Attention Deficit and Disruptive Behavior Disorders Introduction Attention deficit and disruptive behavior disorders are commonly known as child behavior disorders. A child behavior disorder is when a child or teen has a pattern of hostile, aggressive or disruptive behaviors for more than 6 months. All kids misbehave sometimes. And some may have temporary behavior problems due to stress. But behavior disorders are more serious. The behavior is not similar to the behavior of other children of the same age. Kids who have severe, ongoing behavior problems are at higher risk for school failure, other mental health problems and suicide. Classes or family therapy may help parents learn to set and enforce limits. Talk therapy and behavior therapy for your child can also help. This reference summary reviews information related to child behavior disorders. It discusses some of the most common child behavior disorders and treatment options. Child Behavior Disorders All kids misbehave sometimes. It s part of growing up. But behavior disorders are more serious. A child or teen with a behavior disorder has a pattern of hostile, aggressive or disruptive behaviors. This pattern must last for more than 6 months to be considered a behavior disorder. Children with a behavior disorder may show certain warning signs. These signs may include: Damaging or destroying property. Harming or threatening to harm themselves, other people or pets. 1
Showing hostility towards authority figures. Throwing tantrums and arguing. Other signs that suggest a child has a behavior disorder include: Early sexual activity. Smoking, drinking or drug use. Lying or stealing. Not doing well in school or skipping school. Attention deficit and disruptive behavior disorders include: Attention Deficit Hyperactive Disorder, or ADHD. Conduct Disorder, or CD. Oppositional Defiant Disorder, or ODD. Attention Deficit Hyperactivity Disorder (ADHD) Attention deficit hyperactivity disorder, or ADHD, is a common childhood disorder that makes it hard for a child to focus and pay attention. Some children with ADHD may be hyperactive or have trouble being patient or sitting still. ADHD can also make it hard for a child to do well in school or behave at home. Knowing the symptoms of ADHD can help you recognize when your child s lack of focus or extra energy are signs of a behavior disorder. The symptoms of ADHD are categorized into 3 groups: inattentiveness, hyperactivity and impulsivity. Symptoms of inattentiveness may include: Frequent daydreaming. Getting distracted easily. Having trouble following directions. Not listening carefully and having a hard time remembering directions. Symptoms of hyperactivity include: Having a hard time staying seated. Fidgeting and squirming often, also known as motor restlessness. Running around a lot. 2
Impulsivity symptoms include: Blurting out inappropriate comments. Having a hard time waiting their turn. Interrupting others. Impulsivity symptoms also include: Taking needless risks that may cause injuries. Talking nonstop. Touching and playing with everything they see. Some children with ADHD have all of the symptoms of ADHD and are inattentive, hyperactive and impulsive. But some may have more inattentive symptoms. Others may have more hyperactivity symptoms. ADHD happens more often in males than in females, and behaviors can be different in boys and girls. For example, boys may be more hyperactive and girls may tend to be quietly inattentive. Diagnosing ADHD can be hard. If a child does not demonstrate symptoms of hyperactivity, ADHD may not be suspected. Children with hyperactivity are more likely to be diagnosed with ADHD. Children who are inattentive but not hyperactive may not be suspected of having ADHD. Conduct Disorder (CD) Conduct disorder, or CD, is another behavior disorder of childhood. Children with CD may have little empathy or concern for the feelings of others. They may misunderstand the actions of others as threatening and respond aggressively. CD may begin to develop as early as the preschool years. But the first major symptoms usually happen from middle childhood through middle adolescence. For most children and young adults, the symptoms of CD often decrease by adulthood. If the symptoms of CD continue into adulthood, the behaviors often lead to a diagnosis of antisocial personality disorder. 3
Antisocial personality disorder is a type of ongoing mental illness that has negative effects on a person s way of thinking, perceiving situations and relating to others. The behavior of people with antisocial personality disorder is often described as destructive. Symptoms of CD may include: Aggression toward people and animals. Damaging property. Dishonesty, lying, or stealing. Other symptoms of CD can include: Irritability, temper outbursts and recklessness. Lack of appropriate feelings of remorse or guilt. Self-harm. Serious and repeated violations of rules. The aggressive behaviors associated with CD are often the most alarming. A child with CD may bully, threaten or intimidate others. They can be cruel to people or animals. Children with CD often start fights. They may even use a weapon or force someone into sexual activity. A child with CD may also act dishonest. Lying is a common symptom of CD. Children may lie to earn goods or favors from others. They may shoplift or steal from their friends, family members or strangers. Children with CD are often hard to manage because they do not care about another person s feelings. They may not try to hide their aggression. They often have trouble making friends. Destroying property is another symptom of CD. Children may set fires with the intention of causing damage. Other forms of vandalism, such as breaking windows or spray painting property, may also take place. Children with CD often do not obey rules at school or home. This may include staying out past curfew when it is not allowed by the child s parents. The child may skip school or run away from home. CD is often associated with ADHD. It may also contribute to mood disorders and anxiety disorders. 4
Oppositional Defiant Disorder (ODD) Even the best-behaved children can be difficult and challenging at times. But if your child or teen has a persistent pattern of tantrums, arguing and angry or disruptive behavior toward you and other authority figures, he or she may have oppositional defiant disorder, or ODD. Children with ODD may seem rude or angry. They draw attention to themselves by overreacting to minor problems. Signs of ODD generally begin before a child is 8 years old. Sometimes ODD may develop later, but almost always before the early teen years. The signs tend to begin gradually and then worsen over months or years. Symptoms of ODD may include: Excessive arguments with adults. Frequent anger and resentment. Frequent temper tantrums. Low self esteem. Other symptoms of ODD may include: Refusal to obey adults. Regularly challenging or disobeying rules. Using mean and hateful words when upset. Other symptoms of ODD may include: Being overly sensitive or easily annoyed by others. Blaming others for mistakes or misbehavior. Deliberate attempts to annoy or upset others. Spiteful attitude and revenge seeking. Children with ODD may have problems at home and school. They may also have a hard time keeping friends. Oppositional defiant disorder commonly develops alongside ADHD, depression and anxiety. 5
