[Exam 3] Chapter 23 - Disruptive Behavior Disorders Flashcards
What are disruptive behavior disorders?
Problems with person’s ability to regulate his or her own emotions or behaviors.
What are disruptive behavior disorders characterized by?
Persistent patterns of behavior that involve anger, hostility, and aggression toward people and property
Disruptive Behavior Disorders: Primary disorders in here are what?
Oppositional Defiant Disorder (ODD)
Conduct Disorder
intermittent Explosive Disorder (IED)
Disruptive Behavior Disorders: ODD and Conduct Disorder can be viewed on continuum concept that would include what?
antisocial personality disorder
Disruptive Behavior Disorders: Age of onset for IED?
Can occur after age of 6, but often diagnosed from adolescnce to young adulthood
Disruptive Behavior Disorders & Related Disorders: What is Kleptomania?
Characterized by impulsive, repetitive theft of items not needed by the person either for personal use or monetary gain
Often discarded after stolic
Disruptive Behavior Disorders & Related Disorders: Feelings before and after theft?
Before: Tension and anxiety high
After: Feels relief, exhilaration
Disruptive Behavior Disorders & Related Disorders: Kleptomania is more common in who?
Females and often has negative legal, career, family, and social consequences
Disruptive Behavior Disorders & Related Disorders: What is Pyromania?
Characterize dby repeated, intentional fire-setting. Person fascinated about fire and feels pleasure or relief of tension while setting/watching fires.
Oppositional Defiant Disorder: What is this?
Consists of enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figures without major antisocial violation
Oppositional Defiant Disorder: What causes ODD to be diagnosed?
When behaviors are more frequent and intense than in unaffected peers and cause dysfunction in social, academic, or work siutation s
Oppositional Defiant Disorder: Prevelance of ODD?
2-15% of adolescent population, occuring more often in males but increasing now im females
Oppositional Defiant Disorder: What creates ODD?
Genes, temperament, adn adverse social conditions interact together
Oppositional Defiant Disorder: Children with ODD react how in social siutations?
Have lower self-concept and lack competence
Oppositional Defiant Disorder: Children with ODD have limited ability to make what?
associations between their behavior and consequences of behavior. Thus, learning appropriate behavior and learning to refrain from inappropriate behavior are impaired
Oppositional Defiant Disorder: These poeple exhibit impaired what?
Problem-solving abilitites and deficiencies in attention, flexibility of thinking and decision-making
Oppositional Defiant Disorder: Early onset, more severe symptoms and comorbid conditions are associated with what?
poorer long-term outcomes.
Oppositional Defiant Disorder: Early onset is associated with what increased risk?
increased risk for developing conduct disorder
Oppositional Defiant Disorder: This is often comorbid with other psychiatric disorders sucha s what?
ADHD, anxiety, and/or mood disorders that need to be treated as well
Oppositional Defiant Disorder: Treatment for this is based on what?
On parent management training models and behavioral interventions. ODD problem behaviors are learnined and reinforced in school/home.
Oppositional Defiant Disorder: Adolescent children benefit from what types of interventions?
that use enhance of personal strengths to improve behavioral and social functioning
Oppositional Defiant Disorder: Pharmaologic tx of what may also decrease the severity of this?
ADHD
Oppositional Defiant Disorder: What are the two major challenges for parents and caregivers?
Managing the adolescents aggressive, defiant, and deceitful behaviors and interacting frequently with multiple service providers
Intermittent Explosive Disorder (IED): What is this?
Involves repeated episodes of impulsive, aggressive, violent behavior and angry verbal outbursts, usually lasting less than 30 minutes.
Intermittent Explosive Disorder (IED): What may occur during these episodes?
Physical injury to others, destruction to property, and injury to the individual as well.
Intermittent Explosive Disorder (IED): A minor issue or occurence results in what response?
rage, aggression, and assult of others. Seen without any warning.
Afterward, individual may be embarassed and feel guilty or remorseful
Intermittent Explosive Disorder (IED): When is this most common?
In adolescnce and young adulthood. More common inmales.
Intermittent Explosive Disorder (IED): Many people with this have a comorbid psychiatric disorders, most commonly what?
ADHD, ODD, COnduct Disorder, Anxiety Disorders, and Depression
Intermittent Explosive Disorder (IED): What trauma may cause this?
