Disruptive, Impulse-control, and conduct disorders

Oppositional Defiant Disorder

• individual must display a pattern of defiance lasting at least 6 months as evidence by at least 4 symptoms from the following categories

  • angry/irritable mood

  • argumentative/defiant behavior

  • vindictiveness

• ODD is exhibited during an interaction with at least one individual who is not a sibling

Intermittent Explosive Disorder

• Recurrent behavioral outburts that respresent a failure to control agressive impulses

• recurrent is defined as

  • twice weekly, on average, for a period of 3 months OR

  • three outburts involving property damage or physical injury to another person within a period of 12 months

• verbal or physical agression toward property, animals, or individuals

Conduct disorder

longstanding behavior that violates the rights of others and of social norms with little remorse for the behavior

• impact social, academic, or occupational functioning

categories of symptoms

• agression to people and animals

• destruction of property

• deceitfulness or theft

• serious violations of rules

Antisocial personality disorder

only given to individuals 18 years and older and only if there is a history of symptoms of conduct disorder before age 15

• pervasive pattern of disregard for and violation of the rights of others

• display three or more of seven specified behaviors

  • failure to conform to social norms with respect to lawful behaviors, deceitfulness, irritability and aggressiveness, reckless disregard for safety of self or others, and lack of remorse

Pyromania

involves deliberate and purposeful fire setting on more than one occasion

• associated with other types of impulsive behavior

  • alcohol and marijuana use

  • conduct disorder

  • histories of trauma

Kleptomania

relatively rare disorder

• associated with tension or anxiety that is relieved by stealing

  • the stolen objects are not needed for personal use or their monetary value

  • the stealing is done in a self “regulatory” way

Reactive Attachment Disorder (RAD)

Occurs when an attachment between the infant/child and their caregiver is not formed

• may occur from neglect or inconsistent caregiver routines

• OT can address sensory processing and emotional regulation, create a nurturing home environment, and parent coaching!!

Etiology of disruptive disorders

• genetic and parenting: disruptive behavior or boys vs. girls

• environment: history of trauma, maltreatment, and neglect, verbal abuse

• lack of intervention for childhood problems

• low responsivity in the amygdala (limbic system-emotional regulation)

Prevalence and gender considerations

• 4.6% of children aged 3 to 17 years with a history of a behaviorla or conduct problem

• prevalence among males is twice that of females

Course of defiant disorders

diagnosed in children and adolescents

early prevention focusing on life-stage transitions, if done so, the likelihood of antisocial personality disorder forming from conduct disorder is lower

in other cases these individuals go on to live a deviant and criminal lifestyle

Impact on occupational performance

changing life roles may require skills that haven’t been developed within current self-management plan

unable to follow protocols in the classroom or workplace, such as arriving on time or taking directions

difficulty following societal rules can result in legal issues, may lead to incarceration

self-care, and day to day activities, sleep habits and routines (may be erratic)

hygiene and self-maintenance (struggle to focus, identify daily needs and demands, follow societal expectations)

Approaches for intervention

Anger management, CO-OP, Dunn model of sensory processing, zones or regulation or alert programs, sensory rooms, mindfulness