From the Guidelines
Diagnosis of childhood disruptive behavior disorders is primarily based on the presence of oppositional defiant disorder (ODD) or conduct disorder (CD).
Key Diagnostic Criteria
- The diagnosis of ODD is characterized by a recurrent pattern of negativistic, hostile, or defiant behavior, lasting at least 6 months, with symptoms including angry and vindictive behavior and problems with control of temper 1.
- The diagnosis is not given if the symptoms appear only in the context of a mood or psychotic disorder.
- ODD is frequently comorbid with other psychiatric conditions, such as attention-deficit/hyperactivity disorder (ADHD), anxiety disorder, and depressive disorder, and often precedes the development of CD, substance abuse, and severely delinquent behavior 1.
Differential Diagnosis
- The distinction among ADHD, ODD, and CD seems to be supported, but not in all studies, and clinicians need to carefully consider significant comorbid psychiatric conditions when diagnosing and treating ODD 1.
- Clinicians should establish whether the child is receiving ongoing pediatric care and inquire about the child's age-appropriate compliance with the pediatric treatment, as chronic pediatric illness can increase disruptive behavior 1.
Assessment and Evaluation
- The assessment of ODD includes information obtained directly from the child as well as from the parents regarding the core symptoms of ODD, age at onset, duration of symptoms, and degree of functional impairment 1.
- A functional analysis of the child's behavior, including identification of the antecedents and consequences of the child's behavior and parent and others' behavior that may reinforce the child's problem behaviors, is an essential part of the assessment 1.
From the Research
Diagnosis of Childhood Disruptive Behavior Disorders
The diagnosis of childhood disruptive behavior disorders involves identifying symptoms such as aggression, deceitfulness, and defiance, which are common in conditions like oppositional defiant disorder and conduct disorder 2. These disorders are often associated with dysfunctional parenting styles and environmental risks, as well as temperament and psychobiological mechanisms 3.
Key Characteristics
Some key characteristics of disruptive behavior disorders include:
- Frequent aggression, deceitfulness, and defiance 2
- Difficulties in modulating aggressive conducts, self-control, and impulses 4
- Noncompliance and aggressive hostility toward authorities or peers 3
- Exposure to harsh or inconsistent parenting, parental depression, and stress 2
Diagnostic Considerations
When diagnosing disruptive behavior disorders, it is essential to consider the following:
- Developmental sensitivity in defining symptoms 5
- Longitudinal research to disentangle etiologic from mediating factors 3
- Neurophysiologic and structural correlates with DBD 2
- Multifaceted treatment approaches, including parent management training programs 2, 6
Treatment and Intervention
Treatment and intervention for disruptive behavior disorders should focus on: