Disruptive Behavior Disorders

The disruptive behavior disorders are heterogeneous conditions that are associated with very high rates of psychiatric comorbidity. These disorders are very costly and come with a much greater rate of public expenditure than similar neuropsychiatric disorders that occur in children and adolescents. Many societal institutions that serve children and adolescents, including the family—the educational system, juvenile justice systems, community and public health systems, and mental health systems—experience the impact of children with disruptive behavior disorders.

The origin of disruptive behavior disorder is widely accepted as multifactorial: biological, temperamental, learned, and psychological. One controversial issue that has arisen is whether “voluntary” maladaptive behaviors can be misconstrued as a psychiatric disorder or can be better accounted for as maladaptive responses to overly harsh or punitive parenting. Longitudinal studies have demonstrated that for some children and adolescents, early patterns of disruptive behavior may become a lifelong pervasive repertoire culminating in adult antisocial personality disorder.

Disruptive behavior disorders can be divided into two distinct constellations of symptoms categorized as oppositional defiant disorder and conduct disorder, both of which result in impaired social or academic function in children. Some defiance and refusal to comply with adult requests is developmentally appropriate and marks growth in all children, but children with certain disorders are themselves impaired by the frequency and severity of their disruptive behaviors.

Students should study the questions and answers below for a useful review of these disorders.

Questions

Directions

Each of the questions or incomplete statements below is followed by five suggested responses or completions. Select the one that is best in each case.

43.1 To be diagnosed with childhood-onset conduct disorder, at least one criterion for the disorder must be met before what age?

A. 10 years

B. 11 years

C. 12 years

D. 13 years

E. 14 years

View Answer

43.1 The answer is A

Childhood-onset type refers to the presence of one criterion behavior prior to the age of 10 years. In the adolescent-onset type, all the constituent behaviors for diagnosis begin after 10 years old. It has been known for some time that age of onset of antisocial behavior has important implications. The current text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) subtyping reflects evidence from studies reporting that a relatively small group of children (generally boys) with onset of aggressive and antisocial behaviors (i.e., harming animals, stealing, destroying property) in childhood (as contrasted with onset in adolescence) display many features suggestive of chronic psychopathology and neuropsychiatric disease. This early onset conduct disorder subgroup has an especially poor prognosis over the lifespan.

43.2 In oppositional defiant disorder,

A. the average age of onset is 3 years

B. boys always outnumber girls, regardless of age range

C. occurrence is mostly in cohorts of middle to higher socioeconomic status

D. point prevalence has been reported to average around 6 percent

E. all of the above

View Answer

43.2 The answer is D

The epidemiological data for oppositional defiant disorder needs to be regarded with some caution because of the recent modifications of the diagnostic criteria. The point prevalence of the disorder has been reported to vary between 1.7 to 9.9, with a weighted average of around 6 percent. The average age of onset is about 6 (not 3) years. Boys outnumber girls in the prepubertal age range, after which the two genders are more equal. The disorder occurs mostly in cohorts of lower (not middle to higher) socioeconomic status.

43.3 What is the lifetime prevalence rate of oppositional defiance disorder in the United States?

A. 2.5 percent

B. 4.5 percent

C. 6.5 percent

D. 8.5 percent

E. 10.5 percent

View Answer

43.3 The answer is D

The lifetime prevalence of oppositional defiant disorder in the United States is 8.5 percent

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