WJCP 7 9 PDF

WJ CP World Journal of
Clinical Pediatrics
Submit a Manuscript: http://www.f6publishing.com World J Clin Pediatr 2018 February 8; 7(1): 9-26
DOI: 10.5409/wjcp.v7.i1.9 ISSN 2219-2808 (online)
REVIEW
Behavioural and emotional disorders in childhood: A brief

overview for paediatricians
Michael O Ogundele
Michael O Ogundele, Department of Community Paediatrics, disorders, including disruptive, depression, anxiety
NHS Fife, Glenwood Health Centre, Glenrothes KY6 1HK, and pervasive developmental (autism) disorders,
United Kingdom characterized as either internalizing or externalizing
problems. Disruptive behavioural problems such as
ORCID number: Michael O Ogundele (0000-0003-0744-1434).
temper tantrums, attention deficit hyperactivity disorder,
Author contributions: Ogundele MO conceived the idea,
oppositional, defiant or conduct disorders are the
collected and analysed the data and prepared the manuscript. commonest behavioural problems in preschool and
school age children. The routine Paediatric clinic or Family
Conflict-of-interest statement: The author declares no conflict Medicine/General Practitioner surgery presents with
of interest for this article. several desirable characteristics that make them ideal
for providing effective mental health services to children
Open-Access: This article is an open-access article which was and adolescents. DSM-5 and ICD-10 are the universally
selected by an in-house editor and fully peer-reviewed by external accepted standard criteria for the classification of
reviewers. It is distributed in accordance with the Creative
mental and behaviour disorders in childhood and adults.
Commons Attribution Non Commercial (CC BY-NC 4.0) license,
The age and gender prevalence estimation of various
which permits others to distribute, remix, adapt, build upon this
work non-commercially, and license their derivative works on childhood behavioural disorders are variable and difficult
different terms, provided the original work is properly cited and to compare worldwide. A review of relevant published
the use is non-commercial. See: http://creativecommons.org/ literature was conducted, including published meta-
licenses/by-nc/4.0/ analyses and national guidelines. We searched for articles
indexed by Ovid, PubMed, PubMed Medical Central,
Manuscript source: Invited manuscript CINAHL, EMBASE, Database of Abstracts and Reviews,
and the Cochrane Database of Systematic reviews and
Correspondence to: Dr. Michael O Ogundele, MBBS, MRCP, other online sources. The searches were conducted
MSc, Consultant Paediatrician, Department of Community
using a combination of search expressions including
Paediatrics, NHS Fife, Glenwood Health Centre, Napier Road,
Glenrothes KY6 1HK, United Kingdom. [email protected] “childhood”, “behaviour”, “disorders” or “problems”.
Telephone: +44-1592-765096 Childhood behaviour and emotional problems with their
Fax: +44-1592-765096 related disorders have significant negative impacts on the
individual, the family and the society. They are commonly
Received: October 27, 2017 associated with poor academic, occupational, and
Peer-review started: October 29, 2017 psychosocial functioning. It is important for all healthcare
First decision: November 20, 2017 professionals, especially the Paediatricians to be aware of
Revised: November 30, 2017 the range of presentation, prevention and management
Accepted: December 5, 2017
of the common mental health problems in children and
Article in press: December 5, 2017
Published online: February 8, 2018 adolescents.
Key words: Childhood behavioural disorders; Disruptive

behaviour disorder; Conduct disorder; Challenging
behaviour; Emotional disorder; Anxiety; Depression;
Abstract Autism; Pervasive developmental disorders
Mental health problems in children and adolescents
include several types of emotional and behavioural © The Author(s) 2018. Published by Baishideng Publishing
WJCP|www.wjgnet.com February 8, 2018|Volume 7|Issue 1|

