Disruptive Behaviors: Exam 3 Flashcards
Characterized by persistent patterns of behavior toward people and/or property that involve:
Anger
Hostility
Aggression
Disruptive Disorders
What are the types of disruptive behavior disorders?
Oppositional defiant disorder
Conduct disorder
Intermittent explosive disorder
What are the related disorders to disruptive behavior disorders?
Kleptomania – impulsive, repetitive theft of items not needed by the person
Pyromania – repeated, intentional fire-setting
Characterized by a persistent pattern of angry mood and defiant behavior
Interferes with social, educational or other important areas of functioning
Typically begins by age 8, but not usually later than early adolescence
More prevalent in boys before puberty, rates are more closely equal after puberty
Oppositional Defiant Disorder (ODD)
What is the etiology for ODD?
Biological Influences
Genetics, Biochemical alterations remain under study
Contributing factors may be genes for metabolism of dopamine, serotonin, and norepinephrine
Family Influences
Pattern of Family Dynamics
Strong-willed child and authoritarian parents
Frustrated parent increases attempts to enforce authority
Child reacts with anger and increases self-assertion
Negative behavior is inadvertently rewarded
What is the treatment for ODD?
Based on parent management training models of behavioral interventions
Parents learn to ignore maladaptive behavior rather than give the behavior negative attention
Positive behaviors are rewarded with praise and reinforcers; works wonders
Consistent consequences for the child’s defiant behavior are implemented every time the behavior occurs
Adolescent children benefit from interventions that use enhancement of personal strengths; find something the kid is good at and focus on that
Older children may benefit from individual therapy in addition to behavioral programs
Repeated episodes of impulsive, aggressive, violent behavior; angry verbal outbursts
May physically injure self and/or others
May feel guilty after outbursts; this does not prevent future outbursts
Most common in adolescence and adulthood
Intermittent Explosive Disorder (IED)
What is the etiology for intermittent explosive disorder?
Childhood exposure to trauma, neglect, or maltreatment
Neurotransmitter imbalances
Serotonin
Plasma tryptophan depletion: imbalance in those feel good neurotransmitters
Frontal lobe dysfunction
Comorbid psychiatric disorder (if it goes unchecked)
Substance use/abuse
Attention-deficit/hyperactivity disorder (ADHD)
Oppositional defiant disorder
Conduct disorder
Anxiety disorder
depression
What are behavioral symptoms of IED?
physical aggression
verbal aggression
damage to property or objects of value
road rage
physically attacking people/objects
What are physical symptoms of IED?
palpitations: Palpitations seem to be normal, but vitals everything will be increased.
muscle tension
headaches
tingling
tremors
What are cognitive symptoms of IED?
low frustration tolerance
feelings of loss of control over ones thoughts
racing thoughts
What are psychosocial symptoms of IED?
belief periods of emotional detachment
irritability
feeling of rage
What are the treatment options for IED?
Psychopharmacology
Selective serotonin reuptake inhibitors
Lithium and anticonvulsant mood stabilizers
Cognitive-behavioral therapy
Anger management
Relaxation techniques
Avoidance of alcohol and other substances
The best outcomes involve a combination of these interventions and treatment
*SSRI: depression medication
Lithium: bipolar disorder
Depakote: most common
Teach anger management, relaxation, and discourage them to use alcohol and other substances. Can cause the patient to have a dual diagnosis. *
Behavior in which the basic rights of others are violated
Inability to adhere to major age-appropriate societal norms or rules
Physical aggression is common
Peer relationships are disturbed
Callous and unemotional traits exhibited
Frequently associated with reckless/risky behaviors
Conduct disorder
What is the onset and clinical course for conduct disorder?
Subtypes
Childhood-onset type
Involves symptoms before 10 years of age
Includes physical aggression towards others
Disturbed peer relationships
Adolescent-onset type
No behaviors of conduct disorder until after 10 years of age
Less likely to be aggressive
Have more normal peer relationships
Behavior categories
Mild: some conduct problems that cause relatively minor harm to others (ex. Lying, truancy, shoplifting)
Moderate: conduct problems increase as does the amount of harm (ex. Vandalism, bullying, substance use, sexual promiscuity)
Severe: many conduct problems that cause considerable harm (ex. Forced sex, cruelty to animals, use of weapons, burglary, robbery)
Clients with more severe problem behaviors are more likely to develop antisocial personality disorders as adults
What are related problems to conduct disorder?
