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There are many ways you can help children and their families get the care they need.
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:
Another theory suggests that children with oppositional defiant disorder:
Other possible factors may include:
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:
However, children from well-functioning families can—and do—develop conduct disorder, too.
What are the symptoms of a disruptive behavior disorder?
Symptoms of oppositional defiant disorder (ODD)
Signs of ODD include:
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:
The most serious behaviors resulting from conduct disorder can include:
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.
Children’s is working with other health care providers, nonprofit organizations, educators and families statewide to advocate for a comprehensive reform of the Massachusetts mental health system for kids and families. Learn how you can help.
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:
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:
Q: Why is my child acting this way?
A: Your child may be acting out for a number of reasons, including:
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.
We are grateful to have been ranked #1 on U.S. News & World Report's list of the best children's hospitals in the nation for the third year in a row, an honor we could not have achieved without the patients and families who inspire us to do our very best for them. Thanks to you, Boston Children's is a place where we can write the greatest children's stories ever told.”