Disruptive, Impulse Control, Conduct & Neurodevelopmental Disorders

attention-deficit/hyperactivity disorder (ADHD)

an 8 y/o who is disruptive in class, always fidgeting, has difficulty concentrating & does not complete assignments

- characterized by problems paying attention, excessive activity, or difficulty controlling behavior which is not appropriate for a person's age

s/s of ADHD

prior to 12 y/o

- hyperactivity

- impulsivity

- inattentiveness

> 6 symptoms of inattention, hyperactivity-Impulsivity, developmentally inappropriate & duration of symptoms > 6 months

symptoms occur in more than one setting (ex: school & home)

how is ADHD treated?

stimulants (methylphenidate, mixed amphetamine salts)

asperger disorder

a child has normal cognitive development, poor relationships and does not spontaneously seek activities with others

autistic disorder

disruption of social interaction and language at age 3 or earlier

autism spectrum disorder (ASD)

a range of conditions classified as neurodevelopmental disorders

- present with a developmental delay in socialization, language, and cognition

what does ASD encompass?

- autistic disorder

- childhood disintegrative disorder

- pervasive developmental disorder (not otherwise specified)

- asperger disorder

what are the DSM criteria for ASD?

social communication & interaction deficit in many contexts, such as:

- lack of social emotional reciprocity

- lack of nonverbal communivative behaviors

- impairment in developing, maintaining and understanding relationships

restricted & repetitive patterns of behavior, interests or activities, such as:

- motor movements that are stereotyped or repetitive (ex: flipping objects)

- inflexibility to change

- restricted & fixated interests (these are typical w/ abnormal intensity or focus)

- hyper or hyporeactivity or unusual interest in a sensory stimulus (fascination w/ lights)

must be present in early developmental period in the absence of an organic etiology (ex: hearing dysfunction)

these symptoms cannot be better explained by other conditions (ex: intellectual developmental disorder)

how is ASD treated?

- refer (autism specialists, speech & language pathologist)

- audiology evaluation +/- EEG

- behavioral therapy

- meds (SGAs [risperidone, aripiprazole] for aggression/hyperactivity, mood lability (can also use haloperidol or carbamazepine)) & SSRIs for stereotyped/repetitive behavior)

conduct disorder

a child is referred to your office for unusual animal cruelty & bullying at school

- a repetitive & persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated

how is conduct disorder diagnosed?

by the presence of at least 3 of the 15 criteria in the past 12 months from any of the categories below w/ at least one criterion present in past 6 months

- aggression to people and animals

- destruction of property

- deceitfulness or theft

- serious violations of rules

what is conduct disorder often seen as the precursor to?

antisocial personality disorder

- which is not diagnosed until 18 y/o

what is the most effective treatment for an individual with conduct disorder?

a treatment that seeks to integrate individual, school and family settings and addresses familial conflicts (such as, marital discord or maternal depression)

oppositional defiant disorder (ODD)

a child is found to back talk and resist following the instruction from parents or other authorities

- a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months, as evidenced by at least 4 symptoms from any of the following categories & exhibited during interaction w/ at least one individual who is not a sibling

- symptoms:

*frequent temper tantrums

*arguments with adults and authority figures

*does not conform to rules and regulation

*intentional exasperation of others

*easily annoyed by others

*revenge-seeking & vindictiveness

*angry attitude

*harsh & unkind

how does ODD differ from conduct disorder (CD)?

children with ODD are NOT aggressive towards people or animals, do NOT destroy property, and do NOT show a pattern of theft or deceit

how is ODD treated?

- therapies (psychotherapy, CBT, and family therapy)

- pharmacotherapy (mood stabilizers, antipsychotics, & stimulants)

a 9-year-old boy who is brought by his mother after the child was suspended from school for being disruptive during class. The teacher noted that the patient is always fidgeting, has difficulty concentrating, and does not complete assignments. His mother notes that he often gets up and runs around the house when she is trying to call everyone for dinner and that this has been going on since he was 6 years old

ADHD

a 3-year-old boy is brought to your office by his mother due to abnormal behavior. She reports that he does not appear to respond to affection, does not look her in the eyes, and constantly lines up his toys. He becomes agitated when she tries to take him away from his toys or if the mother cooks a different meal for dinner. On physical examination, he does not respond to questions and is distracted by the texture of the exam-table cloth.

ASD

16y/o male with behavioral & impulsive problems since early childhood, manifested more prominently when he was 4. He was removed from his mother's care due to substance abuse. She reported using alcohol, cocaine, & crack during her pregnancy. He has repeated violations of school rules & disruption in class, often aggressive & cut school. Reported torturing animals & doing “sexual things” to them. He set his grandmother's bed on fire while she was sleeping in it. Psych testing was carried out & his results indicated an average IQ using the Wechsler Intelligence Scale for Children. His scale scores included a verbal score of 93, performance score of 104 & a full scale score of 95. Further testing revealed struggles with an extremely low self-esteem. Provided odd answers on a sentence completion assessment, mentioning several times “that I wish I was never born.”

conduct disorder (CD)

a 10-year-old boy whose parents c/o constant arguments. His parents state that he has “been a handful.” He argues all the time. He is always angry and is easily agitated. He seems to enjoy making others upset. At school, he does not listen to his teachers and argues with them all the time. His parents report that they are “fed up" with him and his behavior is "putting a lot of strain on our marriage.” Past medical history is significant for ADHD with panic disorder.

oppositional defiant disorder (ODD)