Specific Behavior Disorders
Conduct Disorder, Oppositional Defiant Disorder
A conduct disorder is a severe emotional and behavioral problem in a child or adolescent that usually shows up by age 16. If left untreated, the child often moves on to antisocial personality disorder as an adult. Children with conduct disorders frequently behave in extremely troubling, socially unacceptable, and often illegal ways. However, they feel justified in their actions and show little to no empathy for their victims.
Treatment for conduct disorder depends on many factors, including the child’s age and the severity of symptoms. With early intervention, the chance of a successful therapy outcome improves; however, without the assistance of a qualified doctor, the risk of incarcerations, mood disorders, and the development of comorbidities such as substance abuse is significant. Children with conduct disorder are at risk of becoming school dropouts, drug addicts, criminals, bullies, or acquiring sexually transmitted diseases and committing suicide or school violence.
Symptoms of conduct disorder generally fall into four categories:
- Aggressive behavior toward people and animals, including bullying, threatening, physical violence, use of a weapon, physical cruelty to people or animals, and forcing someone to perform a sexual act.
- Property destruction, including setting fires and purposefully destroying property.
- Deceit or theft, including lying, breaking into someone else’s property with the intent to steal, and shoplifting.
- Serious violations of rules, including breaking family rules, running away from home, and frequently skipping school before the age of 13.
For a diagnosis of conduct disorder, at least three of these behaviors must have occurred within the past year, with at least one occurring within the past six months.
- Aggressive Behavior
- Property Destruction
- Deceit or Lying
- Serious Violation of Rules
The number of symptoms exhibited and the degree of injury or damage sustained determines whether it is a case of mild, moderate, or severe conduct disorder.
- Psychotherapy aimed at helping the child learn to express and control anger in more appropriate ways.
- Cognitive-behavioral therapy aims to reshape the child’s thinking (cognition) to improve problem-solving skills, anger management, moral reasoning skills, and impulse control.
- Family therapy structured to help improve family interactions and communication among family members.
- Parent management training (PMT), a specialized therapy technique, which teaches parents ways to alter their child’s behavior in the home positively.
- Medication use is limited to the treatment of co-existing conditions designed to provide symptom relief.
Oppositional Defiant Disorder
When a child’s behavior rises above the point of being strong-willed and challenging, the action may fall under the category of Oppositional Defiant Disorder. With this behavioral disorder, the child or teenager demonstrates a persistent and frequent pattern of anger, irritability, arguing, defiance or vindictiveness toward the parent or other authority figures. Signs often begin to show in pre-school but are almost always present before early teens. The behaviors cause significant family, social activity, school, and work disruptions.
Angry and irritable mood:
- Often and quickly loses temper
- Is frequently touchy and easily annoyed by others
- Is often angry and resentful
Argumentative and defiant behavior:
- Often argues with adults or people in authority
- Often actively defies or refuses to comply with adults’ requests or rules
- Often deliberately annoys or upsets people
- Often blames others for his or her mistakes or misbehavior
- Has shown spiteful or vindictive behavior at least twice in the past six months
ODD can vary in severity:
- Mild – symptoms occur only in one setting, such as only at home, school, work, or with peers.
- Moderate – Some symptoms occur in at least two settings.
- Severe – Some symptoms occur in three or more settings.
Oppositional Defiant Disorder Treatment
Treatment for oppositional defiant disorder primarily involves family-based interventions but may psychotherapy and training. Treatment often lasts several months or longer. It’s essential to treat any co-occurring problems, such as a learning disorder, because left untreated, they tend to get worse.
The cornerstones of treatment for ODD usually include:
- Parent training.The development of parenting skills that are more consistent, positive, and less frustrating for you and your child. In some cases, your child may participate in this training with you, so everyone in your family develops shared goals for how to handle problems. Involving other authority figures, such as teachers, in training may be an essential part of treatment.
- Parent-child interaction therapy (PCIT).During PCIT, a therapist coaches parents while they interact with their child. For example, one approach is the use of an “ear bug,” an audio device used by a therapist to guide parents through strategies that reinforce positive behavior in their child while the therapist observes out of view of the group.
- Individual and family therapy.Individual therapy to help the child learn anger management and healthy ways to express feelings. Family therapy may also be encouraged to promoted improved communication skills and help family members learn how to work together to resolve family issues.
- Cognitive problem-solving training.Therapy teaches the child how to identify and change destructive thought patterns that lead to behavior problems. Collaborative problem-solving brings the parent and child together to learn how to create solutions to problems as a team working work rather than against one another.
- Social skills training.The training aimed to help the child develop social skills useful in establishing friendships and interacting positively and effectively with peers at school and in other social situations.
Parents learn how to manage a child’s behavior by:
- Giving clear instructions and following through with appropriate consequences when needed
- Recognizing and praising the child’s desired actions and positive characteristics for promoting desired behaviors
Although some parenting techniques may seem like common sense, learning to use them consistently in the face of opposition isn’t easy, especially if there are other stressors at home. Learning these skills requires practice and patience. Repetition in the face of difficulty and disruptive interactions while a therapist is present to provide support, provides the parent with the resources necessary to develop consistency and to rebuild the ability to express unconditional love and acceptance to their child.