Doctor Whats wrong with my child

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Doctor! Whats wrong with my child?

• Tim -6 year old boy
• Unruly behavior at clinic
• 4 school suspensions
• Aggressive and destructive
• Uncontrollable at home
• Broken dishes and furniture
• Play with fire
• Pull family dog by its tail
• Threw can of soup at his sister

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Conduct Disorder and Oppositional Defiant Disorder

• Tom Wong
• Psyc 2621H
• 4/18/07

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Attention Deficit-Disruptive Behavior Disorder

• What is AD-DBD?
• Disorders
• Attention Deficit Hyperactivity Disorder (ADHD)
• Conduct Disorder (CD)
• Oppositional Defiant Disorder (ODD)

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DSM-IV-TRConduct Disorder

• The manifestation of 3 or more distinct criteria
  for the past 12 months.
• At least 1 criterion existing for the past 6
  months.
• 15 criterions
• Aggression to people or animals
• Destruction of property (fire or non fire)
• Deceitfulness or theft
• Serious violation of rules - runaway

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DSM-IV-TRConduct Disorder

• Disturbance in behavior causes clinically
  significant impairment in social, academic or
  occupational functioning.
• If 18 or older, criteria are not met for
  Antisocial Personality Disorder (APD)

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DSM-IV-TROppositional Defiant Disorder

• The defiance must interfere with the childs
  ability to function in school, home, or the
  community.
• The defiance cannot be the result of another
  disorder, such as depression, anxiety, or the
  more serious Conduct Disorder.
• The childs problem behaviors have been happening
  for at least six months.

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DSM-IV-TR Oppositional Defiant Disorder

• If the child meets at least 4 out 8 of the
  criteria below
• Losing temper
• Arguing with adults
• Refusing to follow the rules
• Deliberately annoying people
• Blaming others for own mistakes
• Easily annoyed
• Angry and resentful
• Spiteful or even revengeful

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Differences between ODD and CD

• ODD - defiant to immediate authority figure
• CD - aggression toward other people and defiant
  against societal norm

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Methods of diagnosis for CD/ODD?

• Assessment interview
• Report from family members or caregiver
• Self report
• Records from school and other agencies

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Etiology

• Genetic Causes
• Decreased baseline autonomic nervous system
  activity required greater stimulation to
  achieve arousal
• Parent Psychopathology - found to contribute to
  children CD/ODD.
• Recent research suggests a possible link between
  parents with antisocial behavior to have children
  with CD/ODD

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Etiology

• Psychosocial risk factors - complex
• Parental antisocial behavior
• Parental substance abuse
• Psychiatric illness
• Marital conflict
• Child abuse
• Child neglect

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Epidemiology

• High Prevalence up to 16
• Sex difference - 31 (CD)
• 6 to 16 of boys
• 2 to 9 of girls
• About 40 of children with CD will grow up to be
  adults with antisocial personality disorder.

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Epidemiology

• Patients suffering from CD are not distress by
  their behavior
• Not all ODD diagnosis lead to development of CD
• Almost all CD patient has earlier ODD diagnosis
  gt90

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Comorbidity

• ADHD
• Mood Disorder major depression, dysthymia,
  bipolar
• Substance abuse
• No comorbid between CD and ODD. Only precursor

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Treatment Therapy

• Cognitive-behavioral approach
• Psychosocial interventions
• Cognitive-behavioral skills training
• effective for aggressive adolescents
• Problem-solving skills training.
• Assume responsibility of their behaviors
• instead of victim mentality

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Treatment Therapy

• Parent management therapy - Behavior modification
• Parental intervention parental behavior
  modification
• Parentchild interaction
• Family therapy
• Improve family environment for problem child

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Treatment Medications

• No pharmacological treatments for CD/ODD approved
  by FDA.
• Why?

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Treatment Medications

• Antipsychotics
• Antidepressants
• comorbid major depression
• Mood stabilizer
• comorbid mood disorder
• Psychostimulant
• comorbid with ADHD

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Treatment

• Other disorders comorbid always encourage the use
  of medication.
• Most effective - pharmacological treatments
  combine with cognitive-behavioral therapy
• Early diagnose for effective treatment.
• Longer treatment time produces more consistently
  better results
• No cure for CD/ODD

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Controversy

• ICD-10 vs. DSM-IV
• ICD-10 combines the list. DSM-IV separate list
  for ODD and CD
• ODD ( ICD-10 )gt 2 from severe list (CD) gt 3 from
  less severe (ODD)

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Controversy

• No clear cutoff.
• No significant finding.
• Required further differentiation.

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Controversy

• Diagnostic differences between boy and girl?
• Symptoms expressed differently in girl?