Disruptive Behavior Disorders

1
Disruptive Behavior Disorders

• Creating an understanding for elementary
• and middle school teachers by piecing
• together the puzzle of
• disruptive behavior disorders.
• Amelia Weishaar

2
Learner Objectives

• Participants in this seminar will be able to
• Identify symptoms and characteristics of
  disruptive behavior disorders (DBDs)
• Recognize the potential causes of DBDs
• Describe risk and protective
  factors for DBDs.

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Identification and Characteristics ofDisruptive
Behavior Disorders
DBDs are the most common mental health disorder
among children with a rate of 4-9 of all
children from birth to 18 years old.1 (Journal
of the American Academy of Child Adolescent
Psychiatry, Official Action, Jan 2007)
4
What is a Disruptive Behavior Disorder?

• The main category in the DSM-IV-TR that
  Disruptive Behavior Disorders fall into is
• Attention-Deficit Disorder and Disruptive
  Behavior Disorders
• Disruptive Behavior disorders are split into
  three more specific diagnoses
• Oppositional Defiant Disorder
• Conduct Disorder
• Disruptive Behavior Disorder (NOS)

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Oppositional Defiant Disorder (ODD)DSM-IV-TR
Definition2

• A pattern of negativistic, hostile, disobedient
  and defiant behaviors. Children display four or
  more of these behaviors for more than 6 months
• Loses Temper Easily
• Argues with Adults
• Actively Defies Adults Requests or Rules
• Deliberately Tries to Annoy Others
• Blame others for their own misbehavior and
  mistakes
• Seems touchy or is annoyed easily
• Angry and resentful
• Spiteful or Vindictive

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Oppositional Defiant Disorder

• Average age of onset is 6 years old, symptoms can
  be seen in children as early as 3 years old3
• Symptoms usually manifests by 8 years old, with
  most children diagnosed during preadolesence1
• Children with ODD have a significantly higher
  rate of having more that one psychiatric
  disorder4
• Most children, 67, will ultimately exit from the
  diagnosis after a 3-year follow-up5
• Early onset of ODD is more likely to
  persist and lead to subsequent
  development of CD6

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Conduct Disorder (CD) DSM-IV-TR Definition1

• Repetitive and persistent pattern of behaviors
  in which the basic rights of others or rules of
  society are violated. Three or more of the
  following behavior will have occurred within the
  last 12 months.
•  
• Aggression Toward People and Animals
• Destruction of Property
• Deceitfulness or Theft
• Serious Violation of the Rules

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Conduct Disorder

• Childhood-onset vs. Adolesent-onset7
• Childhood-onset
• - Average age is 9 years old
• - Males more likely to be affected
• - Prognosis is poor as the earlier the age of
  CD syptom onset, the more severe the disorder
  is likely to be
• Adolescent-onset
• - Usually less severe
• - Tends to coincide with family or peer
  problems.
• - Aggression may or may not be present.
• - Males females for prevalence rates.
• - Adolescent-onset of CD has a much
  better progonsis

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Disruptive Behavior Disorder Not Otherwise
Specified (DBD NOS), DSM-IV Definition1

• This category of DBD was created for children who
  demonstrate similar behaviors as children with
  ODD or CD but do not display the same frequency
  /severity and only met one or two of the behavior
  criteria for this disorder.
• Like ODD and CD, this disorder causes significant
  impairment in the childs life.

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How many children are diagnosed with DBDs?

• A summary of 34 studies suggested the prevelance
  rate for children 4 18 years old is8
• ODD range 3 to 22.5 with median of 3.2
• CD range 0 to 11.9 with a median of 2.0
• Another study indicated that ODD has a wide range
  of prevelance from 1 -16 of children, depending
  on which criteria and assessment methods are
  used9
• Research presents evidence that
  the prevelence and the
  severity of this
  disorder are increasing10

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Overlapping of disorders

• It is rare for ODD/CD to occur outside the
  context of other psychiatric disorders11
• - Most common is ADHD
• 65 of children diagnosed with ADHD also
  had ODD
• 80 of children diagnosed with ODD also
  had ADHD
• - Anxiety disorders
• 45 of children diagnosed with an anxiety
  disorder also had ODD
• - Severe depression
• 70 of children diagnosed with severe
  depression also had ODD
• - Bipolar
• 85 of children diagnosed with bipolar
  disorder also had ODD
• - Language processing disorder (LPD)
• 55 of children diagnosed with LPD also have
  ODD

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What causes Disruptive Behavior Disorders?

