Overview of Disruptive Behavior Problems Students with disruptive behavior disorders are a heterogeneous group Most are boys However, conduct problems

Overview of Overview of Disruptive Behavior Disruptive Behavior

ProblemsProblemsStudents with disruptive behavior Students with disruptive behavior disorders are a heterogeneous disorders are a heterogeneous groupgroupMost are boysMost are boysHowever, conduct problems are However, conduct problems are not uncommon among adolescent not uncommon among adolescent girlsgirls

Overview of Disruptive Overview of Disruptive Behavior ProblemsBehavior Problems

Many youngsters exhibit Many youngsters exhibit individual traits and behaviors individual traits and behaviors in early childhood that in early childhood that foreshadow a developmental foreshadow a developmental path leading to more path leading to more destructive and aggressive destructive and aggressive behaviors as adolescents and behaviors as adolescents and adultsadults


One of the difficulties in One of the difficulties in identifying these disorders is identifying these disorders is that a certain amount of rowdy that a certain amount of rowdy play play

Risk factors may contribute to Risk factors may contribute to the development of these the development of these disordersdisorders


Collectively, these risk factors are Collectively, these risk factors are producing children and youth who:producing children and youth who:

A-see violence as a viable means of A-see violence as a viable means of solving problemssolving problems

B-don’t respect the rights of othersB-don’t respect the rights of others C-are not socially responsibleC-are not socially responsible d-have not been taught basic manners d-have not been taught basic manners

and social conventionsand social conventions


E-don’t value human life as they shouldE-don’t value human life as they should

RISK FACTORS AND PREDICTORS OF RISK FACTORS AND PREDICTORS OF DISRUPTIVE BEHAVIOR DISORDERSDISRUPTIVE BEHAVIOR DISORDERS

Individual factors that predispose a Individual factors that predispose a child to disruptive behaviors include:child to disruptive behaviors include:


1- a difficult temperament1- a difficult temperament 2-cognitive or learning 2-cognitive or learning

impairmentsimpairments 3-neuropsychological problems3-neuropsychological problems 4-mental illness4-mental illness


Family predictors of disruptive Family predictors of disruptive behavior include:behavior include:

1-harsh and ineffective parenting1-harsh and ineffective parenting 2-parental antisocial and 2-parental antisocial and

pathological componentspathological components 3-parents with alcohol and drug 3-parents with alcohol and drug

dependenciesdependencies 4-interrupted parenting4-interrupted parenting


History of abuse or neglectHistory of abuse or neglect Later adoption ageLater adoption age Prenatal drug exposurePrenatal drug exposure Multiple foster placements prior Multiple foster placements prior

to adoptionto adoption


School Factors that may School Factors that may contribute to behavior contribute to behavior disorders:disorders:

1-academic factors1-academic factors

2-negative relationships with 2-negative relationships with peers and adultspeers and adults

3-punitive school environment3-punitive school environment


Community factors include :Community factors include :

1-access to drugs and alcohol 1-access to drugs and alcohol

2-exposure to violence2-exposure to violence

3-lack of educational and 3-lack of educational and employment opportunityemployment opportunity

4-acceptance of aggression as 4-acceptance of aggression as a problem solving strategya problem solving strategy


Treatment OptionsTreatment Options1-Results of treatment interventions in 1-Results of treatment interventions in

residential settings have not transferred residential settings have not transferred to natural setting including the home or to natural setting including the home or schoolschool

2-School based group intervention studies 2-School based group intervention studies have been few in number and the results have been few in number and the results have shown students with disruptive have shown students with disruptive behavior patterns to be very resistant to behavior patterns to be very resistant to treatmenttreatment

Types of Disruptive Types of Disruptive Behavior ProblemsBehavior Problems

DSM-IV-TR (Diagnostic and DSM-IV-TR (Diagnostic and Statistical Manual of the American Statistical Manual of the American Psychiatric Association) lists four Psychiatric Association) lists four clinical diagnoses that may be clinical diagnoses that may be appropriate for students with appropriate for students with specific patterns of disruptive specific patterns of disruptive behaviors. These include:behaviors. These include:

