This document discusses evaluating and understanding disruptive behavior in children. It begins by defining disruptive behavior and providing examples. It explains that some behaviors are developmentally normal for younger children but could become problematic depending on the child's age. Causes of disruptive behavior can be biological, psychological or social. The document provides guidance on when to seek professional help and lists disorders that can involve disruptive behaviors. It also outlines approaches to evaluating a child with disruptive behaviors.
Complex developmental disability in infancy and early childhood, sign and symptom, its treatment via therapist approaches across the child's daily life
Complex developmental disability in infancy and early childhood, sign and symptom, its treatment via therapist approaches across the child's daily life
i was interested in Autism and this semester i find a good opportunity to make a presentation about autism because we are studying a subject called Psychology of Handicap.
I hope you find this presentation useful.
Yahya Fehdi , Psychology major.
A power point presentation on Autism Spectrum disorders I created in collaboration with a team of three other graduate students at the University of Dayton.
This presentation provides a brief overview of early brain development with links made to early years practice. Questions are included to help practitioners reflect on their role in helping to positively influence early brain development.
This presentation is an introductory presentation on Autism (ASD): together with the list of lots of online sources and organizations that can help you to find out more information on this type of brain developmental disorder.
Conduct disorder is an ongoing pattern of behaviour marked by emotional and behavioural problems.
Ways in which Children with conduct disorder behave are
Angry,
Aggressive,
Argumentative, and
Disruptive ways.
It is a diagnosable mental health condition that is characterized by patterns of violating
Societal norms and
Rights of others
It's estimated that around 3% of school-aged children have conduct disorder and require professional treatment .
It is more common in boys than in girls.
i was interested in Autism and this semester i find a good opportunity to make a presentation about autism because we are studying a subject called Psychology of Handicap.
I hope you find this presentation useful.
Yahya Fehdi , Psychology major.
A power point presentation on Autism Spectrum disorders I created in collaboration with a team of three other graduate students at the University of Dayton.
This presentation provides a brief overview of early brain development with links made to early years practice. Questions are included to help practitioners reflect on their role in helping to positively influence early brain development.
This presentation is an introductory presentation on Autism (ASD): together with the list of lots of online sources and organizations that can help you to find out more information on this type of brain developmental disorder.
Conduct disorder is an ongoing pattern of behaviour marked by emotional and behavioural problems.
Ways in which Children with conduct disorder behave are
Angry,
Aggressive,
Argumentative, and
Disruptive ways.
It is a diagnosable mental health condition that is characterized by patterns of violating
Societal norms and
Rights of others
It's estimated that around 3% of school-aged children have conduct disorder and require professional treatment .
It is more common in boys than in girls.
Module 3In this module, you will continue to explore specific hi.docxgilpinleeanna
Module 3
In this module, you will continue to explore specific high-incidence exceptionalities, including those related to behavior, emotions, communication, intellect, and autism spectrum disorders.
Complete the following readings early in the module:
· Human exceptionality: School, community, and family (10th ed.), read the following chapters:
· Emotional/behavioral disorders
· Communication disorders
· Intellectual and developmental disabilities
· Autism spectrum disorders
· Handel, A. (Producer), & Puchniak, T. (Director). (2001). Is love enough? [Documentary]. United States: Filmakers Library. Retrieved from http://flon.alexanderstreet.com.libproxy.edmc.edu/view/1641316/play/true/
· Ravindran, N., & Myers, B. J. (2012). Cultural influences on perceptions of health, illness, and disability: A review and focus on autism. Journal of Child & Family Studies, 21(2), 311–319. doi: 10.1007/s10826-011-9477-9. (EBSCO AN: 73325870)
http://libproxy.edmc.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=73325870&site=ehost-live
As our focus for this module is the specific dynamics between peer groups and the development of children, pay special attention to the assigned readings that deal with the topics listed below. You can even use the search feature in your digital textbook to help pinpoint specific text sections to review.
Keywords to search in your digital textbook and journal articles: strength-based assessment, behavior intervention plan, oppositional defiant disorder, conduct disorder, social maladjustment, adaptive behavior, chromosomal abnormalities, metabolic disorder expressive language, receptive language, Asperger syndrome or Asperger disorder, and stereotypic behavior.
