DISRUPTIVE BEHAVIORS

By G. Lungu-MSc Student
Supervisor: Mrs. Muntambo
 Introduction
• Disruptive behaviors of relatedness are a
common phenomenon among children but
can as well be observed in adults. They are
characterized by poorly controlled, impulsive,
acting out behavior in situations where self
control is expected. The ability to control one’s
behavior depends on a number of skills
developed overtime.
 Intro cont..d
• Those who have not developed these skills,
who continue to be disruptive, impulsive and
aggressive, are at high risk for school
adjustment difficulties, learning problems and
peer rejection.
• Among the disruptive behavior disorders, the
most important ones are Attention Deficit
Hyperactive disorder and conduct disorder
 General objective
• At the end of the lecture/discussion, students
should gain knowledge and understanding on
specific disruptive behaviors and its
management.
 Specific objectives

• At the end of the lecture/discussion; students

should be able to:
1. Describe the characteristics of Disruptive
Behaviors.
2. Review the neurobiology of disruptive behavior
3. Mention the conditions associated with
disruptive behaviors
4. State the treatment goals in disruptive disorders
5. Discuss the management of disruptive behaviors
Characteristics of disruptive behaviors
• Excessive levels of activity:
– Fidgeting,
– squirming, and running around when
inappropriate,
– incessant talking.
 Xristics cont..d
• Distractibility and difficulty concentrating:
– Makes careless mistakes cannot follow
instructions, forgetful.
– difficulty with peer interactions
– temper tantrums,
– physical aggression such as attacking other
children,
– excessive argumentativeness,
– stealing, and other forms of defiance or resistance
to authority.
 Xristic cont..d
• Children with conduct disorder engage in
severe repeated acts of aggression that can
cause physical harm to themselves and others
and frequently violate the rights of others.
 Xristics cont..d
• Children with Conduct disorder usually have
behaviors characterized by :
– aggression to persons or animals,
– destruction of property,
– deceitfulness or theft, and multiple violations of
rules,
– such as truancy from school.
 Neurobiology
• Neurotransmitters:
– Dopamine and nor epinephrine appear to be
depleted in ADHD.
– Serotonin in ADHD has been studied less
extensively, but recent evidence suggests that it
also is reduced in children with ADHD
 Neurotransmitter Functions
• Nor epinephrine: ability to perform executive
functions, e.g. analysis and reasoning, and in
the cognitive alertness essential for processing
stimuli and sustaining attention and thought
(Hunt, 2006).
• Dopamine: Play a role in sensory filtering,
memory, concentration, controlling emotions,
locomotor activity, and reasoning.
 Types of disruptive behavioral
disorders
• (DSM-5) categorizes disruptive behavioral
disorders into Disruptive, impulse control and
conduct disorders which include:
Oppositional defiant disorder (ODD), Conduct
Disorders (CD), Antisocial Personality
Disorder (APD), Intermittent Explosive
Disorders (IED) and Impulse Control Disorder
(pyromania and Kleptomania).
1. OPPOSITIONAL DEFIANT DISORDER
(ODD):
• defined by defiant behaviors which are persistent
and willful.
• emotional (resentful and irritable), behavioral
(argues, angry, dislikes, authority) and cognitive
(vindictive and spiteful).
• have enduring patterns of negativistic,
disobedient, and hostile behavior toward
authority figures, as well as an inability to take
responsibility for mistakes, leading to placing
blame on others.
 ODD cont..d
• Have difficulties in classroom and with peer
relationships, but generally do not resort to
physical aggression or significantly destructive
behavior.
• These symptoms must be present for more
than 6 months and must disrupt social
interactions.
 2. CONDUCT DISORDER (CD)
– Characterized by all the behaviors of ODD plus
aggressive behaviors towards people and animals.
– Such individuals might destroy property, steal
things and hurt pets.
• Aggression to People and Animals
– Often bullies, threatens, or intimidates others.
– Often initiates physical fights.
– Has used a weapon that can cause serious physical
harm to others (e.g., a bat, brick, broken bottle,
knife, and gun).
 Xristics cont..d
– Has been physically cruel to people.
– Has been physically cruel to animals.
– Has stolen while confronting a victim (e.g.,
mugging, purse snatching, extortion, armed
robbery).
– Has forced someone into sexual activity.
 Xistics cont..d
• Destruction of Property
– Has deliberately engaged in fire setting with the intention
of causing serious damage.
– Has deliberately destroyed others’ property (other than by
fire setting).
• Deceitfulness or Theft
– Has broken into someone else’s house, building, or car.
– Often lies to obtain goods or favors or to avoid obligations
(i.e., “cons” others).
– Has stolen items of nontrivial value without confronting a
victim (e.g., shoplifting, but without breaking and entering:
forgery).
 Xristics cont..d
• Serious Violations of Rules
– Often stays out at night despite parental
prohibitions, beginning before age 13 years.
– Has run away from home overnight at least twice
while living in the parental or parental surrogate
home, or once without returning for a lengthy
period.
– Is often truant from school, beginning before age
13 years.
 3. ANTISOCIAL BEHAVIOR (AB)

• They destroy property, steal things and hurt

pets. There are two types:
– Childhood onset: start below 10 years.
– Adulthood onset: 10-18 years
• The earlier the onset, the more SEVERE the
problem.
 4. ANTISOCIAL PERSONALITY
DISORDER (APD)
• They disregards: moral values and societal
norms
• They lack empathy and impulse control: they
hurt others, aggressive, will break laws. They
exalt themselves as sociopath or psychopath.
• They are often in prison, substance abusers.
Do not show remorse or responsibility.
 Cont..d
• WARNING: THEY CAN BE CHARMING AND
MANIPULATIVE.
• DIAGNOSIS: must be above 18 years old and
must have a conduct disorder.
 5. INTERMITTENT EXPLOSIVE
DISORDER (IED)
• Characterized by recurrent explosive out busts
which are brief and spontaneous, intense
anger, violence, response to real or perceived
provocation, out of proportion.
• Diagnosis: A child should be older than 6
years old and should occur twice a week for 3
months with damage.
 6. Pyromania and kleptomania:
• Pyromania
– They purposefully and repetitively start fires but
they are not Arsonists.
– They are motivated by destruction and power.
– Fire is happiness; they hang around fire stations
and enjoy playing with fire. It driven by
compulsion.
 Cont..d
• Kleptomania:
– They have strong impulse to steal.
– They steal not out of need.
– Theft is pleasurable and a sense of relief.
– They steal things that have no value as long as
they have stolen something for pleasure and relief.
 Cont...d
These disorders often first attract notice when they
interfere with school performance or family and
peer relationships, and frequently intensify over
time.
 Treatment
• Goal:
– The treatment is focused on behavior and not
Pharmaceutical and include; cognitive behavioral
therapy, social skills training, anger management
and parent teaching(teaching parents how to
respond)
• NOTE: medical treatment is considered in
severe case.
 Medical management
• CNS Stimulants
– Amphetamines (dextroamphetamine,
methamphetamine, and mixtures): cause the release
of nor epinephrine from central noradrenergic
neurons.
– At higher doses, dopamine may be released in the
mesolimbic system.
– Methylphenidate and dexmethylphenidate: block the
reuptake of nor epinephrine and dopamine into the
presynaptic neuron and increase the release of these
monoamines into the extra neuronal space.
 Med mgt cont..d
• Side effects: restlessness, insomnia,
headache, palpitations, weight loss, and
suppression of growth in children (with long-
term use), increased blood pressure,
abdominal pain, anxiety, tolerance, and
physical and psychological dependence.
 Med mgt cont..d
• Others
– Atomoxetine: selectively inhibits the reuptake of
norepinephrine by blocking the presynaptic
transporter.
– Side effects include headache, upper abdominal
pain, nausea and vomiting, anorexia, cough, dry
mouth, constipation, increase in heart rate and
blood pressure, and fatigue.
 Med mgt cont..d
• Bupropion: inhibits the reuptake of
norepinephrine and dopamine into
presynaptic neurons.
• Side effects include headache, dizziness,
insomnia or sedation, tachycardia, increased
blood pressure, dry mouth, nausea and
vomiting, weight gain or loss, and seizures
(dose dependent).
• Dextroamphetamine sulfate (Adderall) 5–
60mg
• Methamphetamine-5–25mg
• Lisdexamphetamine-30–70mg
• Methylphenidate (Ritalin)- 10–60mg
• Atomoxetine0.5–1.4 mg/kg
• Bupropion-3 mg/kg (ADHD); 100–
300(depression)
 Nursing management
• NURSING CARE PLAN
 CONCLUSION
• We have looked at disruptive behaviors
namely, Oppositional defiant disorder (ODD),
Conduct Disorders (CD), Antisocial Personality
Disorder (APD), Intermittent Explosive
Disorders (IED) and Impulse Control Disorder
(pyromania and Kleptomania).These
conditions are characterized with Impulse
behaviors and lack of self control. They begin
in Childhood and persist into adulthood.
 Concl cont..d
• They are very important to the mental health
field as they define the current behavioral
pattern. Teachers in school are at a critical
point to identify and refer children with
conditions to specialized therapeutic centres
and placement in special schools. Therefore it
is critical and important for the mental health
personnel to acquaint themselves with skills
to identify behaviors that characterize the
abnormality.
 References
• Alloy, L., B et al. (2005). Abnormal psychology, Current Perspectives.
9th Edition, McGraw-Hill companies Inc. New York.
• American Psychiatric Association, (2013). Diagnostic and Statistical
Manual of Mental Disorders, 5th edition. New school Library, 1000
wilson. Boulevard. Washington DC.
• Grizenko, N., & Pawliuk, N,. (1994). Risk and protective factors for
disruptive behavior disorders in children. American Journal of
Orthopsychiatry, 64(4), 534-544. Available at
http://dx.doi.org/10.1037/h0079566
• https://www.healthychildren.org/English/health-
issues/conditions/emotional-problems/Pages/Disruptive-Behavior-
Disorders.aspx accessed on 12/02/2019 at 11:15
• Kay, J., & Tasma, A. (2006). Essential of Psychiatry. Jhn Willey and
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