• It is thought that children with severe behavior
  disorders may be more influenced by neurological
  and genetic factors12
• However mild to moderate DBDs are believed to
  appear in children who have an accumulation of a
  high number of risk factors and a low number of
  protective factors in all contexts of their
  lives7
• This imbalance of risk to protective factors may
  determines the presence and severity of
  a childs DBD. 5 6 7

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Risk Factors
A risk factor is a characteristic within the
individual or a circumstance of the individual
that increases the probability of a Disruptive
Behavior Disorder.
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Biological Risk Factors

• Difficult Temperament at birth irritable,
  easily frustrated, angry and hard to soothe13
• Aggression is highly influenced by genetic
  factors in boys and girls.12
• In severe cases of DBDs neurological factors may
  cause the brain to function differently compared
  to how an average childs brain may function.12
• Children diagnosed with both ODD/CD and ADHD
  (ADHD being highly genetic) are
  likely to have greater symptom
  severity and increased risk of future
  disorders11

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Individual Risk Factors

• Underdeveloped emotional regulation skills
• Low tolerance of frustration
• Little to no problem solving capabilities
• Inability to adapt to new situations
• Language development impairment11

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Family Risk Factors

• Young age of the mother at birth of first child
• Insecure Parental Attachment
• Coercive parent child interactions
• Parental behaviors include inconsistent/harsh
  discipline, poor monitoring/ supervision, low
  levels of warmth/nurturance, high numbers of
  negative verbalizations towards the child.
• Depressed or distressed mother
• High levels of substance abuse and antisocial
  behaviors in parents7 14

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Contextual Risk Factors

• Living in urban, low-socioeconomic settings.
• As the magnitude of poverty increases, so too
  does the severity of aggression and conduct
  problems7
• Living in a disadvantaged neighborhood
  Characterized by dilapidated housing, high crime
  rates, isolation, lack of economic resources and
  unsafe conditions.15
• Witness of violence or being the victim of
  violence or abuse7
• Stressful live events16

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School Risk Factors

• Zero-tolerance discipline which is highly
  punitive and erratic, escalating with little or
  no attention to students good behaviors or
  efforts to achieve10 17
• Negative interactions with adults, typical school
  experience for these students is highly
  negative10
• Discipline including punishments that takes
  students away from the academic environment17
• Deficits in social skills lead to rejection by
  prosocial peers7
• Affiliation with deviant peers7 10

19
Non Factors

• No significant evidence has been found that
  demonstrates increased occurrence of DBDs in
  relation to race and ethnicity 7 18 19
• Although controversial, most researchers have
  concluded that there are no IQ differences
  between children with and without CD.7 19

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Protective Factors
Protective factors reduce the likelihood of
children confronted with risk factors to develop
maladaptive behaviors associated with Disruptive
Behavior Disorders.
21
Resilience in Childhood

• Resilience, a positive adjustment occurring in
  children at-risk, seems to result from a
  combination of internal and external resources
  that function as protective factors.7

22
Child Protective Factors

• Easy Temperament
• Good intellectual functioning
• Self-confidence
• Empathy
• Talents3 7

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Family Protective Factors

• Good supportive relationship with a parent
• Close supervision by parents when not in school
• Positive parent-child relationships warmth,
  structure, high expectations
• Connection to extended supportive family networks
  5 7 8

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School Protective Factors

• Children with ODD/CD who had a positive
  teacher-child relationship showed a decrease in
  aggression.20
• Friendship with prosocial peers7
• Bonds to prosocial adults outside the family7
  17
• Attending effective school3

25
Interventions
Interventions will be more successful if they not
only reduce the risk factors, but also promote
the protective factors observed in resilient
children.7
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School-wide Interventions

• Create a positive school climate
• Define behavioral expectations
• Small set of general expectations and specific
  expectations for different locations in the
  school
• Support positive behavior
• Monitor behavior especially during common problem
  times, acknowledge and reward positive behavior,
  use reminders and review of behavior
  expectations.
• Respond to problem behavior consistently
  and effectively
• Use consistent procedures in responding to minor
  and serious problem
  behaviors. Institute procedures for
  problems solving meetings.

