Behavioral disorders in children

Behavioral disorders in children

All young children can be naughty,
defiant and impulsive from time to
time, which is perfectly normal.
However, some children have
extremely difficult and challenging
behaviours that are outside the norm for their age. The most common disruptive
behaviour disorders include
oppositional defiant disorder (ODD),
conduct disorder (CD) and attention
deficit hyperactivity disorder (ADHD).
These three behavioural disorders share some common symptoms, so
diagnosis can be difficult and time
consuming. A child or adolescent may
have two disorders at the same time.
Other exacerbating factors can include
emotional problems, mood disorders, family difficulties and substance abuse. Oppositional defiant disorder Around one in ten children under the
age of 12 years are thought to have
oppositional defiant disorder (ODD),
with boys outnumbering girls by two
to one. Some of the typical behaviours
of a child with ODD include: Easily angered, annoyed or irritated Frequent temper tantrums Argues frequently with adults,
particularly the most familiar adults
in their lives, such as parents Refuses to obey rules Seems to deliberately try to annoy
or aggravate others Low self-esteem Low frustration threshold Seeks to blame others for any
misfortunes or misdeeds.

Conduct disorder Children with conduct disorder (CD) are
often judged as ‘bad kids’ because
of their delinquent behaviour and
refusal to accept rules. Around five
per cent of 10 year olds are thought to
have CD, with boys outnumbering girls by four to one. Around one-third of
children with CD also have attention
deficit hyperactivity disorder (ADHD). Some of the typical behaviours of a
child with CD may include: Frequent refusal to obey parents or
other authority figures Repeated truancy Tendency to use drugs, including
cigarettes and alcohol, at a very
early age Lack of empathy for others Being aggressive to animals and
other people or showing sadistic
behaviours including bullying and
physical or sexual abuse Keenness to start physical fights Using weapons in physical fights Frequent lying Criminal behaviour such as stealing,
deliberately lighting fires, breaking
into houses and vandalism A tendency to run away from home Suicidal tendencies – although these
are more rare.

Attention deficit hyperactivity
disorder Around two to five per cent of children
are thought to have attention deficit
hyperactivity disorder (ADHD), with
boys outnumbering girls by three to
one. The characteristics of ADHD can
include: Inattention – difficulty concentrating, forgetting
instructions, moving from one task
to another without completing
anything. Impulsivity – talking over the top of others, having a ‘short fuse’,
being accident-prone. Overactivity – constant restlessness and fidgeting.

Risk factors in children’s
behavioural disorders The causes of ODD, CD and ADHD are
unknown but some of the risk factors
include: Gender – boys are much more likely than girls to suffer from
behavioural disorders. It is unclear
if the cause is genetic or linked to
socialisation experiences. Gestation and birth – difficult pregnancies, premature birth and
low birth weight may contribute in
some cases to the child’s problem
behaviour later in life. Temperament – children who are difficult to manage, temperamental
or aggressive from an early age
are more likely to develop
behavioural disorders later in life. Family life – behavioural disorders are more likely in
dysfunctional families. For example,
a child is at increased risk in
families where domestic violence,
poverty, poor parenting skills or
substance abuse are a problem. Learning difficulties –problems with reading and writing are often
associated with behaviour
problems. Intellectual disabilities – children with intellectual disabilities are
twice as likely to have behavioural
disorders. Brain development – studies have shown that areas of the brain that
control attention appear to be less
active in children with ADHD.

Diagnosis of children’s
behavioural disorders Disruptive behavioural disorders are
complicated and may include many
different factors working in
combination. For example, a child who
exhibits the delinquent behaviours of
CD may also have ADHD, anxiety, depression, and a difficult home life. Diagnosis methods may include: Diagnosis by a specialist service,
which may include a paediatrician,
psychologist or child psychiatrist In-depth interviews with the
parents, child and teachers Behaviour check lists or
standardised questionnaires. A diagnosis is made if the child’s
behaviour meets the criteria for
disruptive behaviour disorders in the
Diagnostic and Statistical Manual of
Mental Disorders from the American
Psychiatric Association. It is important to rule out acute
stressors that might be disrupting the
child’s behaviour. For example, a
sick parent or victimising by other
children might be responsible for
sudden changes in a child’s typical behaviour and these factors have to be
considered initially.

Treatment of behavioural
disorders in children Untreated children with behavioural
disorders may grow up to be
dysfunctional adults. Generally, the
earlier the intervention, the better the
outcome is likely to be. A large study in the United States,
conducted for the National Institute of
Mental Health and the Office of School
Education Programs, showed that
carefully designed medication
management and behavioural treatment for ADHD improved all
measures of behaviour in school and
at home. Treatment is usually multifaceted and
depends on the particular disorder and
factors contributing to it, but may
include: Parental education – for example, teaching parents how to
communicate with and manage their
children. Family therapy – the entire family is helped to improve
communication and problem-solving
skills. Cognitive behavioural therapy – to help the child to control their
thoughts and behaviour. Social training – the child is taught important social skills, such as how
to have a conversation or play
cooperatively with others. Anger management – the child is taught how to recognise the signs of
their growing frustration and given
a range of coping skills designed to
defuse their anger and aggressive
behaviour. Relaxation techniques
and stress management skills are also taught.

Support for associated problems – for example, a child with a
learning difficulty will benefit from
professional support.

Encouragement – many children with behavioural disorders
experience repeated failures at
school and in their interactions with
others. Encouraging the child to
excel in their particular talents
(such as sport) can help to build self- esteem.

Things to remember Some children have extremely
difficult and challenging behaviours
that are outside the norm for their
age. These problems can result from
temporary stressors in the child’s
life, or they might represent more
enduring disorders. The most
common disruptive behaviour
disorders include oppositional defiant disorder (ODD), conduct
disorder (CD) and attention deficit
hyperactivity disorder (ADHD). Boys are more likely than girls to
suffer from behavioural disorders. Treatment options include parent
management training, cognitive
behaviour therapy, medication and
treatment for associated problems.