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Behavior Disorders
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Behavior Disorders



Attention-Deficit / Hyperactivity Disorder
(ADHD)
Conduct Disorder
Oppositional Defiant Disorder
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Symptoms of ADHD – Overview

Inattention
–

Hyperactivity
–

Does not pay attention, loses things frequently, is easily distracted,
is forgetful.
Fidgets with hands or feet and squirms in seat, leaves seat when
inappropriate, runs around or climbs excessively, often talks
excessively, has difficulty engaging in quiet activities.
Impulsivity
–
Chapter 13
Blurts out responses while others are talking, has difficulty waiting
his or her turn), often interrupts or intrudes on others.
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV Criteria for ADHD
I. Either A or B:
A. Six or more of the following symptoms of inattention have
been present for at least 6 months to a point that is
disruptive and inappropriate for developmental level:

Inattention
8.
Often does not give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork, chores, or
duties in the workplace (not due to oppositional behavior or failure to
understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of mental
effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school
assignments, pencils, books, or tools).
Is often easily distracted.
9.
Is often forgetful in daily activities.
1.
2.
3.
4.
5.
6.
7.
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV Criteria for ADHD
I. Either A or B:
Six or more of the following symptoms of hyperactivity-impulsivity have
been present for at least 6 months to an extent that is disruptive and
inappropriate for developmental level:
Hyperactivity
1.
Often fidgets with hands or feet or squirms in seat.
2.
Often gets up from seat when remaining in seat is expected.
3.
Often runs about or climbs when and where it is not appropriate
(adolescents or adults may feel very restless).
4.
Often has trouble playing or enjoying leisure activities quietly.
5.
Is often "on the go" or often acts as if "driven by a motor".
6.
Often talks excessively.
Impulsivity
1.
Often blurts out answers before questions have been finished.
2.
Often has trouble waiting one's turn.
3.
Often interrupts or intrudes on others (e.g., butts into conversations or
games).
B.
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
DSM-IV Criteria for ADHD
II - V
Chapter 13
II.
Some symptoms that cause impairment were present before age
7 years.
III.
Some impairment from the symptoms is present in two or more
settings (e.g. at school/work and at home).
IV.
There must be clear evidence of significant impairment in social,
school, or work functioning.
V.
The symptoms do not happen only during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other
Psychotic Disorder. The symptoms are not better accounted for by
another mental disorder (e.g. Mood Disorder, Anxiety Disorder,
Dissociative Disorder, or a Personality Disorder).
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Conduct Disorder & ODD –
Overview
Disorder
Symptoms

Conduct disorder

Behaviors that violate the basic
rights of others and the norms for
social behavior

Oppositional defiant
disorder

Argumentativeness, negativity,
irritability, defiance, but behaviors
not as severe as in conduct
disorder
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Conduct Disorder Symptoms
A. a repetitive and persistent pattern of behavior in which the basic rights of others or
major age-appropriate societal norms or rules are violated, as manifested by the
presence of three (or more) of the following criteria in the past 12 months, with at least
one criterion present in the past six months:
•Aggression to people and/or animals
•Destruction of property
•Deceitfulness or theft
•Serious violations of rules
B. The disturbance in behavior causes clinically significant impairment in social,
academic or occupational functioning.
or older, criteria are not met for antisocial
Chapter 13 C. If the individual is age 18 years Copyright
© 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
personality disorder.
Oppositional Defiant Disorder
Symptoms
A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months,
during which four (or more) of the following are present:
(1) often loses temper (2) often argues with adults (3) often actively defies or
refuses to comply with adults' requests or rules (4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior (6) is often touchy or
easily annoyed by others (7) is often angry and resentful (8) is often spiteful or
vindictive
Note: Consider a criterion met only if the behavior occurs more frequently than is
typically observed in individuals of comparable age and developmental level.
B. The disturbance in behavior causes clinically significant impairment in social,
academic, or occupational functioning.
C. The behaviors do not occur exclusively during the course of a Psychotic or Mood
Disorder.
D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or
Chapterolder,
13 criteria are not met for Antisocial Personality
Disorder.
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Proposed Etiologies for ADHD
Immaturity of the brain,
particularly frontal lobes,
caudate nucleus, and
corpus callosum
Genetic predisposition
Prenatal and birth
complications
Disrupted family
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Etiologies for Conduct Disorder and
Oppositional Defiant Disorder
Genetic predisposition
Deficits in brain regions
involved in planning and
controlling behavior
Difficult temperament
Lower physiological
arousal to punishment
Serotonin imbalances
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Etiologies for Conduct Disorder and
Oppositional Defiant Disorder,
continued
Higher testosterone
level
Poor parental supervision,
parental uninvolvement,
and parental violence
Delinquent peer groups
Cognitions that promote
aggression
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Feedback Loop and Conduct Disorder
Assume others will be aggressive
Incident with another child
Attribute incident to intentional act
Respond aggressively
Other child retaliates or seeks help from adults
Conduct disorder child’s beliefs that others are
against him or her are reinforced
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
Psychological and Social Therapies for
Conduct and Oppositional Defiant Disorders
•Cognitive-Behavioral Therapy: teach problemsolving skills, teach “self-talk,” discuss real and
hypothetical situations, and practice appropriate
responses.
•Cognitive-Behavioral Therapy in a Group Setting:
inclusion of other children, or parents, which can be
effective in reducing aggressive and impulsive behavior
in children, particularly at home.
Eliada Model: TCI, DBT, & Psychoeducation
•
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.
ADHD and Conduct Disorder in Girls
•Overview of article: Predictors, clinical characteristics,
and outcome of conduct disorder in girls with ADHD: A
longitudinal study (2007)
•Methods
•Results
•Discussion / Implications
Chapter 13
Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved.