DISRUPTIVE BEHAVIOR DISORDER:

Oppositional and aggressive behaviors during childhood are among the most frequent reasons that a given youth is referred for mental health evaluation. Many youth exhibit negativistic or oppositional behaviors will find other forms of expression as they mature and will no longer demonstrate these behaviors in adulthood.

OPPOSITIONAL DEFIANT DISORDER:

In oppositional defiant disorder, a child’s temper outbursts, active refusal to comply with rules, and annoying behaviors exceed expectations for these behaviors for children of the same age. The disorder is an enduring pattern of negativistic, hostile, and defiant behaviours in the absence of serious violations of social norms or of the right of others.

Epidemiology:

Oppositional, negativistic behaviour, in moderation, is developmentally normal in early childhood and adolescence. Epidemiological studies of negativistic trails in nonclinical populations found such behaviour in 16 to 22 percent of school-age children.

Etiology:

The ability of a child to communicate his or her own will and opposing other’s will is crucial to normal development as a route toward establishing autonomy, forming an identity, and setting inner standards and control.

DSM-IV-TR Diagnostic Criteria for Oppositional Defiant Disorder:

A. A pattern of Negativistic, hostile, and defiant behaviour last at least 6 months, during which four (or more) of the following are present:

1. Often loses temper2. Often argues with adults3. Often actively defies or refuses to comply with adults request or rules4. Often deliberately annoys people5. Often blames others for his or her mistakes or misbehaviour6. Is often touchy or easily annoyed by others7. Is often angry and resentful8. Is often spiteful or vindictive

Note: Consider a criterion met only if the behaviour occurs more frequently that is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavioural causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a psychotic or mood disorderD. Criteria are not met for conduct disorder, and, if the individual is age 18 years or older, criteria

are not met for antisocial personality disorder.

Treatment:

The primary treatment of oppositional defiant disorder is family intervention using both direct training of the parents in child management skills and careful assessment of family interactions.

CONDUCT DISORDER:

Children with conduct disorder are likely to demonstrate behaviors in the following four categories: physical aggression or threats of harm to people, destruction of their own property or that of others, theft or acts of deceit, and frequent violation of age-appropriate rules.

Epidemiology:

Occasional rule breaking and rebellious behaviour is common during childhood and adolescent, but in youth with conduct disorder, behaviors that violate the rights of others are repetitive and pervasive. Estimated rates of conduct disorder among the general population range from 1 to 10 percent, with a general population rate of approximately 5 percent. The disorder is more common among boys than girls, and the ratio ranges from 4 to 1 to as much as 12 to 1. Conduct disorder occurs with greater frequency n the children of parents with antisocial personality disorder and alcohol dependence than in the general population. The prevalence of conduct disorder and antisocial behaviour is associated with socioeconomic factors.

Etiology:

No single factor can fully account for a child’s antisocial behavior and conduct disorder. Rather, may biopsychosocial factors contribute to development of the disorder.

DSM-IV-TR Diagnostic Criteria for Conduct Disorder:

A. Repetitive and persistent pattern of behaviour in which the basic right of others or major age-appropriate societal norms or ruler are violated, as manifested by the presence of three (or more) of the following criteria in the past 12 months, with atleast one criterion present in the past 6 monthsAggression to people and animals1. Often bullies threatens or intimidate others2. Often initiates physical fights 3. Has used a weapon that can cause serious physical harm to others (e.g., bat, broken bottle,

knife ,gun )4. Has been physical cruel to people5. Has been physical cruel to animals6. Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed

robbery)7. Has forced someone into sexual activityDestruction of property8. Has deliberately engaged in fire setting with the intention of causing serious damage9. Has deliberately destroyed others’ property (other than by fire setting)Deceitfulness or theft10. Has broken into someone else’s house , building, or car11. Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others)12. Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but

without breaking and entering; forgery)Serious violations of rules13. Often stays out of night despite parental prohibitions, beginning before age 13 years 14. Has run away from home overnight at least twice while living in parental or parental

surrogate home (or once without returning for a lengthy period )15. Is often truant from school, beginning before age 13 years

B. The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.

C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder .Code based on age at onset:

Conduct disorder , childhood-onset type :onset of at least one criterion characteristic of conduct disorder prior to age 10 yearsConduct disorder , adolescent-onset type :absence of any criteria characteristic of conduct disorder prior to age 10 yearsConduct disorder , unspecified-onset type : age at onset is not knownSpecify severity :Mild: few if any conduct problems in excess of those required to make the diagnosis and conduct problems cause only minor harm to othersModerate: number of conduct problems and effect on others intermediate between “mild” and ‘severe”.Severe: many conduct problems in excess of those required to make the diagnosis or conduct problems cause considerable harm to others

Treatment:

Multimodality treatment programs that us all the available family and community resources are likely to bring about the best results in efforts to control conduct-disordered behaviour. Multimodal treatments can involved the use of behavioral interventions in which rewards may be earned for prosocial and nonaggressive behaviors, social skills training, family education and therapy, and pharmacologic interventions. Overall, treatment programs have been more successful in decreasing overt symptoms of such as lying or stealing