Disruptive Behavior Disorder in Teens
Disruptive kids may actually be suffering from a mental disorder that makes them behave that way. If not properly diagnosed, the more difficult it becomes to treat the problem as they get older. In some cases, when this disorder happens alongside a drug problem, the risks of both may be amplified.
9 min read
What Is Disruptive Behavior Disorder?
Disruptive behavior disorders (or DBD) are psychological impairments in some children, causing them to act out and be difficult on a regular basis. The disorders are marked by an inability to follow rules and incessant violations of others’ basic rights, and can occasionally result in violent or aggressive responses to situations.
These disorders are broken down into separate categories, most notably oppositional defiant disorder and conduct disorder. Attention deficit hyperactivity disorder (ADHD) was previously considered a disruptive behavior disorder, but as the literature expanded on both of these problems, medical professionals determined they were independent and required separate treatments. Both disorders do often co-exist in young children — 50–65% of kids with oppositional defiant disorder are also diagnosed with ADHD.
Oppositional Defiant Disorder
Oppositional defiant disorder (ODD) is the most prevalent DBD in American youth. The average age of onset is 6 years old, and it affects an estimated 5–10% of children. According to studies, up to 20% of children with ODD exhibit some degree of conduct problems — 33% of those with ODD will develop conduct disorder, and 40% of those kids will eventually develop antisocial personality disorder in adulthood.
ODD is diagnosed in children who exhibit at least 4 of the following behaviors for at least 6 months:
- Often losing their temper
- Often arguing with adults
- Often actively defying or refusing to comply with adults’ rules or requests
- Often deliberately annoying people
- Often blaming others for his or her mistakes or misbehavior
- Is often easily annoyed by others or touchy
- Is often resentful and angry
- Is often spiteful or vindictive
After a 3-year follow-up, approximately 67% of kids with ODD no longer meet the criteria for the disorder. Some children will develop ODD at a later age than usual — referred to as “late starters.” ODD late starters are prone to experience antisocial behavior into adolescence, but are less at risk for conduct problems and often don’t have the same cognitive deficits or motor skill problems that early starters exhibit.
Conduct disorder (CD) is a more destructive relative of ODD. The average age of onset is 9 years old, and it affects an estimated 6–9% of children. The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines CD by 4 main behaviors — kids diagnosed with the disorder typically exhibit at least 3 of these behaviors within the previous 12 months, and one or more in the past 6 months:
These behaviors are:
- Aggression to people or animals (e.g. physical violence, starting fights, intimidation, forced sexual activity, etc.)
- Destruction of property
- Deceitfulness or theft
- Serious violations of rules
Additionally, in order to qualify as CD, the patient must meet the following criteria:
- Significant impairment in social, academic or occupational functioning caused by the disturbance
- Not meeting criteria for antisocial personality disorder if the patient is at least 18 years old
If your son or daughter is diagnosed with CD, the doctor will specify the severity (i.e. mild, moderate or severe). They will also determine if the CD is childhood-onset type (onset of at least one characteristic before the age of 10), adolescence-onset type (CD behaviors aren’t present until at least 10 years old) or unspecified onset (age of onset unknown).
Intermittent Explosive Disorder
Intermittent explosive disorder (IED) is also known as an impulse-control disorder. This disorder, which usually comes about in the early teens, is marked by “spells” or “attacks” of intense aggression that are grossly disproportionate to the events or stressors that provoke them. These episodes are usually immediately followed with a sense of relief, but soon after the individual will show genuine regret, remorse or embarrassment about their actions.
As with other disruptive behavior disorders, young males are more likely than females to develop IED. Approximately 82% of teens with IED have a co-occurring disorder such as depressive disorder, anxiety or substance use disorder, and these individuals tend to be extremely sensitive to alcohol use. Some experts believe that IED is merely a symptom of other disorders, such as CD, but others believe it’s a serious problem on its own.
Disruptive Behavior Disorder NOS
Occasionally, children will show symptoms of disruptive behavior without meeting the exact criteria for a specific disorder. This is referred to as disruptive behavior disorder not otherwise specified (NOS). Your child’s doctor may also refer to it as “unspecified” DBD. A boy or girl with this problem may exhibit symptoms such as:
- Temper tantrums
- Vengeful behavior
As with other disruptive behavior issues, the earlier a parent intervenes, the better the prognosis and the more likely they are to improve with professional help. Many growing children will exhibit certain disruptive behavior but grow out of them just as quickly. But if your son or daughter is particularly problematic in their early childhood, you may consider bringing them in for an assessment.
Causes and Effects
A number of biological risk factors have been associated with past cases of DBD. These include:
- Having a parent with a diagnosis of conduct disorder, antisocial personality disorder, ADHD, schizophrenia or alcohol dependence
- Having a sibling with a disruptive behavior disorder
- Maternal depression
- Serious marital discord
- Maternal smoking during pregnancy
- Being male
Environmental risk factors include:
- Lack of supervision
- Parental neglect
- Multiple caregivers
- Harsh discipline
- Emotional or physical abuse
- Large family size
- Exposure to violence
- Drug and/or alcohol use by parents/caregivers
The effects of ODD can be seen in some children as young as 3 years old. If you notice any of the following early warning signs, take note and reach out for help if they persist. Warning signs include:
- Poor social skills
- Defiance of adults
- Lack of school readiness
- Aggression towards peers
- Coercive interactive style
- Lack of problem-solving skills
How to Treat the Disorder
Your family physician may suggest several routes for treating your child’s disruptive behavior disorder. Once you’ve identified the symptoms, schedule a meeting to have your son or daughter examined. Depending on the severity of their problem, the doctor may recommend one or more of the following treatment methods.