Module 3 learning resources
Use Module 3 learning resources provided on the pages that follow to enhance your understanding of high-incidence disabilities. Take a moment to check out some of these featured learning resources:
· Exceptional Children: This self-assessment activity presents a scenario of Serafina, an exceptional child, and provides you the opportunity of identifying the exceptionalities presented and suggesting an intervention.
· Ethical Considerations: This self-assessment activity presents a scenario of Andrea, an exceptional child, and provides you the opportunity of identifying the ethical considerations that should be taken in this case.
Module Topics:
· High-Incidence Disabilities
· Emotional Disorders
· Behavioral Disorders
· Communication Disorders
· Intellectual Disorders
· Autism Spectrum Disorders
Learning outcomes:
· Describe and discuss the continuum of exceptional development, including identification of exceptionalities and individual strengths.
· Apply current, peer-reviewed research on environmental, biological, and cognitive influences on development to design systemic support and/or intervention plans for home, school, and transition for children with exceptionalities.
· Evaluate cultural, ethical, and legal ...
There is no precise definition of behavioral problems, but we can define them as child behaviors that cause or are likely to cause difficulties in the child's learning activities. A child may show one or more than one behavior problem during his/her period of development. Some behavior problems may occur at a specific stage of development while some behavior problems occur at different stages.
S Vitto Breaking Down The Walls MIBLSI State Conference 09Steve Vitto
This is an overview of the causes and treatment of oppositional defiant behavior (ODD), social maladjustment, and conduct disorder. The presentation included etiology, and evidence based treatment recommendations, using the competing pathways approach..
emotional problems in youngsters.
•Conduct disorder usually happens between the ages of 6 and 15.
•factors contributing to development of conduct disorder
•brain damage
•child abuse or neglect
•genetic vulnerability
• school failure
• traumatic life experiences.
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Changes from DSM-IV to DSM-V
•The chapter on “Disruptive, impulse-control, and conduct disorders” is new to DSM-5.
•It brings together disorders that were previously included in the chapter “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence”.
DISORDER CONTENTOF THOUGHT -DELUSION
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN
Definition of delusion:
Delusions are categorized into four different groups
THERE ARE 2 TYPES OF DISORDERS OF THOUGHT CONTENT
1.DELUSION
2.OVERVALUED IDEAS
DISTINGUISED
DELUSION
OTHER MEMBERS OF THE CULTURE DONOT SHARE THE BELIEF.
NEED NOT BE ASSOCIATED WITH AFFECT.
FIRMLY SUSTAINED BELIEF.
CONVINCED THAT DELUSION IS REAL.
RECOGNIZED AS ABSURED.
CANNOT BE ACCEPTED.
OCCUR IN MENTALLY ILL PATIENTS.
OVERVALUED IDEAS
OTHER MEMBERS OF THE CULTURE SHARE THE BELIEF.
ASSOCIATED WITH VERY STRONG AFFECT.
NOT HELD FIRMLY.
ATLEAST SOME LEVEL OF DOUBT AS TO ITS TRUTHFULNESS.
NOT RECOGNIZED AS ABSURED.
ACCEPTABLE.
CAN OCCUR IN BOTH HEALTHY AND MENTALLY ILL PATIENTS.
KENDLER’S VECTORS FOR DELUSION:
five stages in the development of delusion(FISH & CONRAD)
FACTORS CONCERNED WITH GENERATION OF DELUSIONS
PATHPOPHYSIOLOGY OF DELUSIONS
PRIMARY DELUSIONS
SECONDARY DELUSIONS
SYSTEMATIZATION
DELUSIONS ON THE BASIS OF CONTENT OF DELUSIONS
THANK YOU
SCHENIDER FIRST RANK SYMPTOMS
BY DR.WASIM
UNDER GUIDANCE OF
DR.SANJAY.JAIN.
EVOLUTION OF THE CONCEPT OF FRS
CONCEPTS AND DEFINITION
Schneider formulated what he considered to be pathognomic of first rank symptoms of schizophrenia (Schneider, 1959).