Children respond in different ways to environmental pressures and adversity
Children who externalize their emotions increase the risk for:
Oppositional defiant disorder
Conduct disorder
Children who internalize their emotions increase the risk for:
Somatic complaints
Withdrawal and isolative behavior
Anxiety
Depression
What is the etiology for conduct disorder?
Biological Influences
Genetics
A higher number of individuals with conduct disorder have family members with the disorder
Regions on chromosomes 2 and 19 may contain genes conferring risk of conduct disorder
Temperament
Difficult temperament at age 3 has significant links to conduct disorder
Biochemical Factors
Alterations in norepinephrine and serotonin
High levels of testosterone in pubertal boys
Psychosocial Influences
Poor peer relationships
Aggression is the principal cause of peer rejection
Family Influences
Dynamics contributing to the predisposition of conduct disorder
Parental rejection
Early institutionalization
Harsh discipline
Shifting of parental figures
Marital conflict
Parental permissiveness
Parents with antisocial personality disorder/alcohol dependence
Inadequate communication patterns
Aggression to people and animals
Property destruction
Stealing, lying, truancy (violates curfew)
Lacks feelings of guilt or remorse
Substance use/sexual activity occurs earlier than expected for the peer group
Low self-esteem (manifested by tough guy image)
Low level of academic achievement
Symptomatology
What is the treatment for symptomatology?
Must be geared toward developmental age
Early intervention/prevention
Parenting education
Social skills training
Family therapy
Individual therapy
Medications (in conjunction with treatment
*Medications are used to treat specific symptoms. Early education and prevention is more effective for treatment, especially in families with younger children. Many kids have a problem with the federal system, and end up in incarceration, this is a consequence of behavior not treatment. *
What is the assessment for someone with conduct disorder?
History
Disturbed peer relationships
Aggression toward people or animals
Property destruction
Deceitfulness
Theft
Truancy
Running away
Staying out all night
General appearance and motor behavior
Typical for age group
May be extreme (ex. Body piercings, tattoos, hairstyle, clothing)
sullen
Mood and affect: mad at the world look to them
Quiet, reluctant to talk
Openly hostile
disrespectful
Thought process and content
Perceives the world to be aggressive
Sensorium and intellectual processes
Academic underachievement
Judgment and insight
Limited
Rule breaking
Risky behavior
Self-concept
Tough appearance; they put up a tough front
Low self-esteem
Roles and relationships
Disruptive
Possibly violent
Physiological and self-care
Often at risk for:
Unplanned pregnancy
Sexually transmitted disease
Substance use
SNAP-IV Teacher and Parent Rating Scale (see Videbeck Box 22.3, p.431) look at in the book!
Can be used to determine
Oppositional defiant disorder
Conduct disorder
What are the nursing diagnoses for conduct disorder?
Risk for other directed violence
Ineffective coping
Impaired social interaction
Chronic low self-esteem
Outcomes: the client will
Not hurt others or damage property
Learn effective problem-solving and coping skills
Use age-appropriate and acceptable behaviors when interacting with others
Verbalize positive age-appropriate statements about self
What are the interventions for conduct disorder?
The nurse must protect others from manipulative/aggressive behaviors common with these clients. Limits must be set on unacceptable behavior at the beginning of treatment.
Decrease violence/increase treatment compliance
Improve coping skills, self-esteem
Promote social interaction
Evaluation: treatment is considered effective if the client stops behaving in aggressive or illegal ways, attends school, and follows directions at home. Expect modest progress with some setbacks.
*1. Inform the patient of the rules
2. Explain the consequences to the patient, Let them know that you’re prepared to follow though
3. State the expected behavior, there is a difference in seclusion and timeout. Timeout shouldn’t be used as the last resort. *
