DISRUPTIVE
BEHAVIOR DISORDERS
This subclass of disorders is
characterized by behavior that is socially
disruptive and is often more distressing to
others than to the people with the disorders.
The subclass includes Attention-deficit
Hyperactivity Disorder, Oppositional Defiant
Disorder, and Conduct Disorder. Studies have
indicated that in both clinic and community
samples, the symptoms of these disorders
covary to a high degree. In the literature
the behaviors that these disorders encompass
have been referred to as
"externalizing" symptoms.
Attention-Deficity
Hyperactivity Disorder (ADHD)
The essential features of this disorder
are developmentally inappropriate degrees of
inattention, impulsiveness, and
hyperactivity. People with the disorder
generally display some disturbance in each of
these areas, but to varying degrees.
Manifestations of the disorder usually
appear in most situations, including at home
in school, at work, and in social situations,
but to varying degrees. Some people, however,
show signs of the disorder in only one
setting, such as at home or at school.
Symptoms typically worsen in situations
requiring sustained attention, such as
listening to a teacher in a classroom,
attending meetings, or doing class
assignments or chores at home. Signs of the
disorder may be minimal or absent when the
person is receiving frequent reinforcement or
very strict control, or is in a novel setting
or a one-to-one situation (e.g., being
examined in the clinician's office, or
interacting with a videogame).
In the classroom or workplace, inattention
and impulsiveness are evidenced by not
sticking with tasks sufficiently to finish
them and by having difficulty organizing and
completing work correctly. The person often
gives the impression that he or she is not
listening or has not heard what has been
said. Work is often messy, and performed
carelessly and impulsively.
Impulsiveness is often demonstrated by
blurting out answers to questions before they
are completed, making comments out of turn,
failing to await one's turn in group tasks,
failing to heed directions fully before
beginning to respond to assignments,
interrupting the teacher during a lesson, and
interrupting or talking to other children
during quiet work periods.
Hyperactivity may be evidenced by difficulty
remaining seated, excessive jumping about,
running in classroom, fidgeting, manipulating
objects, and twisting and wiggling in one's
seat.
At home, inattention may be displayed in
failure to follow through on others' requests
and instructions and in frequent shifts from
one uncompleted activity to another. Problems
with impulsiveness are often expressed by
interrupting or intruding on other family
members and by accident-prone behavior, such
as grabbing a hot pan from the stove or
carelessly knocking over a pitcher.
Hyperactivity may be evidenced by an
inability to remain seated when expected to
do so (situations in which this is the case
vary greatly from home to home) and by
excessively noisy activities.
With peers, inattention is evident in failure
to follow the rules of structured games or to
listen to other children. Impulsiveness is
frequently demonstrated by failing to await
one's turn in games, interrupting, grabbing
objects (not with malevolent intent), and
engaging in potentially dangerous activities
without considering the possible
consequences, e.g., riding a skateboard over
extremely rough terrain. Hyperactivity may be
shown by excessive talking and by an
inability to play quietly and to regulate
one's activity to conform to the demands of
the game (e.g., in playing "Simon
Says," the child keeps moving about and
talking to peers when he or she is expected
to he quiet).
Age-specific features. In
preschool children, the most prominent
features are generally signs of gross motor
overactivity, such as excessive running or
climbing. The child is often described as
being on the go and "always having his
motor running." Inattention and
impulsiveness are likely to be shown by
frequent shifting from one activity to
another. In older children and adolescents,
the most prominent features tend to be
excessive fidgeting and restlessness rather
than gross motor overactivity. Inattention
and impulsiveness may contribute to failure
to complete assigned tasks or instructions,
or careless performance of assigned work. In
adolescents, impulsiveness is often displayed
in social activities, such as initiating a
diverting activity on the spur of the moment
instead of attending to a previous commitment
(e.g., joy riding instead of doing homework).
Associated features.
Associated features vary as a function of
age, and include low self-esteem, mood
lability, low frustration tolerance, and
temper outbursts. Academic underachievement
is characteristic of most children with this
disorder.
In clinic samples, some or all of the
symptoms of Oppositional Defiant Disorder,
Conduct Disorder, and Specific Developmental
Disorders arc often present. Functional
incopresis and Functional enuresis are
sometimes seen. Although Tourette's Disorder
is relatively rare in children with ADHD, in
clinic samples many children with Tourette's
Disorder are found to have ADHD as well.
Nonlocalized, "soft," neuralgic
signs and motor-perceptual dysfunction’s
(e.g., poor eye-hand coordination) may be
present.
Age at onset. In
approximately half of the cases, onset of the
disorder is before age four. Frequently the
disorder is not recognized until the child
enters school.
Course. In the majority of
cases manifestations of the disorder persist
throughout childhood. Oppositional Defiant
Disorder or Conduct Disorder often develops
later in childhood in those with ADHD. Among
those who develop Conduct Disorder, a
significant number are found to have
Antisocial Personality Disorder in adulthood.
Follow-up studies of clinic samples indicate
that approximately one-third of children with
ADHD continue to show some signs of the
disorder in adulthood. Studies have indicated
that the following features predict a poor
course: coexisting Conduct Disorder, low IQ,
and severe mental disorder in the parents.
Impairment. Some impairment
in social and school functioning is common.
Complications. School
failure is the major complication.
Predisposing factors.
Central nervous system abnormalities, such as
the presence of neurotoxins, cerebral palsy,
epilepsy, and other neuralgic disorders, are
thought to be predisposing factors.
Disorganized or chaotic environments and
child abuse or neglect may be predisposing
factors in some cases.
Prevalence. The disorder is
common; it may occur in as many as 3% of
children.
Sex ratio. In clinic
samples, the disorder is from six to nine
times more common in males than in females.
In community samples, multiple signs of the
disorder occur only three times more often in
males than in females.
Familial pattern. The
disorder is believed to be more common in
first degree biologic relatives of people
with the disorder than in the general
population. Among family members, the
following disorders are thought to be
overrepresented: Specific Developmental
Disorders, Alcohol Dependence or Abuse,
Conduct Disorder, and Antisocial Personality
Disorder.
Differential diagnosis. Age-appropriate
overactivity, as is seen in some particularly
active children, does not have the haphazard
and poorly organized quality characteristic
of the behavior of children with
Attention-deficit Hyperactivity Disorder.
Children in inadequate, disorganized, or
chaotic environments may appear to have
difficulty in sustaining attention and in
goal-directed behavior. In such cases it may
be impossible to determine whether the
disorganized behavior is primarily a function
of the chaotic environment or whether it is
due largely to the child's psychopathology
(in which case the diagnosis of
Attention-deficit Hyperactivity Disorder may
be warranted).
In Mental Retardation there may be many of
the features of ADHD because of the
generalized delay in intellectual
development. The additional diagnosis of ADHD
is made only if the relevant symptoms are
excessive for the child's mental age.
Symptoms characteristic of ADHD are often
observed in pervasive Developmental
Disorders; in these cases a diagnosis of ADHD
is preempted.
In Mood Disorders there may be psychomotor
agitation and difficulty in concentration
that are difficult to distinguish from the
hyperactivity and attention difficulties seen
in Attention-deficit Hyperactivity Disorder.
Therefore it is important to consider the
diagnosis of a Mood Disorder before making
the diagnosis of Attention-deficit
Hyperactivity Disorder.
Signs of impulsiveness and hyperactivity are
not present in Undifferentiated
Attention-deficit Disorder.
Diagnostic Criteria for Attention
Deficit Hyperactivity Disorder
Note: Consider a criterion
met only if the behavior is considerably more
frequent than that of most people of the same
mental age.
A. A disturbance of at least
six months during which at least eight of the
following are present:
- often fidgets with hands or feet or
squirms in seat (in adolescents, may
be limited to subjective feelings of
restlessness)
- has difficulty remaining seated when
required to do so
- is easily distracted by extraneous
stimuli
- has difficulty awaiting turn in games
or group situations
- often blurts out answers to questions
before they have been completed
- has difficulty following through on
instructions from others (not due to
Oppositional behavior or failure of
comprehension), e.g., fails to finish
chores
- has difficulty sustaining attention
in tasks or play activities
- often shifts from one uncompleted
activity to another
- has difficulty playing quietly
- often talks excessively
- often interrupts or intrudes on
others, e.g., butts into other
children's games
- often does not seem to listen to what
is being said to him or her
- often loses things necessary for
tasks or activities at school or at
home (e.g., toys, pencils, books,
assignments)
- often engages in physically dangerous
activities without considering
possible consequences (not for the
purpose of thrill-seeking), e.g.,
runs into street without looking
B. Onset before the age
of seven.
C. Does not meet the
criteria for a Pervasive Developmental
Disorder.
Criteria for severity of
Attention-deficit Hyperactivity Disorder:
Mild: Few, if any, symptoms
in excess of those required to make the
diagnosis and only minimal or no impairment
in school and social functioning.
Moderate: Symptoms or
functional impairment intermediate between
"mild" and "severe.
Severe: Many symptoms in
excess of those required to make the
diagnosis and significant and pervasive
impairment in functioning at home and school
and with peers.
Links
to Information on ADD(HD)
Medicating
the ADD Child
A
Must read page
Education
Of ADHD Students Demands Accountability
From
Teacher, Student
FOOD
FOR THOUGHT - Special Nutrients for the Brain
ADHD
Owner's Manual
Sydney
Child Assessment centre
**A
must read on Medication
The
Complete Practical Guide for Classroom
Teachers
Information
on Support Groups
ADD(HD)
Newsgroup
If the above does not work
Go to your newsgroup server and type in
alt.support.attn-deficit
A Personal Note -
I have worked with many children
with ADD(HD) over the years and I have found
the best way is the slowest way
Make sure your working with a team
that is trained and not willing to jump right
into medication
Out of the children I worked with who were
diagnosed with ADD(HD), over 75% were able to
control their own lives in school and at home
without medication.
I also know a child with ADD(HD) has the
ability to reach goals including collage,
career choices and marriage. They can be good
partners and parents.
It takes a lot of time, research and
love, but it can be done.
~Joe Mazzafro
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