THANK YOU
Second and third generation antipsychoticsDr Wasim
SECOND & THIRD GENERATION ANTIPSYCHOTIC mechanism of actionmechanism of side effectmanagment of side effect BY DR WASIM UNDERGUIDANCE OF DR SANJAY JAIN
First generation=typical antipsychoticaka conventionalprimary pharmacological property of D2 antagonistSecond generation=atypical antipsychoticlow EPS and good for negative symptomsThird generation=aripiprazole metabolic friendly
MECHANISM OF ACTION
1) serotonin dopamine antagonists
4)serotonin partial agonist
MECHANISM OF SIDE EFFECT
Serotonin-2C, muscarinic-3, and histamine-1 receptors as well as receptors X
identified are all hypothetically linked to cardiometabolic risk.
antagonism of serotonin-2C and histamine-1 receptors is associated with weight gain, while antagonism atmuscarinic-3 receptors can impair insulin regulation.
An unknown receptor X may be involved in the rapid production of insulin resistance and may also rapidly cause elevated fasting plasma triglyceride levels in some patients who experience increased cardiometabolic risk on certain atypical antipsychotics
Atypical antipsychotic and risk for weight gain.FDA and experts agree on three tiers of risk
Atypical antipsychotic and cardiometabolic risk.FDA and experts disagree on one versus three teirs of risk
Metabolic friendly antipsychotic.Low- risk agents for weight gain and cardiacmetabolic illness.
Monitoring and Managment
Baseline investigations :
Family h/o diabetes
BMI
Fasting TG levels (also monitored throughout treatment)
If raised : consider switching to another agent +/- lifestyle changes
For obese/ prediabetic/ diabetic pts :
Monitor BP
Fasting glucose
Waist circumference (before and after Rx)
Be vigilant for DKA/HHS
Sedation
ARIPIPRAZOLE KNOWN AS THIRD GENERATION ANTIPSYCHOTIC
THANK YOU
Neuroimaging of Alzheimer’s disease and Healthy Aging
BY DR WASIM
UNDER THE GUIDANCE OF
DR R.K.SOLANKI
ANATOMICAL BRAIN IMAGING
CT – cerebral tomography
MRI – magnetic resonance imaging
FUNCTIONAL BRAIN IMAGING
SPECT – single photon emission computed tomography
PET – FDG – Positron emission tomography
BRAIN CHEMISTRY MEASUREMENT
MRS (spectroscopy – NAA/Cr: estimate neuronal volume)
BRAIN PATHOLOGY IMAGING
FDDNP – neurofibrillary pathology
Evolution of Neuroimaging in AD
Computed Tomography
MRI
Volumetric MRI
Functional MRI
FDG Glucose PET
Amyloid Imaging
FDG-PET in AD and MCI
JEAN PIAGET
BY WASIM
UNDER GUIDANCE OF
DR.PRADEEP.SHARMA
Jean Piaget (1896-1980) : History
Theory of Cognitive Development
What is Cognition?
What is Cognitive Development?
How Cognitive Development Occurs?
Key concepts
Stages of intellectual development postulated by Piaget
Sensorimotor Stage (Birth to 2 Years)
Stage of Preoperational Thought (2 to 7 Years)
Stage of Concrete Operations (7 to 11 Years)
Stage of Formal Operations (11 through the End of Adolescence)
Clinical applications
Educational Implications
Contribution to Education
Strength
Limitation of jean piaget’s cognitive development theory
Critiques of Piaget
THANK YOU
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Evaluating child with disruptive behaviour
1. Evaluating child with disruptive behaviour
BY DR WASIM
UNDER GUIDANCE OF
DR GUNJAN SOLANKI
2. What is disruptive behaviour?
Disruptive behaviour in children refers to behaviours that occur
when a child has difficulty controlling their actions.
This is often in social settings, and can happen for many different
reasons.
Examples of disruptive behaviours include temper tantrums,
interrupting others, impulsiveness with little regard for safety or
consequences, aggressiveness, or other socially inappropriate acts.
In younger children, some disruptive behaviours are considered
developmentally normal if they occur some of the time.
For instance, temper tantrums, seen as periods of intense emotional
expression such as anger or sadness, along with crying or screaming,
would be considered normal in toddlers. As the child develops and
learns to understand their emotions and behaviour, their ability to
control behaviour improves.
3. When does it become a problem?
Whether a particular behaviour can be considered abnormal depends
on whether that behaviour is to be expected for each child’s
developmental stage.
For instance, it would be unusual for a developmentally normal 10
year old child to have regular tantrums.
Likewise, impulsiveness, often seen as distractibility or apparently
thoughtless behaviour without regard for safety or consequences, is
developmentally normal for a 2 year old, but highly unusual for a 12
year old.
