All children will argue with adults and their caregivers at some point. At times, however, acting out and disruptive actions may be out of the normal range of behavior, be inconsistent with the child’s age and development, be more severe, and persist longer than they should. This may be the result of an externalizing disorder, which is a disorder that impacts those around a person. Disruptive behavior disorders are types of externalizing disorders that include both oppositional defiant disorder (ODD) and conduct disorder (CD), the symptoms for which present before age 8 and no later than age 12, the Centers for Disease Control and Prevention (CDC) publishes.
- The average rate of annual prevalence for disruptive behavior disorders is about 6 percent with a range of 5-14 percent, as reported by the journal Dialogues in Clinical Neuroscience. These disorders are twice as common in boys than girls, and the CDC reports that adolescents between the ages of 12 and 17 have the highest rate of current behavioral or conduct disorders. Poor nutrition and sleep habits, abuse and neglect, inconsistent parenting, difficult transitions, being raised in an environment of drug and/or alcohol abuse or regular fighting and aggression, and poverty are risk factors for developing a disruptive behavior disorder.
Early-onset disruptive behavior disorders generally have greater long-term consequences and may be a predictor of future drug abuse and other mental health issues, Merck Manual publishes. Early intervention and treatment of a disruptive behavior disorder can have a positive influence on the life of the individual and their loved ones, resulting in fewer long-term effects.
Signs of Oppositional Defiant Disorder and Conduct Disorder
Children who suffer from a disruptive behavior disorder will have frequent angry outbursts, defy authority figures on a regular basis, and may embody other antisocial behaviors, such as lying, cheating, and stealing. The main difference between oppositional defiant disorder and conduct disorder is the severity of the symptoms. These disorders may occur on a continuum, starting with ODD and progressing into CD. When CD continues into adulthood, it may present as antisocial personality disorder. Symptoms need to be present for at least six months for a disruptive behavior disorder to be diagnosed. Further specifics of each disorder are outlined below.
Oppositional defiant disorder
A person with oppositional defiant disorder may:
- Be angry on a regular basis and frequently losing their temper
- Be spiteful and resentful
- Work to deliberately annoy others
- Regularly argue with adults and consistently refuse to honor requests and rules that are set by authority figures
- Blame others for their own behavior and mistakes
- Be vindictive and easily annoyed by others
While all children may display these traits from time to time, those who suffer from ODD will do so more often than other children their age. They are also more likely to be openly defiant around family members, caregivers, teachers, and people whom they know really well.
A person with conduct disorder may:
- Display aggression that causes harm to others in the form of fighting or bullying
- Engage in serious rule-breaking, such as skipping school, staying out late at night, or running away
- Damage the property of others on purpose and engage in other antisocial behaviors, such as lying, cheating, stealing, etc.
- Display cruelty toward animals
Patterns of aggression, delinquency, and disobedience that are outside social norms can be signs of conduct disorder. Serious rule violations may result in law breaking, arrest, and difficulties at school. Children battling conduct disorder often struggle to get along with their peers and are more prone to injury than others their age.
- Disruptive Behavior Disorders, Drug Abuse, and Co-Occurring Disorders
Untreated mental illness can be a risk factor for drug abuse, as individuals may attempt to self-medicate their symptoms or use drugs as a method of escaping reality. Drug abuse is also often a form of disobedience, lashing out, or rule-breaking. Disruptive behavior disorders commonly co-occur with mood and anxiety disorders, substance abuse, and addiction. For instance, between a third and half of all children suffering from attention deficit hyperactivity disorder (ADHD) also battle oppositional defiant disorder, which can progress into conduct disorder, CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) publishes. The Journal of Abnormal Child Psychology reports on studies showing a direct link between disruptive behaviors, ADHD, and substance abuse.
Drug abuse in adolescence or young adulthood increases the odds for problems with drug use and addiction later in life. Youth who suffer from substance use disorders are 5-7 times more likely than their peers to also suffer from a disruptive behavior disorder, the Annual Review of Psychology publishes.
Co-occurring disorders can be complex and require specialized treatment for optimal results. Care that is provided in an integrated and simultaneous manner, meaning that both (or all) disorders are managed at the same time by a team of trained professionals, is generally considered the highest standard of care. It is important for all treatment providers to be on the same page when treating co-occurring disorders to minimize complications and improve treatment methods. For instance, a person who struggles with problematic drug abuse may not be a candidate for certain prescription medications that may be addictive in nature or easily misused. Overlapping regions of the brain, environmental aspects, biology, and genetics may all play a role in the onset of co-occurring disorders, which are all addressed with a full continuum of care.
- Treatment Options for Disruptive Behavior Disorders
Early intervention and treatment are ideal in the care of disruptive behavior disorders. A thorough assessment is key in helping to design a comprehensive care plan for individuals suffering from a disruptive behavior disorder, drug abuse, or both. The initial evaluation can identify any co-occurring disorders as well as the severity of the disorders. For example, disruptive behaviors and poor academic output may be the result of a learning disability or other concern, such as ADHD. More significant acting out may signify the presence of not only a disruptive behavior disorder but also potentially a mood or anxiety disorder. Skilled and highly trained professionals can ascertain exactly what the issues may be and how best to manage them.
Families and caregivers are often educated on how best to help their loved one who is suffering from a disruptive behavior disorder, and they may be included in behavioral therapy sessions. In these sessions, parents can be taught how to best handle a child’s aberrant behaviors and how to strengthen the relationship between parent and child. Behavioral therapy is a useful tool to positively influence behaviors by modifying negative thoughts and actions in both the child and the involved family members and caregivers. Mood stabilizers, stimulants, and other medications may be helpful in the treatment of a disruptive behavior disorder as well, although medications should be closely monitored in the case of a co-occurring drug abuse issue.
When a person has been abusing drugs for a long period of time, it is likely that they will suffer from drug dependence and therefore will benefit from the safety of medical detox before entering into a comprehensive treatment program. There are varying levels of care for disruptive behavior and co-occurring disorders, ranging from outpatient sessions and meetings to fully immersive residential, or inpatient, care. Residential treatment programs provide a highly structured and comprehensive level of care that can help families and loved ones build a strong foundation for ongoing recovery.