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8.67: Parenting and Epidemiology for Disruptive Disorders

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    23261
  • Parents

    • Parents need an arsenal of coping strategies to reduce the behavioral problems at home. The first step is effective diagnosis and treatment by a practioner with experience in mental disorders of childhood. Nearly all of the behaviors associated with the Disruptive Behavior Disorders (DBD) may be seen in normal children from time to time. The Disruptive Behavior Disorder (DBD) diagnosis is made when the frequency and persistence of these symptoms result in clinical impairment in social, academic or occupational functioning. Ongoing supervision by a competent mental health practitioner is crucial because the disruptive behavior disorders are frequently accompanied by other disorders such as ADHD, Anxiety, and Mood Disorders.
    • Children with DBD’s need a higher level of supervision than other children of the same age. However, supervision does not always have to be by the parent. In fact, because defiant behavior is often directed primarily at parents and teachers, parents may find that alternative caregivers, such as competent babysitters or aides, are able to develop good relationships with the child that provide social learning for the child and valuable respite for parents.
    • Respite and parent support are important because parents need to be in control of their own emotions during difficult episodes with the child. These kids enjoy making you mad, and they are good at it. Parents need to maintain an emotionally neutral stance when giving instructions or consequences to the disruptive child. This skill does not come naturally and must be practiced and perfected over time. If parents don’t learn to control their own emotions when disciplining the child, the result is often violence and escalation of the disorder.
    • Find ways to maintain a positive relationship with your child. Pay attention to his good qualities and find joy in the moments of closeness. We naturally avoid people who cause us anxiety and are angered when they hurt us. But, we love our children and that drives us forward to seek healing for them and for us. You need an outlet for your own feelings, so seek out support to help you cope. Many parents also find that they need support to maintain a healthy, supportive marriage in difficult situations.
    • Get a plan and stick with it. Learn all you can about how to effectively manage your child’s behavior; find what works for you; and then use those strategies in a consistent and structured way. Routines and clear expectations for behavior benefit all children. They are vital to the healthy development of the disruptive child.
    • Resources for c ommon behavioral problems associated with the diagnosis of Disruptive Behavior Disorder and strategies for parents:
    • Instead of feeling anger, frustrated, and becoming overwhelmed when children display disruptive behavior, as a parent, role models, and educators we need to be empathetic and feel compassion and love for these children. We love those children, just not their disruptive behaviors. One main reasons children are disruptive, is due to a lack of boundaries and goals not being set clearly at an early stage of life, this lack can lead to disruptive behavior in and outside the home. We need to be specific and concrete on what needs to take place in the home, outside the home, in school, ect. We must model what success and appropriate behaviors look like and show children how to exhibit these positive behaviors.
    • When talking to your children, let them know exactly what and how good behavior needs to be implemented. Remember to be specific; don’t just say “be good today” but state “be good today by not disrupting the classroom and listening to your teacher.” Talk about these goals and objectives each day with your child, and if inappropriate behavior follows, consequences need to immediately be followed through as well. Reward immediately and efficiently when your child is effective and responsive. Use eye contact when giving requests, and have your child repeat back to you what you have said in order to ensure that he really understands what needs to be accomplished. Make realistic and achievable goals for your children, and let them know the consequences beforehand to reinforce good behavior. This allows the child to stop and think about actions before reacting. By setting expectations too high for your child, you are setting them up for failure, and they respond by feeling overwhelmed and frustrated.
    • It is also very important to remember not to look at your child’s “C” grade, but to look at the progress from a failing class. Successful treatment does not happen overnight. So many parents want results immediately and get anxious, which causes the child to feel “anxious.” This system does not work. This progress needs to be slow but steady. If a child acts up less each week, that is an example of slow but successful and steady progress, and children need to be acknowledged and rewarded. Gauge success by your own child’s standards, not by what is considered “the norm” or someone else’s standards. Focus on your child, we will be not be set up for failure if we are not constantly comparing our children or ourselves to others. Remember that each child is special, unique, and responds differently.
    • I highly recommend star charts or success charts to gauge students’ progress in specific behavior, but be sure to include your child in this process. It is important the child sees progress daily to focus on the behaviors and positive feedback and be part of this process. Reward systems work well for students of all ages, not just the younger ones. Success charts benefit the child and get the whole family involved. Older children can also use privileges such as pagers, driving the car, cell-phone usage, etc. The family must be supportive and consistent in reinforcing positive responses and outcomes when they occur. Remember: it is essential to set specific, measurable, achievable, realistic, and time efficient goals. This will make a big difference to help disruptive behaviors become deserving behaviors ! This is what we want!
    • We must avoid being reactive towards this resistant behavior from our children. Show your child who’s in control by demonstrating self-control and restraint. Always stay calm, controlled, and collected when your child acts up. Remember: act rational to create rational behavior and responses from your child. Time-outs are highly effective for younger children, and a good formula to use is one minute per one year of age, e.g. 6 minutes for a sixyear old. The child needs to have time out to understand what was done wrong, and what he can do better next time, and should resolve the issue with an apology.

    Epidemiology for Disruptive Disorders:

    • Conduct problems are one of the most frequent reasons for referral to child and adolescent treatment services. Prevalence rates are estimated to be 2-5%.
    • These problems are more often diagnosed in boys than in girls: 3-4:1 ratio, perhaps because of the emphasis on male expressions of aggression.
    • Contextual factors (poverty, high-crime neighborhoods) increase conduct problems.
    • ODD is often a precursor of CD, although the child cannot receive both diagnoses.
    • Average onset for ODD: six years old; for CD: nine years old.
    • Most children (75% in one study) do not progress from ODD to CDl
    • Co-occurring disorders include ADHD (35-70%); ADHD often comes first.
    • Profile of children with disruptive disorders includes peer rejection, lower school achievement, verbal/language deficits, deficits in executive functions.
    • Co-occurring disorders also include anxiety disorders (19-53%) and depression (12-38% of community samples, 33% of clinical samples; boys show greater co-occurrence than girls).
    • Some but not all (estimates of 25%) children continue a course of aggressive and antisocial behaviors into adolescence; early childhood onset is related to more serious and persistent antisocial behaviors; this early onset pattern is less common than the adolescent-onset pattern (3-5% of the general population). These children have often been described as having a “difficult temperament during infancy”.
    • Adolescent-onset pattern is the more common developmental pathway, with slightly more females than males; problematic behaviors often stop after adolescence and are referred to as adolescent-limited.
    • A developmental triple pathway model is provided by the research of Loeber and colleagues: the overt pathway, the covert pathway and the authority conflict pathway.
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