Childhood exposure to trauma, neglect, or maltreatment
Intermittent Explosive Disorder (IED): What may cause this on a neuroligcal level?
Neurotransmitter imbalances (serotonin)
Plasma Tryptophan Depletion
Frontal Lobe Dysfunction
Intermittent Explosive Disorder (IED): What physical illnesses may cause this?
HEart Disease, Hypertension, Stroke, Diabetes, Arthritis, Back/Neck Pain, Ulcer, Headache
Intermittent Explosive Disorder (IED): What meds used for tx?
Fluoxetine (Prozac)
Lithium
Anticonvulsant Mood Stabilizers: Valporic Acid (Depakote), Phenytoin (Dilantin), Topiramate (Topamax), and Oxcarbazepine (Trileptal)
Intermittent Explosive Disorder (IED): Why are SSRI useful?
Reduce aggressive tendencies because serotonin deficiences are often linked to causation
Intermittent Explosive Disorder (IED): Additional interventions can improve outcomes, such as
CBT, anger management thrategies, avoidance of alcohol, and other substances and relaxtion techniques.
Conduct Disorder: What is this?
Characterized by persistent behavior that violates societal norms, rules, laws, and the rights of others
Conduct Disorder: Symptoms are clustered in what four areas?
Aggression to people and animals
Destruction of property
Deceitfulness
theft and Serious Violation of Rules
Conduct Disorder: Children with this exhibiti callous and unemotional traits, which is what?
Having little empathy for others, do not feel bad/guilty/or show any remorse, have shallow emotions, and unconcerned about poor performance at school
Similar to those seen in adults with antisocial personality disorder.
Conduct Disorder: Frequently associated with early onset of what types of behaviors?
sexual behavior, drinking, smoking, use of illegal susbttances, and other reckless or risky behaviors.
Conduct Disorder: How common is this?
8% of children and adolescents have this.
Onset before 10 occurs in boys.
Conduct Disorder and Onset/Clinical: What are the two subtypes?
Childhood-onset type
Adolescent-Onset Type
Conduct Disorder and Onset/Clinical: When does childhood-onset type start?
Involve symptoms before 10 years of age, including physical aggression toward others and disturbed peer relationships
Conduct Disorder and Onset/Clinical: Children with childhood-onset type are more likely to have what persistent issues?
conduct disorder and develop antisocial personality disorders as adults.
Conduct Disorder and Onset/Clinical: When is adolescent-onset type defined?
Until after 10 years of age. Less likely to be aggressive and they have more normal peer relationships.
Conduct Disorder and Onset/Clinical: Behaviors with this fall into what categories?
Mild
Moderate
Severe
Conduct Disorder and Onset/Clinical: What happens in a mild case?
Child has some conduct problems to cause relatively minor harm to others.
Conduct Disorder and Onset/Clinical: Examples of mild cases?
Repeated lying, truancy, minor shoplifting, and staying out late without permission
Conduct Disorder and Onset/Clinical: What happens in moderate case?
Number of conduct problems increases as does the amount of harm to others
Conduct Disorder and Onset/Clinical: Examples of moderate cases?
Vandalism, conning others, running away from home, verbal bullying, and intimidation, drinking alcohol
Conduct Disorder and Onset/Clinical: What happens in severe cases?
Person has many conduct problems that cause considerable harm to others
Conduct Disorder and Onset/Clinical: Examples of severe cases?
Forced sex, cruelty to animals , physical fights, cruelty to peers, use of weapon, burglary, robbery
Conduct Disorder and Onset/Clinical: Which group is prone to have more problems later one?
childhood have more severe problem behviors and are more likely to develop antisocial personality disorders as adults
Conduct Disorder and Etiology: What interacts to cause disorder?
Genetic vulnerability, environmental adversity, and factors such as poor coping
Conduct Disorder and Etiology: Risk factors include what?
Poor parenting, low academic achievement, poor peer relationships, and low self-esteem.
Conduct Disorder and Etiology: Protective factors of this?
Resilience, family support, positive peer relationships and good health
Conduct Disorder and Etiology: What has been found on a neurological level for this?
Lack of reactivity of the autonomic nervous system . This may cause more aggression in social relationships as a result to decreased normal avoidance or social inhibition s
Conduct Disorder and Etiology: What factors can affect development of conduct disorder?
