Disruptive, Impulse-Control, and Conduct Disorders Flashcards
Name the 3 Disruptive, Impulse-Control, and Conduct Disorders
- Oppositional Defiant Disorder
- Intermittent Explosive Disorder
- Conduct Disorder
What category was Disruptive, Impulse-Control, and Conduct Disorders included in in previous version of the DSM?
included with disorders of Infancy, Childhood, and Adolescence
Are Disruptive, Impulse-Control, and Conduct Disorders included with ADHD?
no, now conceptualized as separate from ADHD
What addition was added to Disruptive, Impulse-Control, and Conduct Disorders and why was it controversial?
- Addition of Intermittent Explosive Disorder
- Controversial because of concerns this is insufficiently distinct from normal temper outbursts
What is the diagnostic criteria for Oppositional Defiant Disorder?
A pattern of angry or irritable mood with argumentative, defiant, or vindictive behavior, lasting at least six months, with:
- Angry/irritable mood
- Argumentative/defiant behavior
- Vindictiveness: at least 2x in 6 months
What are symptoms of Oppositional Defiant Disorder often associated with?
distress in the individual or in others
What are the differential diagnosis for Oppositional Defiant Disorder?
- ADHD
- Developmental disorders
What are the comorbidities for Oppositional Defiant Disorder?
- ADHD
- Developmental disorders
What are the genetic/biological etiologies for Oppositional Defiant Disorder?
- Reduced cortisol reactivity to stress
- Reduced amygdala reactivity to negative stimuli
- Altered serotonin and noradrenaline neurotransmission
- Abnormalities in the amygdala and frontal cortex
What are the environmental etiologies for Oppositional Defiant Disorder?
- Prenatal maternal cigarette smoking, alcohol use, or viral illness
- Maternal stress and anxiety
- Low birthweight
- Early neonatal complications
- Parental stress
- Dysfunctional parenting (can be the reason, but not in most cases)
- Early deprivation or adoption all are implicated in development of the disorder
What is the prognosis for Oppositional Defiant Disorder?
- Strong predictor of adult antisocial personality disorder
- Strong predictor of conduct disorder and depression
- Worse prognosis if early onset
- More severe ODD predicts personality disorder
What are the implications for function for Oppositional Defiant Disorder?
- Negatively affects family, school, social, and work performance
- Difficulty in areas of interpersonal skills, emotional regulation
- Difficulty in associating behaviors with +ve or –ve consequences
- Decreased problem solving, attention, decision making
What treatments are used for Oppositional Defiant Disorder?
- Interventions focused on social learning
- Psycho-therapies including cognitive-behavioral therapy, parent training and family therapy
- Collaborative problem solving has shown some modest success-develop skills in problem solving, flexibility, frustration tolerance
What are the implications for OT for Oppositional Defiant Disorder?
- Parent training- understand behavior & social learning
- Behavioral interventions emphasizing engagement in meaningful and acceptable forms of activity, with emphasis on improved social awareness and skill
- Teach problem solving, decision making; train frustration tolerance and attention
- Clear expectations and consequences are essential- Consistent with classroom rules, house rules
What is the diagnostic criteria for Intermittent Explosive Disorder?
-Frequent behavioral outbursts and failure to manage aggressive impulses:
-Verbal aggression- no damage/destruction or
physical injury
-Behavioral outbursts- cause damage/destruction or
physical injury to others twice a week for at least 3
months
-Behavior out of proportion with provocation
-The outbursts are not premeditated to accomplishing some identifiable objective
-The outbursts cause distress in the individual or dysfunction, legal or financial consequences
How old must a child be to be diagnosed with Intermittent Explosive Disorder?
least six years old
What are the neurocognitive changes in Intermittent Explosive Disorder?
- Serotonergic abnormalities, particularly in the limbic system and orbitofrontal cortex, with differential activation of the corticolymbic system
- Individuals with a first degree relative with IED were at higher risk
What gender, education level, and socioeconomic status are most at risk for developing Intermittent Explosive Disorder?
Male gender and low education and income
What is the prognosis for Intermittent Explosive Disorder?
- Chronic
- High risk of heart disease in later life
What are the implications for function in Intermittent Explosive Disorder?
- Negatively affects school, social, and work performance
- Difficulty in developing positive relationship
- Legal difficulties
What techniques in cognitive behavior therapy are used for treatment of Intermittent Explosive Disorder?
- Cognitive restructuring-identify and change negative thoughts
- Coping skills
- Relaxation training
What medications are used for treatment of Intermittent Explosive Disorder?
Antidepressants, mood stabilizers, and antipsychotic drugs to decrease outbursts
What are the implications for OT for Intermittent Explosive Disorder?
- Emotional control strategies; practice skills
- Appropriate expression of emotions
- Focusing on personal strengths
- Assist to gain insight- Identify past situation if possible, rationalize
- Assist to identify appropriate career choice
What is the diagnostic criteria for Conduct Disorder?
- Persistent pattern of behavior with serious violation of the rights of others or rules of conduct
- Aggression to people and animals
- Destruction of property by fire, etc
- Deceitfulness or theft
- Stays out late despite parental rules (younger than 13)
- Often truant from school
- Symptoms cause dysfunction
- At least 3 episodes in one year, with symptoms in past six months
What are the differential diagnoses for Conduct Disorder?
Antisocial personality disorder
What are the comorbidities for Conduct Disorder?
- Substance use disorders
- ADHD
- Intellectual disabilities
- Learning disabilities
What is the etiology of Conduct Disorder?
- Subtle neurological deficits like poor verbal abilities and inhibitory control
- Gray matter volume reductions in the areas that process socioemotional stimuli
- Family histories of antisocial behavior and either harsh or inconsistent parenting- controversial
Is the adolescent form of conduct disorder more or less severe?
Adolescent form less severe
What is the prognosis for Conduct Disorder?
- Poor with associated alcohol or substance abuse
- High probability of developing adult antisocial or borderline personality disorders- may cause financial and legal difficulties
- Early onset of the behavior predicts a worse outcome, including a high potential for violence and criminal behavior over time
- Worst with callous/unemotional traits
What are the implications for function for Conduct Disorder?
- Negatively affects school, social, and work performance
- Difficulty in areas of interpersonal skills, emotional regulation
- Difficulty transitioning to adult roles- work & family life
- Can contribute to legal difficulties which further affect performance
What treatments are used for Conduct Disorder?
- Preventive interventions attempted with early signs
- Parent training- positive child-parent interaction, consistency in discipline
- Behavioral interventions reinforcing prosocial behavior
What are the implications for OT for Conduct Disorders?
- Channel energy to more appropriate activities
- Reinforce acceptable behavior
- Consistent expectations
- Engagement in recreation- provide experience of success
- Opportunities for appropriate expression of emotion – movement, music, art, play; build self-concept
- Anger management, coping strategies
- Parent training for the above
- Treatment of ADHD and other co-existing conditions