Ogundele MO. Childhood behaviour and emotional disorders
Group Inc. All rights reserved. in later childhood. They are often difficult to be recog
nised early by the parents or other carers as many
Core tip: Mental health problems in children and young children have not developed appropriate vocabulary and
people (CYP) include several types of emotional and comprehension to express their emotions intelligibly .
[5]
behavioural disorders, including disruptive, depression, Many clinicians and carers also find it difficult to
anxiety and pervasive developmental (autism) disorders, distinguish between developmentally normal emotions
characterized as either “internalizing” or “externalizing”. (e.g., fears, crying) from the severe and prolonged
The routine Paediatric or General Practitioner clinic emotional distresses that should be regarded as dis
present with several desirable characteristics that [6]
orders . Emotional problems including disordered eating
make them ideal for providing effective mental health behaviour and low self-image are often associated with
services to CYP. Childhood mental health disorders have chronic medical disorders such as atopic dermatitis,
significant negative impacts on the individual, the family
obesity, diabetes and asthma, which lead to poor quality
and the society. It is particularly important for all Paedia [7-9]
of life .
tricians to be aware of the range of presentation, pre
Identification and management of mental health
vention and management of the common mental health
problems in primary care settings such as routine Paedia
problems in CYP.
tric clinic or Family Medicine/General Practitioner surgery
are cost-effective because of their several desirable
Ogundele MO. Behavioural and emotional disorders in characteristics that make it acceptable to children and
childhood: A brief overview for paediatricians. World J Clin young people (CYP) (e.g., no stigma, in local setting,
Pediatr 2018; 7(1): 9-26 Available from: URL: http://www. and familiar providers). Several models to improve the
wjgnet.com/2219-2808/full/v7/i1/9.htm DOI: http://dx.doi. delivery of mental health services in the Paediatric/
org/10.5409/wjcp.v7.i1.9 Primary care settings have been recommended and
evaluated recently, including coordination with external
specialists, joint consultations, improved Mental Health
training and more integrated on-site intervention with
[10,11]
INTRODUCTION specialist collaboration .
A review of relevant published literature was con
Mental health disorders (MHD) are very common
ducted, including published meta-analyses and na
in childhood and they include emotional-obsessive-
tional guidelines. We searched for articles indexed by
compulsive disorder (OCD), anxiety, depression,
Ovid, PubMed, PubMed Medical Central, CINAHL, the
disruptive (oppositional defiance disorder (ODD), conduct
Cochrane Database of Systematic reviews and other
disorder (CD), attention deficit hyperactive disorder
online sources. The searches were conducted using a
(ADHD) or developmental (speech/language delay, combination of search expressions including “childhood”,
intellectual disability) disorders or pervasive (autistic “behaviour”, “disorders” or “problems”.
[1]
spectrum) disorders . Emotional and behavioural
problems (EBP) or disorders (EBD) can also be classified
as either “internalizing” (emotional disorders such as CLINICAL PRESENTATIONS OF CHILD-
depression and anxiety) or “externalizing” (disruptive
HOOD BEHAVIOURAL AND EMOTIONAL
behaviours such as ADHD and CD). The terminologies
of “problems” and “disorders” are interchangeably used DISORDERS
throughout this article. Various definitions for a wide range of childhood be
While low-intensity naughty, defiant and impulsive [12]
havioural disorders are being used. The DSM-5 offers
behaviour from time to time, losing one’s temper, the commonest universally accepted standard criteria
destruction of property, and deceitfulness/stealing for the classification of mental and behaviour disorders.
in the preschool children are regarded as normal, [13]
The ICD-10 is the alternative classification standard .
extremely difficult and challenging behaviours outside
the norm for the age and level of development, such as Challenging behaviours
unpredictable, prolonged, and/or destructive tantrums Any abnormal pattern of behaviour which is above
and severe outbursts of temper loss are recognized as the expected norm for age and level of development
behaviour disorders. Community studies have identified can be described as “challenging behaviour”. It has
that more than 80% of pre-schoolers have mild been defined as: “Culturally abnormal behaviour (s)
tantrums sometimes but a smaller proportion, less than of such an intensity, frequency or duration that the
10% will have daily tantrums, regarded as normative physical safety of the person or others is likely to be
[2,3]
misbehaviours at this age . Challenging behaviours placed in serious jeopardy or behaviour which is likely
and emotional difficulties are more likely to be recognized to seriously limit or deny access to and use of ordinary
as “problems” rather than “disorders” during the first 2 [14]
community facilities” . They can include self-injury,
[4]
years of life . physical or verbal aggression, non-compliance, disruption
Emotional problems, such as anxiety, depression of the environment, inappropriate vocalizations, and
and post-traumatic stress disorder (PTSD) tend to occur various stereotypies. These behaviours can impede
WJCP|www.wjgnet.com 10 February 8, 2018|Volume 7|Issue 1|