Poor family functioning, marital discord, poor parenting, and a family of substance abuse
Conduct Disorder and Etiology: First experience with alcohol?
Before age 12 which resulted in more likely to engage in higher risk behaviors such as alcohol and substance abuse
Conduct Disorder and Etiology: Specific parenting patternes considered ineffective are what?
Inconsistent parental responses to the childs demands and giving in to demands as childs behavior escalates
Conduct Disorder and Etiology: What problems with the child are associated with conduct disorder?
Academic underachievement, learning disabilities, hyperactivity, and problems with attention span
Conduct Disorder and Etiology: These people lack the ability to do what?
Respond appropriately to others and to negotiate conflict, and lose ability to restrain themselves when emotionally stressed
Conduct Disorder and Related Problems: How may people respond to environmental pressures?
Externalize issues by directing anger and frustration into aggressive or delinquent behavior
Others internalize resulting in somatic complaints, withdrawal, and isolative behavior
Conduct Disorder and Related Problems: Examples of externalizing behaviors?
Lying, cheating , swearing, truancy, vandalism, setting fires, and bragging
Conduct Disorder and Related Problems: Examples of internalizing behaviors?
Withdraws , sulks, won’t talk, secretive, overly shy
Conduct Disorder and Cultural Considerations: What may someone from a high-crime area do?
Aggressive behavior may have been necessary for survial, so theys hould not be diagnosed with this
Conduct Disorder and Treatment: What is the best thing to do right away?
early interventiona nd prevention. More effective than treatment
Conduct Disorder and Treatment: What are dramatic interventions?
“Boot Camp”, have not proved effective and may even worsen the siutation
Conduct Disorder and Treatment: Treatment must be geared toward what?
Client’s developmental age, no one treatment suitable for all ages
Conduct Disorder and Treatment: Focus of treatment for school-aged children?
child, family, and school environment. This includes parenting education, social skills training, and to improve peer relationships
Conduct Disorder and Treatment: Tx for adolescents?
Individual therapy. Must address issues of alcohol and drugs.
Most promising is keeping the client in their environment with family and individual therapies. .This includes conflict resolution, nger management, and teaching social skills
Conduct Disorder and Treatment: If client danger to others, they may be prescribed what?
Antipsychotic medication such as risperidone (Risperdal).
Conduct Disorder and Treatment: Clients with labile moods may benefit from what?
Lithium or another mood stabilizer such as carbamazepine (Tegretol) or Valproic Acid (Depakote)
Conduct Disorder & History: These kids have a history of what?
disturbed relationships with peers, aggression toward people/animals, destruction of property, deceitfulness or theft and violation of rules
Conduct Disorder & Appearance/Motor: How will it be here?
Normal but somewhat extremee (body piercings, tattoos, hairstyle, and clothing) Often will slouch and unwilling to be interviewed . May use profanity, and call people names
Conduct Disorder & Mood/Affect: How will their mood be?
Quiet/Reluctant ot talk or openly hostile and angry. M
May be disrespectful toward parents. Irritability , frustration, temper outbursts common.
Conduct Disorder & Thought Process/Content: How do they perceive world?
Aggressive and threatening and they respond in same manner. Preoccupied with looking out for themselves
Conduct Disorder & Sensorium/Intellectual Process: How do they do in school?
Poor grades because of academic underachievement, hebavioral problems in school, or failure to attend class and compelte assignments
Conduct Disorder & Judgement/Insight: How do they act here?
Break rules with no regard. Thrill seeking or risky behaviors is common, such as use of drugs or alcohol, recless driving, sexual activity.
Conduct Disorder & Self-Concept: How is self-esteem here?
Low.. DO not value themselves more than they value others. Identity is related to their behaviors such as being cool
Conduct Disorder & Roles/Relationships: How are relationships?
Those in authority are disruptive and may be violent. Verbal aggression is common. Also limited to others who display similar behaviors
Conduct Disorder & Physiological and Self-Care: Often at risk for what?
Unplanned pregnancy and STDS because their early and frequent sexual behaviors.
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: Nurse must set limits. What are the three steps to protect others?
Inform clients of rule or limit
Explain consequences if clients exceed the limit
State expected behavior
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: Example of limit enforcement?