Types of Disruptive Types of Disruptive Behavior ProblemsBehavior Problems

A-Oppositional defiant disorder A-Oppositional defiant disorder (ODD)(ODD)

B-Conduct disorder (CD)B-Conduct disorder (CD) C-Disruptive behavior disorder-C-Disruptive behavior disorder-

not otherwise specified (DBD-not otherwise specified (DBD-NOS)NOS)

D-Intermittent explosive D-Intermittent explosive disorder (IED)disorder (IED)

Oppositional Defiant Oppositional Defiant Disorder (ODD)Disorder (ODD)

DSM describes oppositional DSM describes oppositional defiant disorder as a defiant disorder as a recurrent pattern of recurrent pattern of negativistic, defiant, negativistic, defiant, disobedient, and hostile disobedient, and hostile behavior toward authority behavior toward authority figures that persist for at figures that persist for at least 6 months.least 6 months.


Behaviors of ODD include:Behaviors of ODD include:

1-losing temper1-losing temper

2-arguing with adults2-arguing with adults

3-defiance/noncompliance with adult requests3-defiance/noncompliance with adult requests

4-deliberately annoying others, blaming others or 4-deliberately annoying others, blaming others or being easily annoyedbeing easily annoyed

5-angry/resenstful attitude5-angry/resenstful attitude

6-spiteful/vindicyive attitude6-spiteful/vindicyive attitude


Actively defy rulesActively defy rules Deny responsibility for their behaviorDeny responsibility for their behavior Exploit others for their own gainExploit others for their own gain

Students with ODD seem to thrive on Students with ODD seem to thrive on conflict, anger, and negativity from others conflict, anger, and negativity from others and are often most difficult with the and are often most difficult with the people they know wellpeople they know well


Prevalence: between 1% and 6% of the Prevalence: between 1% and 6% of the population-Surgeon General’s Reportpopulation-Surgeon General’s Report

DSM reports it as between 2 and 16%DSM reports it as between 2 and 16% More common in males who were More common in males who were

tempermental or hperactive preschoolerstempermental or hperactive preschoolers ODD prevalence after puberty is equal ODD prevalence after puberty is equal

between boys and girlsbetween boys and girls Generally observed before the age of 8 but Generally observed before the age of 8 but

may emerge through late adolescencemay emerge through late adolescence


Co morbid condition:Co morbid condition: a a condition or disorder occurring condition or disorder occurring concurrently with another concurrently with another disorderdisorder

ODD often occurs with ADHD ODD often occurs with ADHD which complicates the diagnosiswhich complicates the diagnosis


Experts have described ODD as a Experts have described ODD as a developmental antecedent to Conduct developmental antecedent to Conduct Disorder (CD) for a significant number of Disorder (CD) for a significant number of children.children.

If this occurs the diagnosis should be CD If this occurs the diagnosis should be CD rather than ODDrather than ODD

Conduct Disorder (CD)Conduct Disorder (CD)

DSM describes CD as a DSM describes CD as a repetitive and persistent repetitive and persistent pattern of behavior in pattern of behavior in which the basic rights of which the basic rights of others or age-appropriate others or age-appropriate societal norms or rules societal norms or rules are violatedare violated


They describe these behaviors as They describe these behaviors as fitting into four groups:fitting into four groups:

1-Aggression toward people and 1-Aggression toward people and animals\2-Harm to propertyanimals\2-Harm to property

3-Deceitfulness or theft3-Deceitfulness or theft 4-Serious rule violations4-Serious rule violations


Associated features and mental disorders Associated features and mental disorders that may occur with CD, as follows:that may occur with CD, as follows:

1-little empathy or concern for the rights 1-little empathy or concern for the rights and feelings of othersand feelings of others

2-Frequent misperceptions of others’ 2-Frequent misperceptions of others’ intentions as hostile or threatening and intentions as hostile or threatening and responding with aggressionresponding with aggression


3-Callous, lack of feelings of 3-Callous, lack of feelings of guilt or remorseguilt or remorse