A disruptive behaviour disorder may be present when the disruption
caused by a child’s difficulties with emotional and behaviour control,
is more than what would be considered typical for a child of their age
and developmental level.
4. What Causes Disruptive Behaviour?
Disruptive behaviour can have a number of different causes. These
causes may have biological, psychological, or social factors that help
explain the behaviour.
Examples of Biological factors include:
1. Difficulties with hearing: leaving a child unable to understand what is
said to them or asked of them;
2. Illness or injury that causes pain: meaning that their usual ability to
control their own emotions and behaviour is affected;
3. Learning impairment or delays in cognitive development: meaning
that a child is less able to understand their world compared to other
children;
4. Difficulties with concentration or attention:, meaning a child is unable
to focus and sustain attention that is out of keeping with normal
concentration for the child’s age;
5. Examples of Psychological factors include:
1. Being more prone to worry: resulting in the child behaving in a way
that helps them to avoid doing something that is frightening or
anxiety provoking;
2. Children who have experienced significant trauma: avoiding or
hiding from things that bring up their memories of their traumatic
experiences;
3. Children who are prone to worry, arising from traumatic
experiences: always being on the lookout for danger, and possibly
reacting to defend themselves in situations they believe are causing
them threat.
Examples of Social factors include:
1. Children who have had little opportunity to learn about social rules
being placed in new environments and being expected to follow
rules they do not know;
2. Stress affecting other family members being felt by the children,
who are aware of feelings of tension in the family, but are unable to
put words to it.
6. When do parents need to seek professional help?
Some disruptive behaviour will disappear without any intervention,
and will not require any change to your parenting style.
Help should be sought, however, if disruptive behaviours stay for
more than a few weeks, or if the behaviours are causing harm to the
child, or others around the child.
Harm refers to not just physical injury, but psychological harm, or
harm arising from missing usual activities such as school or other
extracurricular activities.
7. What disorders or illnesses can result in disruptive behaviour?
Disruptive behaviour can feature in a variety of childhood mental and
behavioural disorders.
Examples include
Attention deficit hyperactivity disorder
Disruptive behaviour disorder
Post-traumatic stress disorder
Intellectual disability
Anxiety & Depression
Psychosis, Organic brain syndrome…
A comprehensive assessment by a specialist or a child health service will consider all of
the possible contributing factors, and make an appropriate diagnosis to assist with
devising a treatment plan.
8. Well-replicated findings for disruptive behavior problems.
1) Disruptive behavior problems commonly start before age 2 years
and may persist over many years.
2) In adult life they are associated with criminality; with the
behavioral and social difficulties identified as DSM Antisocial
Personality Disorder; and with psychiatric disorders such as
substance misuse and depression.
3) Rates of antisocial and delinquent behaviors increase markedly
during adolescence and fall in adult life.
4) Between 50% and 70% of children with disruptive behavior
problems show improvement during childhood, but some
continue to have adjustment problems.
5) Disruptive behavior problems are more common in boys than in
girls.
9. Numerous risk factors are associated with childhood disruptive
behavior.
parental criminality and psychiatric disorders
prenatal anxiety
smoking in pregnancy
Single parent status, marital discord, partner violence, poor parental
supervision, harsh parenting, child physical abuse.
social deprivation
neighbourhood violence
low IQ, language delay, low school achievement,
large family size, low family income, antisocial peers
high delinquency-rate schools, and high crime neighbourhoods.
(Murray & Farrington, 2010).
10. How do we approach the these child
Councilor
pediatrician
teacher
parents
Paramedical
staff
Child and adolescent psychiatrist
Referrals
12. Evaluation of the child
History of child
Classification Criteria
Psychiatric status
Possible Diagnosis according
to probabilities
Specific Rating Scales
Cognitive tests
Continuous
Performance Tests
Specialized tests:
MRI, CT..
Diagnosis and Comorbidity
14. Disruptive Behaviour in ADHD
The first symptoms include:
1. Unregulated sleep and appetite
2. Early motor development
3. Tendency to inattention, a need of parents’ attention and holding
The most prominent feature: the hyperactivity – impulsivity
Attention is sometimes very difficult to measure.
Young children with ADHD exhibit more problem behavior and are
less socially skilled than normal counterparts.
15. Differential Diagnosis
Difficult temperament
Children who have been given no clear limits.
