Disruptive, Impulse-Control, and Conduct Disorders

Question 1

What are the core deficits in disruptive, impulse-control, and conduct disorders (CDs)?

Answer 1

A core deficit in self-regulation of anger, aggression, defiance, and antisocial behaviors.

Question 2

What are the primary disorders included under disruptive, impulse-control, and CDs?

Answer 2

Oppositional defiant disorder (ODD), intermittent explosive disorder (IED), conduct disorder (CD), pyromania, kleptomania, and antisocial personality disorder.

Question 3

What is the primary characteristic of oppositional defiant disorder (ODD)?

Answer 3

A persistent pattern lasting at least 6 months of angry/irritable mood, argumentative/defiant behavior, and/or vindictiveness.

Question 4

How is the severity of ODD determined?

Answer 4

Mild: symptoms in one setting, Moderate: symptoms in two settings, Severe: symptoms in three or more settings.

Question 5

What characterizes intermittent explosive disorder (IED)?

Answer 5

Recurrent verbal or physical aggression disproportionate to the provocation or stressor, impulsive and/or anger-based, lasting <30 minutes.

Question 6

What are the four major symptom categories of conduct disorder (CD)?

Answer 6

Aggression to people and animals, destruction of property, deceitfulness or theft, and serious rule violations.

Question 7

What are the subtypes of conduct disorder based on age of onset?

Answer 7

Childhood-onset type, adolescent-onset type, and unspecified.

Question 8

What specifier in CD indicates lack of remorse or empathy?

Answer 8

The ‘with limited prosocial emotions’ specifier.

Question 9

What percentage of children with ODD progress to conduct disorder (CD)?

Answer 9

Approximately 30%, especially when ODD is comorbid with ADHD.

Question 10

What symptoms of ODD are most associated with the risk for CD?

Answer 10

Defiant, argumentative, and vindictive symptoms.

Question 11

What are the DSM-5 diagnostic criteria for ODD?

Answer 11

Angry/irritable mood, argumentative/defiant behavior, vindictiveness lasting at least 6 months with at least four symptoms present.

Question 12

What distinguishes IED from ODD and CD?

Answer 12

IED lacks serious aggression seen in CD and non-aggressive symptoms of ODD.

Question 13

What percentage of individuals with CD develop antisocial personality disorder?

Answer 13

A substantial fraction.

Question 14

What are the risk factors for developing disruptive behavior disorders?

Answer 14

Neurobiologic markers, cognitive impairments, difficult temperament, ineffective parenting, peer rejection, and exposure to violence.

Question 15

What comorbidities are common with conduct disorder?

Answer 15

ADHD, ODD, anxiety, depression, bipolar, learning, language, and substance-related disorders.

Question 16

What are the DSM-5 criteria for intermittent explosive disorder (IED)?

Answer 16

Recurrent aggressive outbursts disproportionate to stressors, occurring at least twice weekly for 3 months or three significant outbursts in 12 months.

Question 17

What family-level factors increase the risk of behavioral disorders?

Answer 17

Ineffective parenting, harsh discipline, impaired parent-child attachment, exposure to violence, and family genetic liability.

Question 18

What individual-level risk factors are associated with behavior disorders?

Answer 18

Cognitive rigidity, hostile attributions, impulsivity, and abnormalities in the prefrontal cortex and amygdala.

Question 19

What social outcomes are associated with disruptive behavior disorders?

Answer 19

Delinquency, unplanned pregnancy, social instability, academic failure, and criminality.

Question 20

How does ODD differ from CD?

Answer 20

ODD lacks physical aggression and serious rule violations seen in CD.

Question 21

What is the Fast Track program and its outcomes?

Answer 21

“Fast Track is a multicomponent school-based intervention targeting conflict resolution

Question 22

What are the outcomes of the Seattle Social Development Project?

Answer 22

“The program decreased lifetime drug use and delinquency in males by age 19

Question 23

What is a typical screening question for conduct problems in children?

Answer 23

“Does [name] have a lot of trouble controlling [his/her] anger or behavior?”

Question 24

What screening tools are used in primary care to identify conduct problems?

Answer 24

“Pediatric Symptom Checklist and Strengths and Difficulties Questionnaire.”

Question 25

What should pediatric practitioners do when youth self-report aggressive behavior?

Answer 25

“Engage in active listening

Question 26

What is guided self-help in addressing mild behavior problems?

Answer 26

“Providing educational materials

Question 27

What are examples of self-help parenting programs?

Answer 27

“Positive Parenting Program (Triple P) and Incredible Years.”

Question 28

What should be provided to parents in primary care settings for universal prevention?

Answer 28

“Brief versions of behavioral parent training like Incredible Years and Triple P.”

Question 29

What is the duration and focus of behavioral parent training programs?

Answer 29

“10-15 weeks; focuses on social learning principles

Question 30

What predictors are associated with nonresponse to parent training?

Answer 30

“Greater symptom severity and parent involvement with child protection services.”

Question 31

What is a common issue limiting the effectiveness of parent training programs?

Answer 31

“High rates of premature termination

Question 32

What are key techniques used in CBT for disruptive behavior?

Answer 32

“Identifying triggers

Question 33

What are examples of multicomponent treatments for serious behavior disorders?

Answer 33

“Multidimensional Treatment Foster Care and Multisystemic Therapy.”

Question 34

When should pharmacotherapy be considered for disruptive behavior?

Answer 34

“When psychosocial interventions are insufficient or in cases of severe presentations where safety is compromised.”

Question 35

What medications have evidence for managing impulsive aggression in youth?

Answer 35

“Stimulants

Question 36

What is the typical dose range for guanfacine in treating oppositionality?

Answer 36

“1-4 mg/day

Question 37

What are the short-term and ultimate goals of medication treatment for aggression?

Answer 37

“Short-term: ≥50% reduction in aggressive symptoms; Ultimate: Symptom remission.”

Question 38

What is the recommended level of care for most youth with behavior disorders?

Answer 38

“Outpatient care; severe cases (e.g.