Disruptive, impulse-control and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania. These disorders can cause people to behave angrily or aggressively toward people or property. They may have difficulty controlling their emotions and behavior and may break rules or laws.Disruptive behavior disorders (DBD) can seriously impact a child’s daily life. Children with disruptive behavior disorders show ongoing patterns of uncooperative and defiant behavior.
Their responses to authority figures range from indifference to hostility. Their behavior frequently impacts those around them, including teachers, peers, and family members.The most common types of disruptive behavior disorders include disruptive behavior disorder not otherwise specified (DBD NOS), oppositional defiant disorder (ODD) and conduct disorder (CD). Children with these behavioral disorders can be stubborn, difficult, disobedient, and irritable.Children with conduct disorder show the same responses to authority figures as discussed above, but in addition, they have a tendency to be physically aggressive and both actively and intentionally violate others’ rights.The main differences between these disorders are severity, intensity and intentionality of behavior exhibited by the child.
The precise cause of disruptive behavior disorders is unclear. Risk factors include a family member with ADHD/ODD, depression or an anxiety disorder and environmental factors like stress in the home (from divorce, separation, abuse, parental criminality or serious conflicts within the family). The disorders are also more likely to occur along with other conditions such as ADHD.
Children with disruptive disorder lose their temper quickly, have temper tantrums, are physically aggressive particularly with other children, negative, argumentative, defiant, disobedient, steal and behave in other ways to show their hostility or resistance to authority figures. They tend to struggle in school and may have legal problems later in life. If symptoms worsen and become more extreme the child/adolescent is defined as having a Conduct disorder (CD).
Children/adolescents with CD are those that have a repetitive and persistent pattern of behavior which violates the rights of others and where social rules are disregarded. They are seriously aggressive, destroy property, steal, run away from home, miss school, behave as a delinquent and have non-desired police contact.
Cognitive Behavioral Therapy
More commonly known as child behavior therapy when used to address disruptive behavior disorders, cognitive behavior therapy is one of the most common client-focused interventions used to treat behavioral health conditions. To improve client behaviors, a CBT therapist will use techniques like:
- Modeling: Displaying the type of actions they would like the client to mirror
- Role-play: Helping clients develop communication and coping skills by playing the part of other people in therapy sessions
- Behavior charts: Identifying desired behaviors and rewarding the occurrence of these behaviors visually with a chart to improve the child’s chances of practicing these behaviors
Parent Training (PT): Parent training has been shown to be effective for treating oppositional and defiant behaviors. Standardized parent training programs are short-term interventions that teach parents specialized strategies including positive attending, ignoring, the effective use of rewards and punishments, token economies, and time out to address clinically significant behavior problems. Such training programs may include periodic booster sessions.
Severe cases of CD may require multisystemic therapy, an intensive family- and community-based treatment that addresses the multiple causes of serious antisocial behavior in youth. This approach is very comprehensive and demanding. The therapist using such an approach must possess access to developmental and clinical expertise. These intervention services are delivered in a variety of settings, such as home, school and peer groups. Academic and school-based problems are included and some therapists work directly with an entire peer group to influence change.
Parent-child interaction therapy is a treatment that teaches parents to strengthen the relationship with their child and to learn behavior management techniques. It has been found to be effective in the long term for young children with disruptive behaviors, ODD and ADHD. Three to six years after treatment, the mothers of children with these disorders reported that the changes in their children’s behavior and their own feelings of control had lasted. Mothers’ reports of disruptive behavior decreased with time after treatment.
Parent-Child Interaction Therapy (PCIT)
PCIT is an innovative therapeutic approach that combines psychoeducation, parent training and other treatment strategies. During treatment, a therapist observes the interactions between client and parent while offering suggestions and encouragement to the parent through an earpiece without the child’s knowledge.
PCIT is conducted through "coaching" sessions during which you and your child are in a playroom while the therapist is in an observation room watching you interact with your child through a one-way mirror and/or live video feed. You wear a "bug-in-the-ear" device through which the therapist provides in-the-moment coaching on skills you are learning to manage your child's behavior.
Younger children with disruptive behavior disorders may benefit from play therapy. During play therapy, children play with toys like puppets, sand trays, dolls and blocks to express ideas they may have trouble explaining with words.In play therapy, the role of the therapist is to: Provide the child with positivity and warmth. Help the child communicate and process their thoughts and feelings. Offer safety and encouragement. The goal of the relationship between the therapist and the child is to improve and decrease unwanted behaviors and symptoms.
Although they are not usually used for disruptive behavior disorders, medications may be helpful for instances when symptoms remain despite therapy. Some medication options for disruptive behavior disorders include
Stimulants: Psychiatrists and primary care doctors frequently use stimulant medications to treat attention-deficit/hyperactivity disorder (ADHD) in children and adults. There is some indication that these could help with disruptive behaviors as well. Some stimulant medications for disruptive behavior disorders include Adderall, Concerta, Focalin, Metadate and Ritalin.
Nonstimulant ADHD medications: Nonstimulant medications like Strattera and Intuniv, which are mostly used for ADHD symptoms, may also be prescribed for behaviors linked to ODD, conduct disorder and intermittent explosive disorder.
Anticonvulsants: Medications like Depakote are typically used to limit seizures, but some professionals also prescribe these to address the aggression characteristic of disruptive behavior disorders.
Antipsychotics: This class of medicines can help reduce symptoms of disruptive behavior disorders. Using an antipsychotic medication does not mean someone has hallucinations or delusions. Antipsychotics available include options like Abilify, Risperdal and Geodon.
Parent behavior therapy has the strongest evidence as an effective treatment for disruptive behavior problems. The research studies used approaches that involved therapists who were trained in specific behavior therapy programs, and that used a training manual and specific steps to work with parents on skills to help them manage their child’s behavior. During this type of parent training in behavior therapy, parents work with a therapist to learn strategies to create structure, reinforce good behavior, provide consistent discipline, and strengthen the relationship with their child through positive communication. It is possible that therapists who use these