4-Low or overly inflated self 4-Low or overly inflated self esteemesteem

5-Early onset of risk-taking 5-Early onset of risk-taking behavior including sex, drinking, behavior including sex, drinking, smoking, using drugssmoking, using drugs


6-High rates of suicidal 6-High rates of suicidal ideationideation

7-Lower than average 7-Lower than average cognitive ability, cognitive ability, especially verbal IQespecially verbal IQ


The long term prognosis for students with The long term prognosis for students with CD is grimCD is grim

Prevalence between 1 and 4%Prevalence between 1 and 4% More than ¼ to ½ of all individuals with More than ¼ to ½ of all individuals with

CD go on to become antisocial adultsCD go on to become antisocial adults DSM indicates between 1-10% of the DSM indicates between 1-10% of the

populationpopulation Higher than males than femalesHigher than males than females


CD may be evident as early as preschool, but CD may be evident as early as preschool, but most significant symptoms emerge from middle most significant symptoms emerge from middle childhood through middle adolescencechildhood through middle adolescence

Childhood-onset CD is most common in males Childhood-onset CD is most common in males and is frequently preceded by a diagnosis of and is frequently preceded by a diagnosis of ODD. Early diagnosis has a poor prognosisODD. Early diagnosis has a poor prognosis

Co morbid conditions with CDCo morbid conditions with CD

Disruptive aBehavior Disruptive aBehavior Disorders-Not Otherwise Disorders-Not Otherwise

Specified (NOS)Specified (NOS) DBD-NOS is used by DSM to DBD-NOS is used by DSM to

classify children whose classify children whose behavior is behavior is oppositional/defiant or oppositional/defiant or conduct disordered, but does conduct disordered, but does not meet all the required not meet all the required criteria for either ODD or CD.criteria for either ODD or CD.

Intermittent Explosive Intermittent Explosive Disorder (IED)Disorder (IED)

While the DSM-IV TR does not classify While the DSM-IV TR does not classify intermittent explosive disorder (IED) as a intermittent explosive disorder (IED) as a disorder often diagnosed in childhood or disorder often diagnosed in childhood or adolescence, it is a diagnosis some adolescence, it is a diagnosis some students bring with them to school. It is students bring with them to school. It is characterized by infrequent, unexpected characterized by infrequent, unexpected outbursts of disruptive behavior that result outbursts of disruptive behavior that result in significant harm to people and/or in significant harm to people and/or property.property.

General Rules for General Rules for Classroom ManagementClassroom Management The most important element in classroom The most important element in classroom

management is to have a plan. Answer the management is to have a plan. Answer the following questions to see if you are 'ready for following questions to see if you are 'ready for anything'. anything'.

1. What do students do when they come into 1. What do students do when they come into your classroom in the morning? After recess and your classroom in the morning? After recess and lunch?lunch?2. What is the consequence for not completing 2. What is the consequence for not completing assigned work both in class and out?assigned work both in class and out?3. What is the consequence for student(s) 3. What is the consequence for student(s) interrupting the class or a small group?interrupting the class or a small group?

General Rules for General Rules for Classroom ManagementClassroom Management 4. How do your students request to leave 4. How do your students request to leave

the room for a drink or to visit the the room for a drink or to visit the washroom?washroom?5. What is the process for the whole 5. What is the process for the whole class leaving for lunch or recess or to go class leaving for lunch or recess or to go to the gym?to the gym?6. What is the consequence for the child 6. What is the consequence for the child who forgets things?who forgets things?

General Rules for General Rules for Classroom ManagementClassroom Management 7. After giving a set of instructions or 7. After giving a set of instructions or

directions, what is in place for the directions, what is in place for the student(s) that still don't understand?student(s) that still don't understand?8. How do you respond to the child that 8. How do you respond to the child that keeps leaving his/her seat?keeps leaving his/her seat?9. How will your students know about 9. How will your students know about acceptable voices/noise levels to use for acceptable voices/noise levels to use for the various activities?the various activities?

General Rules for General Rules for Classroom ManagementClassroom Management Basic psychology of children with Basic psychology of children with

behavior disorders-What the teacher behavior disorders-What the teacher needs to know.needs to know.