Causes The cause of behavior disorders in children is not known. A combination of biological, genetic, environmental, psychological and social factors may lead to behavior disorders. Although the exact cause of child behavior disorders is unknown, there are many things that children with behavior disorders have in common. For example, more boys are diagnosed with disruptive behavior disorders than girls. Behavior disorders happen more often in children where at least one parent has experienced a mood disorder or substance abuse disorder. Contributing causes of behavior disorders may be a combination of factors, including: A child's natural disposition. Family conflicts. Limitations or developmental delays in a child's ability to process thoughts and feelings. Lack of supervision. Other factors that may be related to behavior disorders include: Inconsistent or harsh discipline. Abuse or neglect. An imbalance of certain brain chemicals, such as serotonin. Parents with substance abuse problems. Financial stress. Diagnosis Behavior disorders may be hard to diagnose. Most healthy children are inattentive, hyperactive or impulsive at one time or another. The definition of normal child behavior is always changing. What is considered normal child behavior by one family may not be considered normal by another family. It's normal for preschoolers to have short attention spans and be unable to stick with one activity for long. Even in older children and teenagers, attention span often depends on the level of interest. 6
Young children are naturally energetic. In addition, some children just naturally have a higher activity level than others do. Children should never be classified as having a behavior disorder just because they're different from their friends or siblings. Viewing a child s behavior as normal or abnormal depends on the child s: Age. Emotional development. Intellectual development. Personality. Physical development. To receive a diagnosis of a behavior disorder, a child must have symptoms for 6 or more months. Symptoms must be more severe than what is normal for other children at the same age and they must happen in more than one setting. The disorder also must significantly interfere in the daily life of the child. There is no single test that can diagnose a child as having a behavior disorder. A health care provider will gather information about the child s behavior and environment. This is usually done by a mental health specialist. The mental health specialist will first try to rule out other possibilities for the child s symptoms. For example, certain situations, events or health conditions may cause temporary disruptive behaviors in a child. Sometimes a physical examination and blood test will be done to determine if the symptoms of a behavior disorder are caused by another medical condition. Rarely, a brain scan may also be used to rule out other disorders. The specialist will also check school and medical records to see if the child's home or school settings are unusually stressful or disrupted. The specialist will also gather information from the child's parents and teachers. A child will be diagnosed with a behavior disorder if the information that is gathered meets the criteria for a specific disorder. 7
Treatment Treatment for a behavior disorder depends on the type of disorder and how serious is it. Treatment usually consists of talk therapy, medication or both. During talk therapy, a child learns how the behavior disorder affects his or her thoughts, behaviors, mood and feelings. Social skills training may be included to help the child learn how to interact more positively with peers and adults. There are many different kinds of talk therapy. A health care provider can help you decide which type of talk therapy is best for your child. Several medications may be used to treat the symptoms of conduct disorder, oppositional defiant disorder and ADHD. ADHD is usually treated with stimulant medications that decrease impulsivity and hyperactivity and increase attention. In some cases, stimulants also may be used to treat CD and ODD. Other medications may be used to treat disruptive behavior disorders and ADHD. Talk to your child s health care provider to learn more about the different kinds of medications. Treatment for behavior disorders should not be limited to the use of medications alone. Treatment should also include some form of talk therapy and behavior management. Treatment of a behavior disorder is often most successful when the child s family is involved. Parents and other family members can learn techniques to help manage their child s problem behavior. Summary Attention deficit and disruptive behavior disorders are commonly known as child behavior disorders. A child behavior disorder is when a child or teen has a pattern of hostile, aggressive or disruptive behaviors for more than 6 months. All kids misbehave sometimes. And some may have temporary behavior problems due to stress. But behavior disorders are more serious. The behavior is not similar to the behavior of other children of the same age. 8
Children with a behavior disorder may show certain warning signs. These signs may include: Damaging or destroying property. Harming or threatening to harm themselves, other people or pets. Showing hostility towards authority figures. Throwing tantrums and arguing. Other signs that suggest a child has a behavior disorder include: Early sexual activity. Smoking, drinking or drug use. Lying or stealing. Not doing well in school or skipping school. Attention deficit hyperactivity disorder, or ADHD, is a common childhood disorder that makes it hard for a child to focus and pay attention. Some children with ADHD may be hyperactive or have trouble being patient or sitting still. Conduct disorder, or CD, is another behavior disorder of childhood. Children with CD may have little empathy or concern for the feelings of others. They may misunderstand the actions of others as threatening and respond aggressively. If your child or teen has a persistent pattern of tantrums, arguing and angry or disruptive behavior toward you and other authority figures, he or she may have oppositional defiant disorder, or ODD. Children with ODD may seem rude or angry. They draw attention to themselves by overreacting to minor problems. The cause of behavior disorders in children is not known. A combination of biological, genetic, environmental, psychological and social factors may lead to behavior disorders. Treatment for a behavior disorder depends on the type of disorder and how serious it is. Treatment usually consists of talk therapy, medication or both. Treatment of a behavior disorder is often most successful when the child s family is involved. 9