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33 Cards in this Set
- Front
- Back
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What (Disruptive Behavior Disorders) DBDs are NOT:
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Terrible Twos:
18-24 months Normal children express autonomy and individuation. Physical aggression peaks at 2-3 yo. Remember Freudian anal phase, Eriksonian autonomy vs. shame and doubt, Mahler rapprochement Teen Identity Crisis: Normal teens go through a phase of struggle to establish identity that is separate and distinct from parents. May look ODD but not really |
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Oppositional Defiant Disorder
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Pattern of negativistic, hostile, defiant behavior lasting more than 6 months.
Four or more of following: Loses temper Argues with adults Defies adult rules and requests Blames others for mistakes Deliberately annoys others Is easily annoyed by others Angry, resentful Spiteful, vindictive Criterion only met if behavior in excess of what normally seen in child of comparable age/developmental level Impairment in functioning (social, academic, occupational) Not due to mood/psychotic disorder Rule out Conduct Disorder, if older than 18yo, rule out Antisocial Personality Disorder. |
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ODD Features
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Most commonly emerges in late pre-school or early school aged children but clinical attention is usually later.
Average point prevalence (# with disease at one point in time) is 6% Boys outnumber girls up until puberty. After puberty, two genders are more equal. ¼ with ODD will have no further diagnoses. Most common comorbidity is ADHD. Severe ODD may progress to Conduct Disorder. 30-40% boys with severe ODD progress to CD. Of those 40-50% progress to develop Antisocial PD as adults. So in essence, 1/5-6 ODD go on to ASPD as adults. |
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____ with ODD will have no further diagnoses.
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¼
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Most common comorbidity is _______
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ADHD
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Severe ODD may progress to ____________
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Conduct Disorder
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_____% boys with severe ODD progress to CD.
Of those ____% progress to develop Antisocial PD as adults. So in essence, ____ ODD go on to ASPD as adults. |
30-40%
40-50% 1/5-6 |
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ODD Risk Factors
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Family history of parent with Mood, SUD, ODD, ADHD, ASPD
Family discord, crowded families Abuse, neglect Harsh or inconsistent discipline Lack of supervision Lack of positive parental involvement Reading or Language Learning Disorders Low IQ (BIF or MR) *******Note: If can’t do well in school, leads to low self esteem, anguish, anger, frustration. |
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ODD Comorbidities
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50-60% ODD kids have ADHD
45-65% ADHD kids have ODD ADHD and ODD are highly comorbid! 35% ODD kids develop mood, anxiety disorders 20% will have major mood disorder (MDD or BPAD) 15% will go on to develop personality disorder as adult |
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ODD Treatment
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Treat psychiatric comorbidities: ADHD, anxiety, mood
Stimulants: shown to decrease classroom aggression Parent Child Interaction Training (PCIT) Empirically supported Young children Improves relationship and changes interactions Behavioral treatments Prosocial behavior + reinforced. Negative behavior not reinforced or punished. Skill building, social skills, problem solving, negotiation, communication. Parent Management Training Set up reasonable age appropriate consequences and enforce consistently. Develop and implement contingency management plan (reward good behavior, aka token economy). Parents modify expression of demands. Give less attention to unwanted behavior and more attention/praise to desired behavior. Family Therapy |
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ODD Treatment
Treat psychiatric comorbidities (ADHD, anxiety, mood) with: |
Stimulants: shown to decrease classroom aggression
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ODD Treatment
Parent Child Interaction Training (PCIT) |
Empirically supported
Young children Improves relationship and changes interactions |
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ODD Treatment
Behavioral treatments |
Prosocial behavior + reinforced.
Negative behavior not reinforced or punished. Skill building, social skills, problem solving, negotiation, communication |
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ODD Treatment
Parent Management Training + Family Therapy |
Set up reasonable age appropriate consequences and enforce consistently.
Develop and implement contingency management plan (reward good behavior, aka token economy). Parents modify expression of demands. Give less attention to unwanted behavior and more attention/praise to desired behavior. |
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Conduct Disorder
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CD symptoms cluster in 4 areas:
Aggression to people and animals Destruction of property Deceitfulness and theft Serious violation of rules Male to Female 4:1 to 12:1 (much higher in boys!) Disruptive behavior in young children may be manifestation of mood disorder… |
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Male to female ration in CD?
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Male to Female 4:1 to 12:1 (much higher in boys!)
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Conduct Disorder Diagnosis
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3 out of 15 antisocial behaviors present over period of one year with at least one in the past 6 mos.