“It is unacceptable to hit another eprson. If you are angry , tell a staff person about your anger”
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: For limit setting to be effective, what must happen?
Consequences must have meaning for client. You have to threaten them with something that they value
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: Nurse can negotiate with a client a behavioral contract outlining what?
expected behaviors, limits, and rewards to increase treatmetn compliance.
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: Time-out is what?
retreat to a neutral place so client can regain self-fcontrol. Not a punishment. This simply prevents aggression or acting out.
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: What should nurse do here?
Protect otheres from clients aggression
Set limits for unacceptable behavior
Provide consistency with clients tx
Use behavioral contracts
Institute time-out
PRovide routine schedule of daily activies
Conduct Disorder & Intervention - Improving coping skills and self esteem: What should nurse do here?
Show acceptance of the person, not behavior
Encourage client to keep a diary
Teach and practice problem-solving skills
Conduct Disorder & Intervention - Promoting social interaction: What should nurse do here?
Teach age-appropriate social skills
Role model and practice social skills
provide positive feedback for acceptable behavior
Conduct Disorder & Intervention - Decreasing Violence and Increasing Compliance: What type of schedule helps?
those for hygiene, school, homework, and leisure time.
Conduct Disorder & Intervention - Improving Coping Skills and Self-Esteem: How must nurse act?
Nurse must be matter of fact about setting limits and must not make judgemental statements about clients. Focus only on behavior.
Conduct Disorder & Intervention - Improving Coping Skills and Self-Esteem: Example of what nurse shoul dsday?
John, breaking chairs is unacceptable behavior. You need to let staff know you’re upset so you can talk about it instead
Conduct Disorder & Intervention - Improving Coping Skills and Self-Esteem: What should nurse not say?
“Whats the matter with you? Don’t you know any better?
Conduct Disorder & Intervention - Promoting Social Interaction: What does nurse identify?
What is not appropriate, such as profanity, and also what is appropriate. May have little experience discussing the news, current events, sports, or other topics.
Conduct Disorder & Intervention - Providing Client/Fam Education: Parents need to replace what old patterns?
yelling, hitting, or simply ignoring behavior with more effective strategies.
Conduct Disorder & Intervention - Providing Client/Fam Education: Nurse can teach parents what?
Age-appropriate activites and expectations for clients such as reasonable curfews, household responsibilities, and acceptable behavior at home.
Conduct Disorder & Eval: Considered effective when?
Client stops behaving in aggressive or ilelgal ways, attends school, adn follows reasonable rules and expectations at home.
Conduct Disorder & Community-Based Care: Seen in acute care settings when?
Their behavior is severe and only for short periods of stabilization
Conduct Disorder & Community-Based Care: Long-term work takes place where?
Place at school and home or another community settings.
Conduct Disorder & Community-Based Care: Where may patietns go?
Parents home for short/long periods.
Group homes, halfway homes, and residental tx setting designed to provide safe environment.
Conduct Disorder & Menta;l Health Promotion: Why do children have a higher chnce of having this?
When parents engage in risky behaviors such as smoking, drinking and ignoring their health.
Disruptive behavior disoraders are characaterized by what?
persistent patterns of behavior involving anger, hostility, and aggression toward people and property including ODD, conduct didsorder, and IED
What does ODD involve?
enduring pattern of uncooperative, defiant, disobedient, and hostile behavior toward authority figure that far exceeds periodic negative behavior seen in adolesence
Child and adolescents with ODD do not associate their behavior with waht
consequences but blame others for their problems
Treatment goals for ODD involves what
learning appropriate behavior and refraining from inappropriate behavior
Parent management training is based on behavioral principles of what?
decreasing reinforcing attention for negative behaviors, rewarding positive behaviors, and consistent expectations and consequences for both. Used for ODD and conduct disorders
What is conduct disorder?
Most common disruptive behavior disorder characterized by aggression to people and animals, destruction of property, deceitfulness and theft
Interventions for conduct disorder include what?
decreasing violent behavior, increasing compliance, improving coping skills and self-esteem, promoting social linteraction, and educating and supporting parents
Children and adolescents with ODD and conduct disorder may be diagnosed with what?
antisocial personality disorders as adults.
What is time-out?
Retreat to a neutral place so that clients can regain self-control
