Disruptive Behaviors Flashcards
What is a Disruptive Behavior Disorder?
These disorders are all characterized by problems in self-control of emotions and behaviors.
Minimum age required for dx
6 years dev. Level
Comorbiity of behavior d/o
ADHD
Additional problems involving disruptive behavior d/o
self-control of emotions and behaviors
How are disruptive behavior d/o unique
behaviors violate the rights of others
aggression, destruction of property and/or that bring the individual into significant conflict with societal norms or authority figures
Underlying cause of disruptive behavior d/o
can vary greatly across the disorders and among individuals within a given diagnostic category
Impact: all tend to be more common in males than in females, although degree of male predominance may differ across disorders and within a disorder at different ages
Symptoms defining d/o
developing individuals; critical that frequency, persistence, pervasiveness across situations, and impairment associated with behaviors be considered relative to norms for person’s age, gender, & culture when determining symptoms of a disorder
3 types of ODD
Angry/irritability
Argumentative/defiant behavior
Vindictiveness
Angry/irritable mood
often loses temper, is touchy or easily annoyed, is often angry and resentful
Argumentative/defiant behavior
argues with authority figures (in children/adolescents—with adults), actively defies or refuses to comply with requests from authority figures/rules, deliberately annoys others, blames others for their mistakes or misbehavior
Vindictiveness type
spiteful or vindictive at least twice within past 6 months
How is ODD diagnosed
6 months w/ 4 symptoms from any of the categories and during interaction with at least 1 individual who is not a sibling
distress in the individual or others in immediate social context (family, peer group, work colleagues)
impacts negatively on social, educational, occupational, or other important areas of functioning
Behaviors do not occur exclusively during the course of a psychotic, substance use, depressive, or bipolar disorder
Severity levels of ODD
Mild – symptoms confined to 1 setting
Moderate – symptoms are present in at least two settings
Severe – symptoms are present in 3 or more settings
Features of ODD
threshold of 4 or more symptoms within the preceding 6 months
Individuals with disorder often justify their behavior as a response to unreasonable demands or circumstances
Conduct d/o dx criteria
Repetitive and persistent pattern of behavior where basic rights of others or major age-appropriate societal norms or rules are violated
as manifested by at least 3 of the following 15 criteria in the past 12 months from any of the categories listed, with at least 1 present in the past 6 months:
1. Aggression to people or animals
2. Destruction of property
3. Deceitfulness or theft
4. Serious violations of rules
Specifiers of conduct d/o
childhood onset type – 1 symptom prior to age 10
adolescent onset type – no symptom characteristic prior to age 10
unspecified onset – not enough info available to determine
Specify conduct d/o if
With limited prosocial emotions
— lack of remorse or guilt
— callous – lack of empathy
— unconcerned about performance
— shallow or deficient affect
Conduct d/o severity
mild – lying, truancy, staying out after dark without permission, other rule breaking
moderate – stealing without confronting a victim, vandalism
severe – forced sex, physical cruelty, use of a weapon, breaking and entering,
PREVALENCE of conduct d/o
2% to 10%; 4% median per one-year population prevalence estimates
Fairly consistent across countries that differ in race and ethnicity
Rates rise from childhood to adolescence
Higher among males than females
Few children with impairing conduct disorder receive treatment
Onset of conduct d/o
Rare after 16y/o
Temperamental risk of conduct d/o
difficult undercontrolled infant temperament, lower than average intelligence (verbal IQ)
Environmental conduct d/o
family level & community level risk factors; both common in childhood onset subtype
Genetic and physiological risk of conduct d/o
influenced by genetic and environmental factors; increased risk in kids with biological or adoptive parent or a sibling with conduct disorder; biological parent having a severe alcohol use disorder, depressive and disorders, or schizophrenia or biological parents who have a history of ADHD or conduct disorder; slower resting heart rate is noted; reduced autonomic fear conditioning is also well documented
Males w/ conduct d/o dx
frequent exhibit fighting, stealing, vandalism, and school discipline problems (both physical and relational aggression)
Females w/ conduct d/o dx
exhibit lying, truancy, running away, substance use, and prostitution (more relational aggression)
Antisocial personality d/o
This disorder is closely connected to the spectrum of “externalizing” conduct disorders.
Expressive
It involves a pattern of disregard for, and violation of, the rights of others. It is classified as a personality disorder
Pyromania
Fire
Kleptomania
Stealing
10 substance classes
Alcohol
Caffeine
Cannabis
Hallucinogens
Inhalants
Opioids
Sedatives
Stimulants
Tobacco
Other (or unknown)
Two groups of substance-related and addictive d/o
substance use disorders
substance –induced disorders
The following conditions may be categorized as substance-induced:
Intoxication
Withdrawal
Other substance/medication induced mental disorders (psychotic disorders, bipolar and related, depressive disorders, anxiety disorders, obsessive-compulsive and related, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders)
Substance use can be taken
orally, intravenously, via smoking, or inhaling
Results of substance use
cognitive, behavioral, and physiological symptoms, with apparent changes in brain circuits that last beyond immediate intake
These criteria apply in diagnosing a substance use disorder:
Impaired control
Social impairment
Risky use
Pharmacological criteria
Intoxication
Refers to and describes the immediate effects of the substance
Tolerance
A need to increase the dose as the body accommodates to the substance.
