jueves, 2 de mayo de 2019

What are Disruptive Behavioral Disorders?

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By Chloe Bennett, B.Sc.Reviewed by Dr. Jennifer Logan, MD, MPH

Children and young people can experience a range of mental health issues specifically behavioral and emotional psychological conditions such as disruptive behavioral disorders (DBD).

What are Disruptive Behavioral Disorders?

Disruptive behavioral disorders are a category of psychiatric conditions which can be differentiated into subtypes including conduct disorders (CD) and oppositional defiant disorder (ODD). These can commonly be seen in preschool and school-aged children. Most children, especially toddlers, will go through periods of displaying low-intensity ‘naughty behavior’ for example, damaging items and losing their temper. However, if a child exhibits extremely difficult behavior such as severe outbursts and prolonged tantrums that become very challenging for caregivers to handle, and is not typical for the level of development, and age of the child, then they might be considered to have a disruptive behavioral disorder.

Oppositional Defiant Disorder

Those with oppositional defiant disorder will often present with prolonged disobedient, hostile or defiant behavior. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), those with ODD display a pattern of defiant behavior or irritable mood for at least six months. In addition to this, those with the condition may often argue with those with a level of authority, act in a spiteful nature, and shift the blame to others for their own misbehavior.

Conduct Disorder

Conduct disorder is characterized by repetitive patterns of behavior which violates age-appropriate rules and goes against the basic rights of others. The DSM-5 outlines that in order to be diagnosed with a conduct disorder there should be a presence of behaviors such as truancy from school; repeatedly running away from home; damaging property or objects; pyromaniac tendencies; and aggression towards both animals and humans.

Etiology of Disruptive Behavioral Disorders

Research literature has highlighted a complex range of psychosocial and biological factors thought to influence the development of disruptive behavioral disorders.

Parental Factors

Research has found that parental factors and the family environment can play a role in the onset of DBD. For example, a child is more likely to develop DBD is they have repeatedly witnessed episodes of domestic abuse. Furthermore, if there’s a lack of structure, the use of physical or verbal aggression towards the child by their caregiver, and substance abuse issues in the family home, this may lead to maladaptive behavior in the child.

School Factors

If the child’s classroom size is large, and as a result, there are more children per teacher, then the child may experience a reduced amount of positive feedback for good behavior from the teachers.

Biological Factors

Research has highlighted a range of biological factors linked to the onset of DBD. Those with symptoms of DBD may have higher levels of testosterone which is thought to be linked to an increase in aggressive behavior. Furthermore, some researchers suggest that there may be a genetic association with the disorder, as those whose parents display antisocial and aggressive behavior are more likely to act in the same manner.

Neurological Factors

For some with DBD, the increase in aggression levels may be linked to neurological damage caused by seizures or traumatic brain injury. In addition to this, there is a growing body of research which highlights structural differences in the brain of those with ADHD.

Comorbidity

Like many other psychological conditions, those diagnosed with DBD may also present symptoms linked to a range of psychiatric disorders including attention deficit hyperactivity disorder (ADHD), depression and learning disorders.

Treatment

There is a range of treatment options which target both the individual’s environment and their own behavior. Anger management can often be prescribed to enable the individual to help cope with periods of anger and prevent it leading to outbursts of aggression. Parent management training may also be used to teach caregivers strategies to reward positive behavior. Drug treatments may be used in order to manage symptoms from other comorbid psychological disorders such as selective serotonin reuptake inhibitors for depressive symptoms and mood stabilizers for disorders such as bipolar.