Week 8: Disruptive Behavior Disorder & ADHD

Disruptive Behavior Disorders

• Involve difficulty regulating emotions/behaviors.

• Characterized by anger, hostility, and aggression.

• Targeted behaviors can affect people and property.

• Primary disorders include:

  • Oppositional Defiant Disorder (ODD)

  • Conduct Disorder

  • Intermittent Explosive Disorder (IED)

• Continuum Concept:

  • ODD and Conduct Disorder are viewed on a continuum with Antisocial Personality Disorder.

  • ODD is seen as a milder variant of Conduct Disorder.

• IED is an impulse control disorder, diagnosed from adolescence to young adulthood.

Related Disorders

• Kleptomania: Impulsive, repetitive theft of unnecessary items.

  • More common in females; negative consequences arise.

• Pyromania: Repeated intentional fire setting; no external motivations.

  • Often leads to legal issues.

Oppositional Defient Disorder (ODD)

• Common in children/adolescents. Patterns of defiance and hostility toward authority.

• Diagnosis: Behaviors more intense than peers; significant anger toward authority.

  • Disruptive in social, academic, and work settings.

  • Initial Settings: intensity begins at home, particularly with parents.

• Common behaviors include:

  • Frequent temper tantrums.

  • Argumentative behavior.

  • Refusal to comply.

• Risk Factors: family history, inconsistent discipline, exposure to trauma.

• Prognosis Factors for ODD: Limited association of behavior and consequences and impaired problem-solving abilities.

  • Common comorbid disorders: ADHD, anxiety, mood disorders.

Treatment for ODD

• Parent management training, cognitive-behavioral therapy, and social skills training.

• Use different strategies to address comorbid conditions and focus on behavioral interventions.

Intermittent Explosive Disorder (IED)

• Defined by repeated impulsive, aggressive behavior disproportionate to stressors.

  • Emotional outbursts characterized by disproportionate intensity.

• Diagnosis: Seen in late adolescence (can occur after 6 years of age); often follows stressful situations.

• Etiology: Linked to trauma, neglect, neurotransmitter imbalances, and frontal lobe dysfunction.

• Demographics: Common onset during adolescence; more prevalent in males.

• Common comorbid disorders include substance use, anxiety disorders, depression, ADHD, and ODD.

Treatment for IED

• Psychopharmacology: SSRIs, mood stabilizers, anticonvulsants.

• CBT aims to identify triggers and develop coping strategies through cognitive restructuring and modifying behaviors.

• Anger Management Strategies

  • Techniques: deep breathing, progressive muscle relaxation.

Medications for IED

• SSRIs like Fluoxetine (Prozac).

• Lithium as a mood stabilizer for labile mood/behaviors.

  • Cannot be given if pregnant.

• Anticonvulsant mood stabilizers (e.g., valproic acid [Depakote], phenytoin [Dilantin], topiramate [Topamax], oxcarbazepine [Trileptal]).

Reduce aggressive impulses and irritability, but do not eliminate outbursts.

Conduct Disorder

• Characterized by persistent behavior violating societal norms; includes aggression and deceit.

  • Callous traits and a lack of empathy were noted.

  • Harm/kill animals, family pets, or seek easy human targets.

• Onset and Clinical Course: Childhood-onset (before age 10, higher risk) vs adolescent-onset (after age 10, lower risk).

• Risk factors: family history, prenatal exposure, poor parenting.

• Protective factors: positive role models, healthy relationships.

Treatment for Conduct Disorder

• Emphasis on prevention and early intervention more effective than treatment.

• Pharmacological treatment has limited efficacy, with some medications targeting specific symptoms.

  • Antipsychotics (2nd and 3rd generation) for aggression, mood stabilizers for labile moods.

Nursing Assessment and Interventions

Recognizing and Analyzing Cues: Assessment includes a history of aggression and deceitfulness.

Prioritization and Planning: Key interventions focus on injury prevention and treatment engagement.

Interventions: Decreased violence; increased treatment compliance.

Self-Awareness: Recognizing personal beliefs and adopting supportive approaches in behavior management for the child and parents.

ADHD

Characterized by inattention and impulsiveness, affecting 9% of school-age children, with 60% of symptoms persisting into adulthood.

Key traits: inattention, hyperactivity, and impulsivity.

Diagnosis: often occurs in preschool, with symptoms potentially recognized earlier.

Causes: not fully understood, but genetic and environmental factors, such as family history and prenatal influences, play a role.

Risk Factors: Includes family history, environmental toxins (e.g., lead), prenatal exposure (e.g., alcohol, tobacco), severe early childhood malnutrition, family discord, low birth weight, and maltreatment.

Treatment Options for ADHD

Treatment includes behavioral interventions and medications like stimulants (e.g., Ritalin, Adderall) and non-stimulants (e.g., Atomoxetine).

• Common Side Effects: Anorexia, weight loss, nausea, irritability, and potential growth suppression.

Patient Teaching: Take doses after meals; avoid caffeine, sugar, and chocolate; and ensure medications are stored out of children's reach.