Behavior Disorders

1. Behavior Disorders

2. Behavior Disorders • Attention-Deficit / Hyperactivity Disorder (ADHD) • Conduct Disorder • Oppositional Defiant Disorder

3. Symptoms of ADHD – Overview • Inattention • Does not pay attention, loses things frequently, is easily distracted, is forgetful. • Hyperactivity • 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 • Blurts out responses while others are talking, has difficulty waiting his or her turn), often interrupts or intrudes on others.

4. 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 • 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. • Is often forgetful in daily activities.

5. 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 • Often fidgets with hands or feet or squirms in seat. • Often gets up from seat when remaining in seat is expected. • Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). • Often has trouble playing or enjoying leisure activities quietly. • Is often "on the go" or often acts as if "driven by a motor". • Often talks excessively. Impulsivity • Often blurts out answers before questions have been finished. • Often has trouble waiting one's turn. • Often interrupts or intrudes on others (e.g., butts into conversations or games).

6. DSM-IV Criteria for ADHD II - V • Some symptoms that cause impairment were present before age 7 years. • Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). • There must be clear evidence of significant impairment in social, school, or work functioning. • 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).

7. Conduct Disorder & ODD – Overview

8. 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. • C. If the individual is age 18 years or older, criteria are not met for antisocial personality disorder.

9. 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 older, criteria are not met for Antisocial Personality Disorder.

10. Proposed Etiologies for ADHD Immaturity of the brain, particularly frontal lobes, caudate nucleus, and corpus callosum Genetic predisposition Prenatalandbirthcomplications Disrupted family

11. Etiologies for Conduct Disorder and Oppositional Defiant Disorder Geneticpredisposition Deficits in brain regions involved in planning and controlling behavior Difficult temperament Lower physiological arousal to punishment Serotonin imbalances

12. 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

13. 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 Conductdisorder child’s beliefs that others are against him or her are reinforced

14. Psychological and Social Therapies for Conduct and Oppositional Defiant Disorders • Cognitive-Behavioral Therapy:teach problem-solving 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

15. 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