Level I Behavior DisordersLevel I Behavior Disorders Level II Behavior DisordersLevel II Behavior Disorders

Management of Conduct Management of Conduct DisordersDisorders

The youth at highest risk of extreme The youth at highest risk of extreme violence may be the conduct disordered violence may be the conduct disordered child. child.

Remember that the hallmark of being a Remember that the hallmark of being a conduct disorder (c.d.), is having no conduct disorder (c.d.), is having no heart, no conscience, no remorse. heart, no conscience, no remorse.


Only a mental health professional can Only a mental health professional can diagnose a conduct disorder for sure, but diagnose a conduct disorder for sure, but being aware that you may have a being aware that you may have a conduct disordered child in your class or conduct disordered child in your class or group, is important to ensuring your group, is important to ensuring your safety, along with the safety of your kids, safety, along with the safety of your kids, because you work with conduct disorders because you work with conduct disorders completely differently than other kids. completely differently than other kids.


Since the c.d. child has little relationship Since the c.d. child has little relationship capacity, you should not use relationship-capacity, you should not use relationship-based approaches with a diagnosed based approaches with a diagnosed conduct disorder. conduct disorder.


It would be insensitive to call a conduct It would be insensitive to call a conduct disorder a "baby sociopath," but that is disorder a "baby sociopath," but that is close to what the term means. It means close to what the term means. It means that the child acts in ways that appear to that the child acts in ways that appear to be seriously anti-social, and the concern be seriously anti-social, and the concern is that the child may grow up to be a is that the child may grow up to be a sociopathic type of person sociopathic type of person


Since this child cares only about Since this child cares only about himself (c.d.'s are predominately himself (c.d.'s are predominately male), there are little brakes on this male), there are little brakes on this child from serious or extreme child from serious or extreme violence. violence.


DO'S: DO'S: *The main point we give in our classes is *The main point we give in our classes is

that these children operate on a cost-that these children operate on a cost-benefit system, and that to control your benefit system, and that to control your c.d. kids, you must keep the costs high, c.d. kids, you must keep the costs high, and benefits low. and benefits low.


*Your goal is to teach them that when *Your goal is to teach them that when they hurt others, it often hurts them too. they hurt others, it often hurts them too. All interventions must be in the context of All interventions must be in the context of "I-Me," because that is all this kid is "I-Me," because that is all this kid is capable of caring about. capable of caring about.


Don't: have a heart-to-heart relationship. Don't: have a heart-to-heart relationship. *Don't work on building trust. *Don't work on building trust. *Don't put an emphasis on compassion, *Don't put an emphasis on compassion,

caring, empathy, values, morals. caring, empathy, values, morals. *Don't expect compassionate behavior. *Don't expect compassionate behavior. *Don't trust. *Don't trust. *Don't give second chances. *Don't give second chances. *Don't believe they care or feel remorse. *Don't believe they care or feel remorse.


Conduct disorders are "wired" differently than Conduct disorders are "wired" differently than other students. That means that they may not other students. That means that they may not be able to care. Because of that difference, the be able to care. Because of that difference, the following interventions will fail: character ed, following interventions will fail: character ed, values clarification, empathy building, second values clarification, empathy building, second chances, making amends, and more-- far too chances, making amends, and more-- far too many to list here. These methods fail because many to list here. These methods fail because the child must care about others if these the child must care about others if these techniques are to work. techniques are to work.


These approaches are absolutely fine for These approaches are absolutely fine for other types of children, but will never be of other types of children, but will never be of value with C.D.s. In fact, these methods value with C.D.s. In fact, these methods make the situation worse because they make the situation worse because they communicate to these children that you communicate to these children that you don't understand who they are, and don't don't understand who they are, and don't understand how to control them. That understand how to control them. That perception generally leads these perception generally leads these youngsters to believe that they may be able youngsters to believe that they may be able to do whatever they want without having to to do whatever they want without having to deal with consequences that would be of deal with consequences that would be of significant concern to them. significant concern to them.


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Overview of Disruptive Behavior Problems Students with disruptive behavior disorders are a heterogeneous group Most are boys However, conduct problems