The most effective, non-pharmacological treatments for CD and ODD are:
- Parent Management Training (PMT) – where parents meet with a therapist without the child present, learning and role-playing different parenting skills to then practice at home
- Parent Psychoeducation – where parents are taught extensively about their child’s illness, its effects, how best to work with their special needs (including reasonable expectations), and what to expect from treatment
- Attending – encouraging the parent or guardian to provide positive attention and pay attention to the child’s positive behaviors, in spite of occasional misbehaving, and set aside time each day to engage in an activity of the child’s choosing. Other important aspects of this are praise — effectively using words to reward good behaviors — and tangible rewards, actual objects or activities rewarded to children who behave as requested
- Commands – the strategy of clear and consistent instructions, done in a way that makes it more likely the child will do what is asked of them
- Time Out – a brief break from all activities and attention, enforced when a child needs to calm down — when used effectively, putting kids in “time out” will help them mold good behaviors and break out of rebellious habits
At a certain point, you may need to enlist the help of a professional. Parent-child interaction therapy (PCIT) and cognitive-behavioral therapy (CBT) are sometimes effective (and perhaps necessary) ways to retrain disruptive children how to act and think in a healthy manner. To promote healing and reduce your child’s outbursts, the doctor may also suggest medication. No prescription drugs are approved specifically for use in cases of DBD, but numerous medications have been studied for their effects on these disorders with promising results.
Possible medications include:
- Atypical antipsychotic medications, such as risperidone, aripiprazole and clozapine
- Mood stabilizers, such as lithium, carbamazepine and valproic acid
- Alpha antagonists, such as clonidine and guanfacine
In the event your doctor recommends a prescription for your child, do extensive research on the drug and its possible side effects.
Common co-occurring disorders with DBD are ADHD, bipolar disorder and other mood disorders. Approximately one-third to one-half of children with ADHD may have accompanying ODD. Around 39% of girls and 46% of boys with CD meet the criteria for at least one co-occurring mental health problem, including anxiety disorders and depression.
Kids with disruptive behavior disorders are also at risk for addiction to illicit drugs and alcohol — especially as symptoms continue to progress into the teen years. A diagnosable substance use disorder that occurs alongside a conduct disorder — or other mental disorder — is what doctors call a dual diagnosis.
Does My Child Need Treatment?
If you see signs of substance abuse or addiction in your child, take action right away. Speak to a treatment professional such as your family doctor, who can help determine whether addiction is present in your child. If it is, then a specialized program is the best bet for treating your teen’s co-occurring disorders. This kind of integrated treatment approach addresses both substance abuse and emotional problems simultaneously.
You’re not alone — millions of families deal with teen addiction. Speaking with a professional can help you figure out what to do in order to bring your child back to health. 352.771.2700 for free, private, professional assistance. Our addiction treatment specialists are available to answer any questions you may have about treatment, or even provide you with a list of facilities that may fit your teen’s needs. The important thing is that you don’t delay in taking action — your child needs you now more than ever. Call today to start finding your child the help they need.
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- Gathright, Molly M., and Laura H. Tyler. “Disruptive Behaviors in Children and Adolescents.”Psychiatry Research Instittue. University of Arkansas for Medical Sciences, 31 Mar. 2014. Web. 16 Feb. 2016. http://psychiatry.uams.edu/files/2015/02/disruptive.pdf
- Warner-Metzger, Christina M., and Suzanne M. Riepe. “Disruptive Behavior Disorders in Children and Adolescents.” Tennessee State Government. N.p., 25 Feb. 2013. Web. 16 Feb. 2016. https://www.tn.gov/assets/entities/behavioral-health/attachments/Pages_from_CY_BPGs_132-161.pdf
- Gardner, Amanda. “Brain Structure Difference Linked to Disruptive Teens.” Consumer HealthDay. HealthDay, 2 Dec. 2002. Web. 17 Feb. 2016. http://consumer.healthday.com/kids-health-information-23/attention-deficit-disorder-adhd-news-50/brain-structure-difference-linked-to-disruptive-teens-510525.html
- “Intermittent Explosive Disorder.” Psychology Today. Psychology Today, 27 Dec. 2015. Web. 23 Feb. 2016. https://www.psychologytoday.com/conditions/intermittent-explosive-disorder
- “Disruptive Behavior Disorders: Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) Fact Sheet.” NAMI Minnesota. National Alliance on Mental Illness, n.d. Web. 16 Feb. 2016. http://www.namihelps.org/assets/PDFs/Childrens-Disruptive-Behavior-ODD-EBPs.pdf
- “Interventions for Disruptive Behavior Disorders: Medication Management.” SAMHSA. US Department of Health and Human Services, 2011. Web. 23 Feb. 2016. https://store.samhsa.gov/shin/content/SMA11-4634CD-DVD/MedicationManagementChild-IDBD.pdf
- “Disruptive Behavior Disorders.” CHADD – The National Resource on ADHD. CHADD, n.d. Web. 17 Feb. 2016. http://www.chadd.org/Understanding-ADHD/About-ADHD/Coexisting-Conditions/Disruptive-Behavior-Disorders.aspx
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