Behavioral disorder or ODD
Deviations in IQ (talented / retarded).
Spasms of Petit Mal type.
Chronic inflammation of the middle ear, antihistaminic
medications.
Undiagnosed sight and hearing problems.
Other physical and/or chronic conditions, such as impaired
sight, impaired hearing, hyperthyroid, hypothyroid and
severe anemia.
16. ADHD: Comorbidity
Preschool children with ADHD are likely to exhibit ODD, anxiety, or
mood disorders.
Many children with ADHD also show developmental disorders such
as: fine motor skills disorder, language disorder, etc.
Childhood ADHD
The time factor begins to be critical (before adolescence)
There is high frequency of comorbidity, which increases with age.
17. Disruptive Behavior Disorders
The term “disruptive behavior disorders” refers to a broad set of
aggressive, disruptive, oppositional, and anger-related behaviors.
A core paradox about childhood disruptive behavior problems is that
while they are widely viewed as having social origins, reflecting
parental and societal failures, and so readily amenable to social,
educational, economic or political solutions, they are also among the
most intransigent and harmful of known mental health disorders.
A review of conceptual issues has to embrace both sides of this
paradox.
On the one hand many of these problems represent a failure of
socialization in childhood and then in adult life, so that sufferers find
themselves in disadvantageous situations, such as social isolation and
school exclusion in childhood, youth offender institutions in
adolescence and prison in adult life. This socialization process might
be altered by changes in social, educational, or economic conditions.
18. On the other hand, children with behavioral problems differ from
other children in multiple ways, genetic, temperamental,
physiological and social cognitive, and even early in childhood many
do not gain from improvements in environmental conditions.
Children who display a broad range of behaviors that bring them into
conflict with their environment.
Age-inappropriate actions and attitudes that violate family
expectations, societal norms, and personal property rights of
others.
Heterogeneous Behaviors fall along a continuous dimension of
externalizing behavior, which includes a pattern of….
Impulsivity
Over-activity
Defiance
Aggressiveness
Delinquency (*legal term)
19. Prevalence:
General Disruptive Behavior
50% of preschoolers display disobedience.
26% of preschoolers destroy property.
60% of teenagers engage in more than one type of
delinquent behavior.
Referrals for males outnumber females anywhere from 4:1
to 6:1
20. Prevalence:
Diagnosable Behavior Problems
One of the most common referrals (1/3-2/3 of all
child referrals)
8-12% of children meet specific DSM criteria for
diagnosis of ODD and/or CD
21. The Disruptive Behavior Disorders might best be described along a
continuum as the emergence of ODD may be a precursor to CD. It is
estimated that ADHD is a co-occurring condition in approximately half
of all children with ODD or CD.
Although ODD is more common among boys prior to puberty, the
trend does not persists after puberty. The ratio of CD is greater in
males than females. The manifestation of CD is also different
between males and females.
CD onset in girls is generally prior to adolescence (Keenan, 2010).
As the following diagram depicts, the possibility of progression exists
with a Disruptive Behavior Disorder. Steiner and Remsing (2007)
indicate that approximately two-thirds of children diagnosed with
ODD will no longer meet diagnostic criteria after three years.
However, earlier onset is three times more likely to progress to CD.
They also report that forty percent of those diagnosed with CD
eventually meet the criteria for Antisocial Personality Disorder .
22.
23. Etiology
There are a number of factors associated with the cause of Disruptive
Behavior Disorders.
Biological
Parent with a diagnosis of:
Alcohol Dependence
Antisocial Personality Disorder
Attention Deficit/Hyperactivity Disorder
Conduct Disorder
Schizophrenia
Sibling with a Disruptive Behavior Disorder
ODD: Familial Pattern ODD is more common in families in which at
least one parent has a history of Mood Disorder, ODD, CD, ADHD,
ASPD, or a Substance Related Disorder. ODD is more common in the
families where there is serious marital discord.
24. CD: Familial Pattern Twin and adoption studies show genetic and
environmental factors.
Maternal smoking during pregnancy
Environmental Risk Factors
Parental rejection/neglect
Harsh discipline
Inconsistent parenting/multiple caregivers
Lack of Supervision
Large family size
Single parent status
Marital discord
Abuse – emotional, physical or sexual
Poverty
Parental criminality & psychopathology
Drug and alcohol use by parents/caregivers
25.
