Understanding Disruptive Behaviour in Children and Helping them Cope Presented by: Lauren Snailham Clinical Psychologist laurensnailham@dbnmail.co.za
INTRODUCTION Disruptive Behaviour Disorders * Oppositional Defiant Disorder * Conduct Disorder * Attention deficit Disorder Bipolar Mood Disorder Social Skills What can you do to help?
Disruptive Behaviour Disorders Mood Disorder ADHD ODD Conduct Disorder Bipolar Mood Disorder SOCIAL PROBLEMS
DISRUPTIVE BEHAVIOUR DISORDERS a group of childhood mental disorders consisting of behaviour that is disruptive and violates social norms. children who externalize, are extroverted, under-controlled, and act out. They act out their emotions instead of holding them in, exhibiting behaviours such as fighting, bullying, cursing, and other forms of violence.
Oppositional Defiant Disorder A four year old boy was told by his nursery school teacher that he had to lie down on his cot at rest time. The boy said that he was not going to lie down. The teacher insisted upon compliance. The boy calmly walked over to the cot, urinated in it, and announced, I guess that I don t have to lie down on it, now.
Oppositional Defiant Disorder ODD for short A pattern of negative, hostile and defiant behaviour lasting at least 6 months, with 4 (or more) of following: Loses temper easily and frequently Often argues with adults Often actively defies/refuses to comply with adults requests/rules Blames others for his mistakes or misbehaviour Low tolerance for frustration Often touchy or easily annoyed by others Often angry and resentful Deliberately annoys people
ODD cont. Behaviour must occur more often than might be expected for the child's age and developmental stage. Must cause impairment in social and academic functioning.? One study found that 20% of children with ODD were also diagnosed with bipolar disorder, while 45% of children with both ODD and Conduct Disorder also had bipolar disorder.
CONDUCT DISORDER Most serious childhood mental illness. Repetitive and persistent pattern of behaviour in which the basic rights of others or major ageappropriate societal norms/rules are violated. Presence of 3(or more) of the following Sx in past 12 months and at least 1 Sx in last 6 months. Causes significant impairment in social and academic functioning
Aggression to people and animals 1) often bullies, threatens or intimidates others 2) often initiates physical fights 3) has used a weapon that can cause serious harm 4) has been physically cruel to people 50 has been physically cruel to animals 6) has stolen while confronting a victim 7) has forced someone into sexual activity Destruction of property 8) has deliberately engaged in fire setting with intention of causing serious damage 9)has deliberately destroyed others property
Deceitfulness or theft 10) has broken into someone else s house, building or car 11) often lies to obtain goods, favours or to avoid obligations. cons 12) has stolen items of nontrivial value without confronting a victim e.g. Shoplifting Serious violations of rules 13) often stays out at night despite parental prohibitions, beginning before age 13 14) has run away from home overnight at least twice while living in parental home (or once without returning for a lengthy period) 15) is often truant from school, beginning before age 13
Causes of DBD Temperament of child Neurological Genetics Parent/child relationship Family dynamics Known/unknown stress in child s environment
Attention Deficit Hyperactivity Disorder a controversial childhood mental disorder onset before age seven characterized by: inattention (e.g., distractibility, forgetfulness, not appearing to listen) hyperactivity and impulsivity (e.g., restlessness, excessive running or climbing, excessive talking, and other disruptive behaviour) or combination of both types.
Bipolar Disorder I m really scared...it s like he s possessed. One minute he is the sweetest, kindest person. He would do anything for you. Then, for no reason, something sweeps over his brain and he turns on me. There s screaming and yelling and things flying around the room. Once he gets going, his rages may take hours. He can be irritable and moody for days on end. Sometimes, he s so down that I m afraid for his own safety not to mention my own. Sometimes, though, he s so up that his judgement gets really poor. Where does he get off thinking that he s going to be a senator one day! And it always seems to be worse when he s at home. When i tell people about it they think I m crazy. My father-in-law was manic depressive and it led him to a drinking problem. I m so scared...
Bipolar Disorder Life-disrupting mental illness. Also known as manic depressive disorder. Characterized by: extreme swings in mood from high (manic) to low (depressive). In children, these occur more rapidly than in adults, most often presenting as a continuous, mixed, rapidly cycling mood.? Child and Adolescent Bipolar Foundation estimated significant number of children diagnosed with ADHD are actually afflicted with early-onset BAD.
Depressive Symptoms Extremely irritable and quick to anger often to the point of throwing rage-filled, uncontrollable tantrums. May become very needy and cry excessively. May lose sense of curiosity and natural adventure or may lose all interest in friends, family, school work and normal activities. May develop a very low sense of self-esteem. May express a desire to commit suicide. Other symptoms include: excessive sleep, fatigue, feigning illness, weight loss, lack of concentration, disorganized thoughts and actions and psychosis (delusions and hallucinations).
Manic Symptoms Extreme fits of joy and laughter. These episodes may occur for no reason and in an inappropriate environment such as school or church. May speak rapidly, jumping from one topic to another in an excited, unorganized manner. Have an exaggerated perception of own intelligence and abilities, becoming antagonistic and bossy with authority figures, refusing to listen or even believing has super-human abilities. Other symptoms include: little need for sleep, lack of patience, hypersexual behavior and psychosis.
ADHD BIPOLAR DISODER hyperactive / restless behaviors distractibility poor concentration Impulsivity racing thoughts strong genetic link sleep disturbances poor social relationships feelings of anxiety, depression, frustration and self-doubt significantly impact daily functioning Main symptom: DISTURBANCE IN ATTENTION same same same same same same same same same same Main symptom: DISTURBANCE IN MOOD
SOCIAL SKILLS Being able to get on with others. To create and maintain positive relationships. To be able to adjust our behaviour to different situations. Include behaviours such as making/maintaining eye contact, smiling, taking turns and the give and take of compliments during social interactions. Involves: seeing, thinking and then doing.
Seeing: - picking up on social cues - noticing the context (casual/formal; close friends/acquaint./strangers). - noticing other 's behaviour. Thinking: - interpreting others behaviour to understand why they're doing what they're doing (playful /aggressive; deliberate /accidental). - predicting others' likely responses and coming up with effective strategies for influencing peers in desired ways. Doing: - means interacting with peers in positive ways. - some children know what they ought to do, but have trouble actually doing it. - e.g. Want to join in but feel anxious and freeze up and say nothing. Or want to join in and act impulsively, blurting out inappropriate comments.
What can you do? Be empathic (understanding, validating) Be firm (boundaries, consequences) State the rules Be consistent Be predictable Be a safe place Create opportunities for social learning Build up with praise
CLASSROOM ACTIVITIES Learning about feelings and recognising them in others: List of feelings Feeling bear Discussion feelings Exploding balloon Catch a coping skill Self-control Make the statue laugh Feeling charades Role plays Feeling posters/collages
CLASSROOM ACTIVITIES Eye contact: Staring contest Eyes on the forehead Funny faces Face it Conversations Staying on topic Listening: Simon says Name game Red light Green light Extra: Worksheets Stories Board games