Disruptive, Impulse-Control, and Conduct Disorders

Oppositional Defiant Disorder

Individual must display a pattern of defiance lasting at least 6 months
as evidenced by at least 4 symptoms from various 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 outbursts that represent a failure to control aggressive impulses

Recurrent” is defined as
+ Twice weekly, on average, for a period of 3 months or
+ Three outbursts involving property damage or physical injury to another
person within a period of 12 months
+ Verbal or physical aggression toward property, animals, or other individuals

Conduct Disorder

Long standing behavior that violates the rights of others and of social
norms with little remorse for the behavior
Clinically significant impairment in social, academic, or occupational
functioning
4 Categories of symptoms:
• 1. Aggression to people and animals (e.g., often initiates physical fights or has been physically cruel to animals)
• 2. Destruction of property (e.g., has deliberately engaged in fire setting with the intention of causing serious damage)
• 3. Deceitfulness or theft (e.g., has stolen items of nontrivial value without confronting a victim or shoplifting without breaking and entering)
• 4. Serious violations of rules (e.g., is often truant from school, beginning before age 13 years)

Antisocial Personality Disorder

Only given to individuals 18 years of age 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
+ An individual must display three or more of seven specified behaviors, such as 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 disorders
+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 for their monetary
value, the stealing is not committed to express anger or vengeance and is
not in response to a delusion or a hallucination, and the stealing is not
better explained by another disorder.

Reactive Attachment Disorder (RAD)

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, creating a nurturing home environment, parent coaching.

Etiology

Genetics and parenting
+ “harsh discipline was related to disruptive behavior of both boys and girls,
whereas only permissive discipline was related to disruptive behavior of
boys”
+Environment – hx of trauma, maltreatment, and neglect.
+Verbal abuse creates very negative view of the world.
+Lack of early intervention for childhood challenges.
+Low responsivity in the amygdala.

Prevalence and Gender Considerations

• 4.6% of children aged 3 to 17 years with a history of a behavioral or conduct problem such as ODD or conduct disorder

• An estimated 3.5% of children had a current behavioral or conduct problem

• Prevalence among males is twice that of females.

• Conduct disorder, often with co-occurring ADHD, is linked to substance use disorders in adulthood

ADLs and IADLs

Areas impacted may include
+ Self-care and day-to-day activities
+ Sleep habits and routines - may be erratic, with the resulting sleep
deprivation and fatigue enhancing problems with cognition, conduct/irritability, and overall daily performance
+ Hygiene, self-maintenance, and care of others in adult life - may all be
compromised as the individual struggles to focus, identify daily needs and demands, and prioritize according to societal expectations.

Role of Occupational Therapy

Assess the impact of cognitive, sensory processing, and emotion regulation concerns as they relate to problematic behaviors
+ Many times their disruptive behavior excludes them from participation in typical activities (e.g., spending the night at a friend’s house, being a
member of a sports team), thereby resulting in a lack of opportunity to experience typical developmental milestones