disorder (ODD). Such
children are argumentative, rude, noncompliant, angry and throw frequent temper
tantrums. They seem to deliberately annoy others, appear touchy or spiteful
and blame others for their own mistakes. While all children display
at times, the term oppositional defiant disorder is reserved for those children
who display a constant pattern of those behaviors for at least six months.
Perhaps 50% of these children persist in violating the basic rights
of others and are
referred to as conduct disorder (CD). Children and adolescents with conduct
disorders often display aggressive or destructive behavior, repetitive
lying or stealing,
school disruptive behavior, or truancy. Usually these disruptive or antisocial
behavior patterns are evident in early childhood, but some children begin this
behavior pattern in early adolescence.
Children with oppositional or conduct disorders
are unlikely to outgrow these disorders without treatment. In fact, the earlier
the symptoms emerge, the greater
the risk in adult life for serious antisocial or substance abuse problems.
The combination of childhood aggressive behavior and peer rejection is also
highly predictive of adolescent conduct disorders. Follow-up studies have
demonstrated that half of the children with conduct disorders will
go on to display such
in adulthood and one third will go on to display serious antisocial, criminal
or substance abuse problems. Individuals with conduct disorder are also at
higher risk for mood or anxiety disorders.
Children and adolescents with oppositional
or conduct disorders may also suffer from an attention deficit/hyperactivity
disorder (ADHD), a specific learning
disability (LD), or a mood disorder. Such disorders are considered different
or distinct disorders from oppositional defiant disorder, or conduct disorder.
The combination or co-morbidity of conduct disorder and attention deficit/hyperactivity
disorder, learning disabilities, or depression leads to even higher risk of
future emotional, behavioral, social, academic, and vocational problems.
The terms seriously
emotionally disturbed (SED) and severe behavior disorders (SBD) are used by
many school districts to describe students with severe conduct
disorders, severe mood disorders, or psychotic disorders. Such children or
adolescents make up between .5-3% of school age children, the prevalence
depending on the
specific criteria used by each school district. The term behavior disorders
(BD) is a more generic or “umbrella” term used to describe all children
who display persistent behavior problems.
How Are Behavior Disorders Diagnosed?
Psychologists and other mental health professionals or educators will attempt
to “measure” a child’s behavior through standardized rating scales completed
by parents and/or teachers. A careful history of the problem will also be collected.
Psychologists may make systematic observations of children’s behaviors or interactions,
or ask parents or teachers to keep track of specific problem behaviors. Psychologists
may also administer intelligence, academic, or personality tests to rule in
or out other disorders, and physicians may rule out medical conditions. Mental
health professionals use the Diagnostic and Statistical Manual of Mental Disorder
(or DSMIV) to diagnose disorders and educators use state special education
Many children display temporary adjustment problems due to divorce,
family disruptions, grieving, inappropriate school programs or peer difficulties,
do not meet the criteria for oppositional or conduct disorder. They would,
however, also benefit from brief psychological services.
What Causes Behavior
Psychologists and other specialists are not sure of all the reasons children
develop oppositional or conduct disorders. Research demonstrates that behavior
disorders are associated with both genetic and environmental factors. Conduct
and oppositional disorders are more common in families with a parent or sibling
with severe conduct disorders, alcohol abuse, mood disorders, schizophrenia,
or attention deficit/hyperactivity disorder. Conduct and oppostitional disorders
are also more common in families with serious marital conflicts. Inappropriate
or coercive parenting styles, abuse, neglect or violence, or exposure to
antisocial behavior can also contribute to behavior disorders.
How Are Behavior Disorders
The most common and effective treatment for behavior disorders requires parents,
teachers, and caretakers to learn and implement structured behavior management
procedures. Such procedures include providing clear and specific expectations,
contingently rewarding positive behavior and punishing noncompliant and antisocial
behavior, monitoring children and adolescents more closely, and modeling
appropriate prosocial and problem-solving behaviors. Although many parents
have tried these
procedures on their own, successful treatment usually requires professional
help to implement procedures skillfully and consistently. This is especially
true in families where behavior problems have persisted for a number of years.
Other techniques include teaching children and adolescents specific social,
communication, and problem-solving skills, utilizing token reinforcement
systems or powerful rewards, and maintaining records to promote consistency
long period of time. Usually such procedures are taught in family therapy sessions. Cognitive
or supportive therapy, group therapy and social skills training groups are
also utilized at times to teach specific skills, and to
treat associated problems such as depression, low self-concept, or friendship
problems. In general, the more antisocial or “out of control” the child,
the less effective individual or group therapy is, and the more direct and
the behavior management procedures must be. The length and frequency of therapy
are usually determined by the severity and history of the problems. Mild
or moderate behavior problems may only require a few sessions, while severe
or conduct disorders often require lengthy and comprehensive services. Medications
such as stimulants, antidepressants, clonidine, mood stabilizers, and antipsychotics
have been found helpful in some cases, but no medications alone or in combination
with psychological therapies have been demonstrated to be consistently beneficial.
experts believe that conduct disorder is a chronic lifelong disorder which
requires evaluation, intervention, and monitoring over the course of one’s
life. It therefore seems much wiser to implement psychological services at
the earliest stage, hopefully preventing behavior problems from progressing
into a conduct disorder. Many studies have demonstrated that these specific
psychological therapies can bring about lasting improvement when implemented
before a behavior disorder becomes severe.
If you would like more information on behavior disorders, learning disorders,
or attention deficit hyperactivity disorder, please call:
Steve Waksman, Ph.D.
Licensed Clinical Child Psychologist and Certified School Psychologist
Additional copies of this pamphlet are available from the author at:
2302 NE Tillamook Street
Portland, OR 97212
Copyright 1998. Steven Waksman, Ph.D.
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