Aggression to people/ animals Bullies, threatens, intimidates others Initiates physical fights Used weapon that can cause serious harm in a fight Physically cruel to people Physically cruel to animals Has stolen while confronting a victim Has forced someone into sexual activity Destruction of property Firesetting with intent to cause serious damage Deliberately destroyed others’ property other than by fire Deceitfulness or theft Breaking and entering Cons others Stolen without confronting victim (shoplifting) Serious rule violations Breaks curfew before age 13 Run away overnight at least twice or once for long time Truant from school before age 13 Impairment caused If >18yo, criteria are NOT met for ASPD. Childhood onset type: one criterion <10yo Adolescent onset type: No criterion <10yo Mild: Few sx in excess of those required to make dx. Moderate: Number of conduct problems and effect on others intermediate range. Severe: Many conduct problems in excess of those required to make the diagnosis OR conduct problems cause serious harm to others |
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Childhood onset type for CD?
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: one criterion <10yo
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Adolescent onset type for CD?
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: No criterion <10yo
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Type of CD's
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Mild: Few sx in excess of those required to make dx.
Moderate: Number of conduct problems and effect on others intermediate range. Severe: Many conduct problems in excess of those required to make the diagnosis OR conduct problems cause serious harm to others |
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CD Etiology
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Interplay between:
Genetic predisposition Temperament Bad parent role model (impulsive, rule breaker) Association with delinquent peer group Trauma (abuse, loss, illness) may trigger ODD or CD behavior as a defense against feeling helpless/anxious |
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ONly list the Biopsychosocial Risk Factors
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Biological Risk Factors
Psychodynamic Risk Factors: Social Risk Factors |
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Biopsychosocial Risk Factors Biological Risk Factors for CD
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Low Serotonin correlates with aggression/violence
High cortisone/testosterone Disturbed language/communication development Early physical maturity in females Temperament – ambivalently attached child |
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Psychodynamic Risk Factors for CD:
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Unresponsive parents who cause anxious-avoidant attachment
Fixation at separation/individuation stage, lack of development of internalized mental representation of mom (lack of object constancy) leads to low self esteem, anxiety, ODD. Early age aggression or shyness predisposes to CD later. Unresolved conflict with authority figure Abused child’s “identification with the aggressor” – internalization of abuser who represents source of fear, pain, and frustration. |
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Social Risk Factors for CD
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Familial – both ODD and CD aggregates in families
Poor parenting – low supervision, poor conflict management, power struggle, harsh or inconsistent discipline, lack of warmth from parent to child Poverty, bad neighborhood Paternal aggression associated with CD in some sons Mother-daughter antisocial behavior pattern: Moms with CD who provide attention to problem behavior and ignore good behavior. Parental criminal behavior is associated with CD and poor prognosis due to progression to ASPD |
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CD Comorbidities
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ADHD is predictive of early onset (<10yo) CD
Pesence of ADHD + CD increases risk of mood disorder and lends worse prognosis LD: Mainly Reading LD BPAD SUD Depression: Increases risk of future SUD ASPD: Lack of emotional reactivity and callousness predicts future ASPD Cognitive impairment (BIF/MR) carries poor prognosis. |
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CD Assessment
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Psychiatric Evaluation
Multi modal assessment of conduct Assessment instruments (DISC,KSADS,BPRS) Screen for comorbidities like ADHD, mood, anxiety, SUD Physical Exam Signs of abuse Head trauma (traumatic brain injury or TBI) Signs of STDs Labs Urine drug screen, HIV, Hep B/C Neuropsych testing: IQ and LD |
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CD Treatment
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Multimodal Approach
Involve everyone who interacts with the kid Parents, teachers, coaches, court worker, child protective services, church youth leader, etc. Multi-Systemic Therapy (MST) Family Therapy +Individual Therapy + Group Therapy for Social Skills Training + Use of community resources (churches, Big Brothers/Sisters, mentors) Lasts minimum 4 months with multiple therapist-family sessions per week and therapist available to family 24/7 Use family and community resources all ready available Services delivered in patient’s real world environment Goal: Empower families to build a healthy environment for child through mobilization of resources ***Only therapy for CD that is evidence based! |
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CD Prognosis
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High risk of suicide in females with CD
High prevalence of residential care in CD kids 90% of CD boys have met ODD criteria before CD Females with DBD prone to SUD and other psychiatric comorbidities Poor Prognostic factors: Comorbidities Poor language skills |
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when ODD starts?
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late pre-school or early school aged children but clinical attention is later
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Boys outnumber girls up until _________ After that the two genders are more equal.
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puberty
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ODD Risk Factors
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Family history of parent with Mood, SUD, ODD, ADHD, ASPD
Family discord, crowded families Abuse, neglect Harsh or inconsistent discipline Lack of supervision Lack of positive parental involvement Reading or Language Learning Disorders Low IQ (BIF or MR) *****Note: If can’t do well in school, leads to low self esteem, anguish, anger, frustration. |
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ODD Comorbidities
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50-60% ODD kids have ADHD
45-65% ADHD kids have ODD ADHD and ODD are highly comorbid! 35% ODD kids develop mood, anxiety disorders 20% will have major mood disorder (MDD or BPAD) 15% will go on to develop personality disorder as adult |
