Disruptive Behavior Disorders
What causes oppositional defiant disorder (ODD)?
The exact cause of ODD isn’t known, but two theories help explain why a child could develop the disorder: the effect of developmental factors and the influence of learned factors.
One theory suggests that children with ODD:
- begin to experience problems in their toddler years
- may have had an unusually hard time separating from parents (“standing on their own two feet,” so to speak) while younger
- did not resolve their normal development issues in their younger years, leading to later behavioral problems
Another theory suggests that children with oppositional defiant disorder:
- developed unusually strong levels of negativity and pessimism (two main traits of ODD) because a parent or other authority figure meted out excessive punishment or other forms of negative reinforcement
- learned to associate the parent or authority figure’s negative reinforcement with receiving more attention, time and concern
- started a pattern of acting out in order to receive more of this perceived “extra attention”
Other possible factors may include:
- permissive parenting, when a parent too often and too easily gives in to a child’s demands and doesn’t really teach them the “rules”
- strong will in the child, which can be caused by any or all of the following:
- ingrained personality or tempermental characteristics
- lack of positive attachment to a parent
- significant stress or a lack of predictable structure in the home or community environment
What causes conduct disorder?
Conduct disorder is a highly complex condition, and its causes aren’t fully understood. It’s likely that both genetic and environmental factors influence children who develop conduct disorder. Many of these children have a family history of:
- substance abuse problems
- antisocial behavior or antisocial personality disorder
- mood disorders like depression and bipolar disorder
However, children from well-functioning families can—and do—develop conduct disorder, too.
Signs and symptoms
What are the symptoms of a disruptive behavior disorder?
Symptoms of oppositional defiant disorder (ODD)
Signs of ODD include:
- frequent temper tantrums
- excessive arguments with adults
- refusing to comply with adult requests
- always questioning rules
- refusing to follow rules
- behavior intended to annoy or upset others
- blaming others for misbehavior or mistakes
- becoming easily annoyed with others
- frequently demonstrating an angry attitude
- speaking harshly or unkindly to others
- behavior designed to seek revenge
Symptoms of conduct disorder
Children and adolescents with conduct disorder display behaviors that deliberately ignore or abuse the feelings and rights of others. Warning signs may include:
- aggressive behaviors toward others, including bullying or making threats
- misinterpreting others’ behaviors as threatening
- inability to tolerate frustration, restrictions or rules (either at home or at school)
- chronic lying without remorse
- stealing or destroying property
- substance abuse
The most serious behaviors resulting from conduct disorder can include:
- using, or threatening to use, weapons
- abusing or mistreating animals
- physically attacking others
These behaviors must always be taken seriously.To protect both your child and others, you should involve mental health professionals and—in cases of violent threats or acts—law enforcement authorities immediately.
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Questions to ask your doctor
You and your family play an essential role in your child’s treatment for a disruptive behavior disorder. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.
You’ve probably thought of many questions to ask about your child’s disorder and treatment. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)
Initial questions to ask your doctor might include:
- What type of disruptive behavior disorder do you believe my child has?
- What criteria did you use to reach this diagnosis?
- Is there any other condition my child may have?
- What are the goals of treatment for my child?
- Is my child’s behavior potentially dangerous for himself, our family or others?
- If so, what precautions do you recommend?
- What role should I play in my child’s treatment?
- Will you be working with my child’s other caregivers?
- How can I tell if my child is making progress?
- How long do you expect my child to need therapy?
- How should I involve my child's school in treatment?
- How should I explain my child's condition to other members of the family?
- Will you prescribe medication for my child? If so, what are the possible side effects of this medication?
- What other resources can you point me to for more information?
Q: Can I prevent my child from developing a disruptive behavior disorder?
A: While there is no way to completely prevent a child from developing a disruptive behavior disorder, you may be able to lessen the seriousness of your child’s disorder by seeking treatment from a qualified mental health professional as soon as warning signs emerge.
Q: How can I distinguish signs of a disruptive behavior disorder from the typical challenging behavior most kids display?
A: Determining whether your child has a disruptive behavior disorder can be difficult, since most children show some of the symptoms every now and then (especially when they’re tired, hungry or upset).
A child with a disruptive behavior disorder, however, will:
- display these symptoms much more often than other children
- consistently demonstrate behavioral issues for a period of at least six months
- often have problems with school and friendships as a direct result of the behavior
Q: Why is my child acting this way?
A: Your child may be acting out for a number of reasons, including:
- a chemical imbalance in his brain
- responding to stresses in his environment
- expressing a need for attention
- “testing the waters” to gauge how much he can get away with
- mimicking behavior observed in others who act in problematic ways
Q: Are disruptive behavior disorders permanent?
A: Since these disorders are behavioral conditions, they’re considered to last as long as the problematic behaviors persist. As they age, children with disruptive behavior disorders may have a greater tendency to argue, refuse to comply with requests, blame others for mistakes, deliberately irritate others or act in disruptive ways than their peers (and in the case of conduct disorder, the behaviors can be much more serious—including violent and criminal behavior).
However, early treatment can give your child—and your family—critical tools for replacing the behavior with appropriate, constructive new patterns.
Q: Does having a disruptive behavior disorder put my child at greater risk of developing more serious problems as an adult?
A: The likelihood of a child with a disruptive behavior disorder experiencing greater difficulty as an adult depends upon the child’s individual circumstances.
In cases of oppositional defiant disorder (ODD), as the child ages, his diagnosis may change from ODD—which involves behavior that is problematic, annoying and hostile, but not violent or extremely aggressive—to the much more serious diagnosis of conduct disorder.
Most children diagnosed with ODD are not automatically going to develop conduct disorder. It’s important, however, for parents to closely monitor the behavior of their child and seek treatment from a credentialed professional as early in the child's life as possible.
Q: What should I do to ensure my family is safe during an outburst?
A: If your child has oppositional defiant disorder or conduct disorder, it’s important that you have a safety plan, in those cases where it is needed, in place to protect both your child and others should hostile, threatening or intimidating behaviors escalate.
Your clinician will work with you to develop a plan that includes when you should seek emergency support.
Q: What is the “black label warning” I keep hearing about when it comes to certain psychiatric medications?
A: Since 2004, the U.S. Food and Drug Administration has placed a black warning label on antidepressant medications. The warning label states, in part:
“Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior.”
If your child is prescribed any medication during treatment, your clinician will carefully go over the specifics of the drug, as well as any potential side effects you should watch for.
At Children’s Hospital Boston, our team has years of experience managing the use of psychiatric medications in children of all ages and with a wide variety of conditions. We always closely monitor your child for any sign of a negative response to the medication, and are always here to answer your questions and address any concerns you may have.
If you suspect your child may have a disruptive behavior disorder, it is important to speak with a qualified mental health professional as soon as possible. By closely working with a treatment team, you can help your child go on to enjoy a fulfilling family, school and personal life.
Battling spaceships helps kids learn to control anger
Joseph Gonzalez-Heydrich, MD, chief of Children’s Psychopharmacology Clinic, along with colleagues Peter Ducharme, LICSW, and Jason Kahn, EdD, developed the RAGE-Control Game—a game in the tradition of the popular arcade staple “Space Invaders” that teaches children to:
The effectiveness of the RAGE-Control Game as a possible alternative to psychiatric medication is now being tested through a clinical trial on the Children’s Inpatient Psychiatry Service.
Read a Boston Globe article about the RAGE-Control game.