Withdrawal
Term used to describe the physiological symptoms that can accompany reduced use of the substance or the gradual decrease of the substance in the body as it is eliminated.
Addiction
When both tolerance and withdrawal symptoms are present
Some medically necessary drugs may lead to tolerance that requires gradually increased dosage, and a number have withdrawal symptoms as well; they do not fall into the substance-related disorders as conceptualized in the DSM framework
Alcohol
A CNS depressant
Causes brief sense of excitement; ultimately has the effect of slowing responses over time.
Alcohol use d/o
Common disorder
Prevalence alcohol use d/o
Prevalence varies across race/ethnic subgroups in US
12 to 17 year olds: Hispanics 6%, Native Americans & Alaska Natives (5.7%), Whites (5%), African Americans (1.8%) and Asian Americans & Pacific Islanders (1.6%)
First episode occurs during mid-teens
Characterized by periods of remission and relapse
Typical individual with the disorder has a more promising prognosis
Adolescents – co-occur with conduct disorder and repeated antisocial behavior
Environmental risk of alcohol use d/o
cultural attitude toward drinking and intoxication, availability of alcohol (including price), acquired personal experience w/alcohol, & stress levels
Genetic and physiological risk in alcohol use d/o
runs in families with 40-60% of risk explained by genetic influences; low-risk phenotypes are the acute alcohol-related skin flush
Males in alcohol use d/o
have higher rates of drinking and related disorders
Females i alcohol use d/o
generally weigh less than males, have more fat and less water in their bodies, and metabolize less alcohol in their esophagus and stomach—likely to develop higher blood alcohol levels per drink than males; heavy drinking more vulnerable to liver disease
Alcohol intoxication
Clinically significant problematic behavioral or psychological changes that develop during or shortly after alcohol ingestion
inappropriate sexual or aggressive behavior
mood lability
Impaired judgment
impaired social or occupational functioning
Symptoms of alcohol intoxication
slurred speech
Incoordination
unsteady gait
nystagmus
impairment in attention or memory
stupor or coma
Alcohol intoxication prevalence
in 2010, 44% of 12th grade students admitted to having been “drunk in the past year”; 70% of college students reported the same
Average age of first intoxication is approx. 15 years
Frequency and intensity usually decrease with age; earlier the onset of regular intoxication, the greater the likelihood of developing alcohol use disorder
Temperamental risks of alcohol intoxication
sensation seeking and impulsivity
Culture of alcohol intoxication
increases with a heavy drinking environment
Culture of alcohol intoxication
certain dates of cultural significance (New Year’s Eve), college fraternities and sororities may encourage alcohol intoxication, during specific events (wakes following funerals), at religious celebrations (Jewish and Catholic holidays); other subgroups discourage drinking or intoxication (Mormons, Muslims, fundamentalist Christians)
Gender in alcohol intoxication
Western societies more accepting of drinking and drunkenness in males
Caffeine
The most commonly used psychoactive substance around the world
Cannabis
For many years in the U.S., it has been illegal and its use highly discouraged because of perceived problems associated with ingestion and its reputation as a “gateway drug”
Hallucinogens
Includes LSD and PCP
Familiar names: angel dust, super grass, killer weed
Ecstasy is a more recent addition to the list
Salvia is a newly emerging drug and is marketed as an “herbal high”
Inhalants examples and consequences
Significant medical and psychological consequences—can lead to depression, suicide, and long-term impaired memory and learning
Examples: spray paint, glue, nail polish remover
Opioids
This is a public health crisis
Includes some that are illicit and others that include prescribed analgesics, anesthetics, and cough suppressants
Heroin is used less frequently than many of the other aforementioned drugs
Stimulants
Stimulant use disorder is similar to alcohol use, but with stimulants
Pattern of onset tend to be different (in particular between prescription amphetamines (Adderall and others used to treat ADHD) and methamphetamine and cocaine (illicit drugs)
As a rule, users increase use over time; a significant number eventually self-limit
Tobacco
Tobacco use disorder is similar to alcohol use, but with tobacco
Less likely to cause dysfunction
Two major categories of stimulants
amphetamines and cocaine
Stimulants can cause
tachycardia, pupillary dilation, elevated or lowered blood pressure, perspiration or chills, nausea/vomiting, weight loss, psychomotor agitation or retardation, muscle weakness, impaired respiration, chest pain or cardiac arrhythmias, confusion, seizures, and coma