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Classroom Interventions

• Establish and teach the classroom rules and
  procedures
• - Classroom rules and procedures need to be
  established and clearly stated, explicitly
  taught, closely monitored and consistently
  followed.
• Manage common problem times transition, seat
  work, other unstructured times of the day
• Promote social and emotional functioning
• Use rewards effectively
• Use mild punishment effectively
• Manage angry/acting out behavior

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Three-level Triangle ApproachSchool-Based
Interventions
Green-Zone Positive behavior support
interventions that are school-wide will support
all children. This foundational level is
sufficient for promoting positive behavior for
approximately 80 of students
Red-Zone Comprehensive and individualized
interventions that focuses on 5 of children with
significant difficulties
Yellow-Zone Early interventions for children at
risk, will affect 15 of children
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Individual Interventions

• Consistently reinforce good behavior
• Use of proactive and instructive teaching
  strategies to teach adaptive behaviors and
  problem solve with the student
• Train student to self-monitor disruptive
  behaviors
• Use positive reinforcement when
  students reaches behavior goals.

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IDEA Classification Special Education
Interventions

• If a student with DBDs is labeled emotionally
  disturbed they are included under and given all
  protections under the Individuals with
  Disabilities Education Act (IDEA)
• But, if a student with DBDs is labeled socially
  maladjusted but not emotionally disturbed,
  they are denied any protection under
  IDEA and special education services10

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Piecing it all together What does all of this
mean for a teacher?
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Parent Involvement

• Home-school collaboration has the potential to
  significantly increase academic success for
  students with DBDs
• Teacher and parent use a partnership approach
  to childs success in school
• Send daily report card home
  about the students behavior
• Encourage positive parental reinforcement of
  specific desired
  behaviors

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What teachers should avoid

• Use of only reactive behavioral strategies
• Model antisocial behaviors by yelling or
  insulting student, instead teachers should model
  prosocial or problem solving behaviors.
• Use of harsh punishment
• Only coercive interactions
  with student

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What teachers should do

• Understand that teaching children with DBDs may
  take a superhuman tolerance for interpersonal
  nastiness 10
• Directly teach adaptive behavior strategies
• Model and teach prosocial skills, problem
  solving, empathy and self-control
• Use individual interventions for
  students with DBDs
• Understand the teacher-student
  conflict cycle and how to
  avoid it

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The Conflict Cycle
Retrieved from http//cecp.air.org/interact/autho
ronline/april98/3.htm
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Questions?
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Glossary

• DSM IV - DSM-IV (Diagnostic and Statistical
  Manual of Mental Disorders, Fourth Edition)   An
  official manual of mental health problems
  developed by the American Psychiatric
  Association. Psychiatrists, psychologists, social
  workers, and other health and mental health care
  providers use this reference book to understand
  and diagnose mental health problems. Insurance
  companies and health care providers also use the
  terms and explanations in this book when
  discussing mental health problems. (site is the
• Prosocial behavior -The term prosocial behavior
  describes acts that demonstrate a sense of
  empathy, caring, and ethics, including sharing,
  cooperating, helping others, generosity,
  praising, complying, telling the truth, defending
  others, supporting others with warmth and
  affection, nurturing and guiding.
• Antisocial behavior The term anitsocial
  behavior describes behaviors that are
  unacceptable in our society. Examples are acts of
  aggression or malice, over-reactive displays of
  anger, inability to work or get along with
  others, disrespectful towards others, and abusive
  towards others.

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References

• 1. AACAP Official Action, (2007). Practice
  parameters for the assessment and treatment of
  children and adolescents with oppositional
  defiant disorder. Journal of the American Academy
  of Child Adolescent Psychiatry, 46(1), 126-141.
  
• 2. American Psychiatric Association. (2000).
  Diagnostic and statistical manual of mental
  disorders. (4th text revision ed.). Washington
  DC Author.
• 3. Quay, H.C., Hogan, A.E. (1999). Handbook of
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  Academic/Plenun Publishers.
• 4. Angold, A., Costello, E.J. Erkanli, A.
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• 5. Lahey, B.B., Loeber, R. (1994). Framework
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• 6. Burke JD, Loeber R, Birmaher, B. (2002)
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References

• 9. Loeber, R, Burke JD, Lahey BB, Winters A, Zera
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References

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