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The children meeting criteria for these disorders have a conduct that is socially unacceptable, they cause disruption in their classrooms and families, and find it difficult to learn from experience.

 

Often these two conditions are seen as part of a continuum of symptoms that that spans from the less to the more severe. Most often, the children with CD have been diagnosed at some point in time with ODD and the condition worsened.

ODD and CD are quite frequent

 

  • 5% of the children ages 6 to 18 met criteria for ODD or CD in the previous 3-6 months.
  • Looking at any time before 16 years of age, 9.1% of the girls and 13.4% of the boys met criteria for ODD.
  • 3.8% of the girls and 14.1% of the boys met criteria for CD at any point before age 16.

To diagnose ODD, 4 or more of the following symptoms need to be present for a period of more than 6 months.

 

  • easily annoyed

  • angry and resentful

  • loses temper

  • spiteful and vindictive

  • annoys

  • defies requests or rules blames others

  • argues with adults

To diagnose CD, 3 or more of the following symptoms need to be present during the last 12 months with at least one in the last 6 months.

  • Bullies, threatens or intimidates others

  • Initiates physical fights

  • Used a weapon

  • Cruel to people

  • Cruel to animals

  • Stolen with confrontation

  • Forced sexual activity

  • Deliberate fire setting

  • Destroyed property

  • Breaking into someone’s house, building or car

  • Lies

  • Stealing nontrivial items

  • Leaving home without permission before age 13

  • Run away from home overnight at least twice

  • Truant from school, beginning before age 13

Subtypes of CD

  • the early (childhood) onset CD (before age 10) tends to be seen as more severe or disabling than the late (adolescent) onset CD that may be more opportunistic and transient
  • another distinction that is usually seen as meaningful is between the types of behaviors that are carried out: the overt behaviors (with confrontation) being seen as different than the covert behaviors (deception)

Children with ODD

  • Are 10 times more likely to have ADHD
  • Are 7 times more likely to have major depression
  • Are 4 times more likely to have substance abuse as adolescents

Developmental Considerations

Age 3 – stubbornness

Age 5 – defiance and temper tantrums

Age 6 – argumentativeness

Age 4-8 – hitting, biting, smashing objects

Age 8 – lying

Age 9 – bullying

Age 8-11 – disobedience and defiance in the school

Age 12 – stealing

Early adolescence – rebelliousness

Adolescence – covert antisocial actions (stealing, truancy, running away)

Childhood ODD and CD are associated with:

  • Educational difficulties
  • Teenage pregnancy
  • Substance abuse
  • Major depression
  • Psychosis
  • Suicidal behavior
  • Delinquency
  • Unemployment
  • Antisocial Personality Disorder
  • Passive-aggressive Personality Disorder

Risk factors

Generally it is considered that about 50% of the factors contributing to the development of ODD and CD are inherited. This suggests that the other 50% of the factors are environmental. Multiple risk factors or vulnerabilities contribute to the development of Disruptive Behavior Disorders.

Biological

  • Genetic (one or both parents with history of ODD/CD)
  • Maternal smoking during pregnancy
  • Pregnancy and birth complications
  • Low birth weight
  • Brain injury
  • Brain disorders (seizures)
  • Male gender
  • Lower heart rate, lower skin conductance have been associated with disruptive boys and criminality.

Individual

 

  • Below average IQ
  • Language impairment
  • Reading Problems
  • Executive Functions Deficits
  •  Impulsivity and hyperactivity (deficits in behavioral inhibition)
  • Attentional problems
  •  Difficult temperament (emotional, intense, reactive, inflexible)
  • Attachment (disorganized, insecure attachment)
  • Has poor social skills
  • Has a hard time understanding other people (how they feel, why they do what they do)
  • Tends to perceive that people around mean, that their intent is hostile.
  • Are lower in warmth and empathy.
  • Feel more confident in their ability to carry out aggressive responses.

Family

  • Parental antisocial behavior or substance use
  • Exposure to domestic violence, neglect or abuse
  • Single parent, divorce
  • Maternal depression and anxiety
  • Early motherhood
  • Lack of parental supervision
  • Harsh, punitive, inconsistent discipline
  • Parent–child conflict
  • Excessive parental control
  • Distant, low-warmth parenting

Social and School

  • Stressful life events
  • Poverty
  • Association with deviant peers/siblings
  • Rejection by peers
  • History of victimization or of being bullied
  • Disorganized, disadvantaged, or high crime neighborhoods
  • Dysfunctional or disorganized schools
  • Intense exposure to media violence

 

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