26. Early Warning Signs
Irritable temperament
Inattentiveness
Impulsivity
Defiance of adults
Poor social skills
Lack of school readiness
Coercive interactive style
Aggression toward peers
Lack of problem-solving skills
27. Diagnostic Criteria
Oppositional Defiant Disorder
Loses temper
Angry
Arguing with adults
Disobedience
Easily annoyed
Spiteful
Blames others for mistakes
Deliberately annoys others
The principal subdivision to be made in ODD is between the variety
that appears to progress to CD and the variety that does not.
Greater severity and early onset of oppositional behavior, frequent
physical fighting, parental substance abuse and low socio-economic
status appear to increase the risk of progression to more severe
antisocial behaviors observed in CD (Dulcan & Loeber, 1995)
28. Conduct Disorder
Exhibits a pattern of behavior that violates the rights of others
or disregards age-specific social norms
o Deliberately break rules
o Aggressive toward people or animals
o Destructive of property
o Lying and theft
o Violation of rules
Protective factors would include
o Late onset
o Early assessment
o Effective treatment
o The absence of co-occurring disorders
o Negative family history for DBD
29. Angry, argues, easily
annoyed, disobedient,
spiteful, loses temper,
blames others
Violates others’ rights,
physical harm, property
damage, deceitful,
serious violations of
rules
Prognosis Guarded with onset
before age 10 or if more
serious symptoms are
present
Guarded
Risk Factors As an infant was fussy,
reactive or excessive
motor activity
Male, parental
rejection, harsh
parenting, peer
rejection, trauma
Family History
Protective
Factors
Early identification ,
Effective treatment,
Absence of ADHD,
No family history of
DBD
Mild symptoms,
Early Assessment and
Effective, Timely
Treatment,
No co-occurring
Substance Use,
No family history
30.
31. Differential Diagnosis for Disruptive Behavior Disorders
• In many children, increased negativity and hostility may occur in the
context of a mood or psychotic disorder, and the diagnosis of ODD is
not allowed when the symptoms occur exclusively during the course
of one of these.
• Many children and adolescents who meet the criteria for a diagnosis
of CD or ODD have coexisting psychiatric disorders that may have led
to their disruptive behavior and will influence their responsiveness to
treatment and their long term.
32. Disruptive behaviour in Child with PTSD
SIX GROUP OF SYMPTOMS
1. A communicative style of avoidance: difficulties in forming ties with
people
2. Depressive symptoms
3. A high degree of anxiety (stress syndrome).
4. A high degree of aggressiveness
5. Suicidal tendencies.
6. A more widespread use of primitive defense mechanisms: denial,
projection, interviction (identification with the attacker), regression
and also repression.
The fourth characteristic is the chief one which includes these children
in the category of “difficult children”.
33. Salmon & Bryant (2002): 3 groups of symptoms
PTSD children exhibit 3 groups of symptoms
1. A recurrent experience of the trauma
2. Avoidance characteristics
3. Arousal symptoms such as insomnia, irritability, lack of
concentration and heightened startle response
This third group is what makes the child “difficult”.
34. Disruptive behaviour in ID
The diagnosis of an intellectual disability (ID) relates to a
heterogeneous group of individuals, approximately 3% of the
population, whose intelligence quotient is <70.
Behaviour disorders are frequent in children with an ID, can create
problems in everyday life.
The four most common of behavioural problems: sleep disturbances,
agitation (as it relates to attention-deficit hyperactivity disorder
[ADHD]), aggression and self-injury in ID.
The prevalence rate of ADHD in the general population is 5%, and
between 9% to 16% in the paediatric population with an ID. The long-
term impact of ADHD is significant in children with an ID, and can
result in anxiety, aggression and social ostracism problems, especially
in adolescents.
Children with an ID manifest aggressive behaviour more often than
children with average intelligence. In this population, planned
aggressive behaviours are quite rare.
35. References:
Rutter’s child and adolescent psychiatry 6th edition.
Disruptive Behaviors in Children and Adolescents (Molly M. Gathright, M.D.Assistant Professor, Laura H. Tyler, PhD, LPC Assistant Professor
Updated 3-31-2014.)
Ageranioti-Bélanger S, Brunet S, D’Anjou G, Tellier G, Boivin J, Gauthier M. Behaviour disorders in children with an intellectual disability.
Paediatrics & Child Health. 2012;17(2):84-88.