Chapter 16 - Disruptive, Impulse-Control, and Conduct Disorders

Oppositional Defiant Disorder

• display a negativistic pattern of behaviors that limit social and academic development.

• characterized by “a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months

• exhibit at least four symptoms within these three domains

• indicated only when the observed emotional and behavioral dysregulation causes distinctive distress in the child or others within important social contexts

Treatment Strategies and Interventions (ODD)

• Parent Management Training Programs

• Parent–Child Interaction Therapy

• Family Therapy

• Cognitive Problem-Solving Skills Training

• Social Skills Training

Social Skills Training

engages clients in the intentional learning and practice of basic to advanced social interaction behaviors associated with actively contributing to conversations, collaborating with others, and helping behaviors.

Cognitive Problem-Solving Skills Training

This approach educates, models, and practices systematic strategies for finding adaptive approaches to solving everyday problems within the social environment that is associated with ODD symptoms

Family Therapy

promote developmental change and well-being through changing family dynamics and includes interventions such as psychoeducation, communication skills training, systems coaching, and related strategies

Parent–Child Interaction Therapy

This is a therapeutic approach integrating aspects of social learning theory, traditional play therapy, and attachment theory intended to enhance the quality of interactions within the parent–child relationship.

Parent Management Training Programs

based on social learning theory and teach parents how to use basic behavioral interventions with children

Intermittent Explosive Disorder

• an inability to control their anger or temper, frequently resulting in discrete acts of aggression directed at individuals, objects, or animals

• prone to unprovoked acts of aggression, including verbal aggression, but also can be observed making behavioral outbursts characterized by the absence of provocation

• made when children reach the chronological age of 6, or equivalent developmental level.

• disproportionate verbal or physical aggression toward a person, an animal, or property that does not result in bodily injury or property damage and occurs twice weekly, on average, for a period of three months

Assesment for IED

• Interview Module for Intermittent Explosive Disorder

  • consists of a structured clinical interview that assesses the frequency of outbursts, level of aggression, and level of social impairment.

  • includes items related to drug use, psychosis, depression, and medications.

Treatment for IED

• Medication

• Cognitive Behavior Therapy

• Play Therapy

Play Therapy

developmentally informed approach that uses play as a therapeutic medium for children to overcome developmental hurdles and achieve optimum growth and development.

Cognitive Behavior Therapy

• is the most widely recognized therapy for treating IED in child, youth, and adult populations

• include modeling, relaxation training, cognitive restructuring, teaching coping skills, behavior rehearsal, and strategies to resist aggressive impulses

Medication (IED)

• Children and adolescents with IED often have co-occurring mental health conditions, which complicate treatment options

• there is neither a cure for IED nor a medication or therapy modality designed specifically to militate associated symptom

• Medications that have been found to promote anger regulation in both adult and child populations include antidepressants (namely, selective serotonin reuptake inhibitors, or SSRIs), mood stabilizers (lithium and anticonvulsants), antipsychotic drugs, and antiepileptic drugs

Conduct Disorder

• represents a repetitive and persistent set of behaviors that either violate the rights of others or demonstrate disregard for major age-appropriate standards

• children must exhibit at least three symptom criteria from any of the available four categories in the past 12 months, with at least one symptom occurring in the past six months

• indicated only when the persistent pattern of behavioral dysregulation is associated with marked impairments in academic, social, or occupational functioning.

Assessment (CD)

include data related to

• (a) developmental issues that may present similarly to ODD,

• (b) history of abuse or neglect,

• (c) history of problematic substance use,

• (d) family dynamics and parenting style,

• (e) history of legal problems and adjudication, and

• (f) the degree that the child’s activities have endangered self or others.

Treatment for ODD

• Medication

• Multisystemic Therapy

• Parent Management Training

• Functional Family Therapy

• Brief Strategic Family Therapy

• Cognitive Behavioral Skills Training

Cognitive Behavioral Skills Training

• are intended to teach adaptive thinking and behaviors across five domains:

  • (a) social interactions,

  • (b) emotions,

  • (c) thinking style,

  • (d) behaviors, and

  • (e) parent or family interactions

• CBST is most effective when completed through engagement with family members and requires that the family system make changes in relations while teaching coping skills to both the youth and their parents or guardians

Brief Strategic Family Therapy

tends to view the undesired behaviors of youth with CD as a product of unhealthy, dysfunctional family dynamics.

Functional Family Therapy

• interventions with youth who have CD engage the family in understanding the underlying dynamics that promote undesirable behaviors and evaluation of the function that they serve

• family members evaluate how their behaviors influence the actions of others in an effort to promote reciprocal and reinforcing interactions while decreasing harmful manipulation and intimidation in the home

Parent Management Training

• has been indicated for the treatment of CD.

• This approach, which integrates aspects of social learning theory, traditional play therapy, and attachment theory, can be helpful for developing parent–child relationships, teaching parents to give clear instructions and rewards, reorganizing activities to prevent problems, and promoting prosocial play

Multisystemic Therapy

is an intensive approach to treatment that engages the youth and important family members in community-based settings

Medication (CD)

• several psychopharmacological interventions are commonplace for treating associated co-occurring or associated symptoms and thus supporting counseling interventions.

Antisocial Personality Disorder

a pervasive pattern of callous indifference is noted as remorse for actions that harm others appears to be largely absent

Pyromania

• characterized by a compulsion to set fires for purposes of pleasure and affective relief

• a relatively difficult disorder to diagnose and treat because clinicians are challenged to distinguish pyromania from other fire setting resultant from delinquency, inadequate supervision, or psychopathology.

• six distinct diagnostic criteria related to fire setting, including multiple episodes of fire setting; affective arousal from the planning, preparation, and execution of a fire; and a fascination with fire and fire setting paraphernalia.

Kleptomania

• an impulse-control disorder characterized by a compulsive desire to steal items not needed for one’s survival, personal use, or monetary gain

• report feeling intense tension or stress; these feelings are followed immediately after conducting the theft by feelings of relief, elation, and gratification

• must manifest five distinct diagnostic criteria as described in the DSM-5

  • Persistent impulse to steal objects not needed for personal use or gain

  • Experience of increased tension before carrying out a theft

  • Pleasure, gratification, or relief at the time of the theft

  • The impulse to steal does not result from ulterior motives, such as revenge or anger or a response to a hallucination or delusion

  • The act of stealing is not better explained by another disorder.