Table 1 Subtypes of attention deficit hyperactivity disorder (based on DSM-5)
Subtypes Predominantly inattentive (ADD) Predominantly hyperactivity/ impulsivity Combined ADHD

Criteria 6 of 9 inattentive symptoms 6 of 9 hyperactivity/ impulsivity symptoms Both criteria for (1) and (2)
Details Fails to pay close attention to details or makes careless mistakes Squirms and fidgets
Has difficulty sustaining attention Can’t stay seated
Does not appear to listen Runs/climbs excessively
Struggles to follow through on instructions Can’t play/work quietly
Has difficulty with organization “On the go”/“driven by a motor”
Avoids or dislikes tasks requiring a lot of thinking Blurts out answers
Loses things Is unable to wait for his turn
Is easily distracted Intrudes/interrupts others
Talks excessively
Other criteria Onset before age of 12, lasting more than 6 mo, symptoms pervasive in 2 or more settings, causing significant impairment of daily
functioning o development
ADHD: Attention deficit hyperactivity disorder.
[19]
learning, restrict access to normal activities and social retardation, autism, bipolar disorder, PTSD, or dyslexia .
opportunities, and require a considerable amount of both
manpower and financial resources to manage effectively. Disruptive behaviour problems
Many instances of challenging behaviour can be Disruptive behaviour problems (DBP) include attention
interpreted as ineffective coping strategies for a young deficit hyperactivity disorder (ADHD), oppositional
person, with or without learning disability (LD) or impaired defiant disorder (ODD) and conduct disorder (CD). They
social and communication skills, trying to control what constitute the commonest EBPs among CYP. Recent
is going on around them. Young people with various evidence suggests that DBPs should be regarded as
disabilities, including LD, Autism, and other acquired a multidimensional phenotype rather than comprising
neuro-behavioural disorders such as brain damage and distinct subgroups .
[20]
post-infectious phenomena, may also use challenging ADHD is the commonest neuro-behavioural disorder
behaviour for specific purposes, for example, for sensory in children and adolescents, with prevalence ranging
stimulation, gaining attention of carers, avoiding demands between 5% and 12% in the developed countries .
[21]
[15]
or to express their limited communication skills . People ADHD is characterized by levels of hyperactivity, im
who have a diverse range of neurodevelopmental disorders pulsivity and inattention that are disproportionately ex
[16]
are more likely to develop challenging behaviours . cessive for the child’s age and development . The
[12]
Some environmental factors have been identified [13]

ICD-10 does not use the term “ADHD” but “hyperkinetic
which are likely to increase the risk of challenging be disorder”, which is equivalent to severe ADHD. DSM-5
haviour, including places offering limited opportunities for distinguishes between three subtypes of the disorder:
making choices, social interaction or meaningful occupa predominantly hyperactive/impulsive, predominantly
tion. Other adverse environments are characterized by inattentive and combined types (Table 1).
limited sensory input or excessive noise, unresponsive CD refers to severe behaviour problems (Table 2),
or unpredictable carers, predisposition to neglect and characterized by repetitive and persistent manifesta
abuse, and where physical health needs and pain are not tions of serious aggressive or non-aggressive behaviours
promptly identified. For example, the rates of challenging against people, animals or property such as being
behaviour in teenagers and people in their early 20s is defiant, belligerent, destructive, threatening, physically
30%-40% in hospital settings, compared to 5% to 15% cruel, deceitful, disobedient or dishonest, excessive
among children attending schools for those with severe fighting or bullying, fire-setting, stealing, repeated lying,
[15]
LD . intentional injury, forced sexual activity and frequent
Aggression is a common, yet complex, challenging school truancy
[13,22]
. Children with CD often have trouble
behaviour, and a frequent indication for referral to child understanding how other people think, sometimes
and adolescent Psychiatrists. It commonly begins in described as being callous-unemotional. They may falsely
childhood, with more than 58% of preschool children misinterpret the intentions of other people as being
[17]
demonstrating some aggressive behaviour . Aggression mean. They may have immature language skills, lack
has been linked to several risk factors, including individual the appropriate social skills to establish and maintain
temperaments; the effects of disturbed family dynamics; friendships, which aggravates their feelings of sadness,
[12]
poor parenting practices; exposure to violence and frustration and anger .
the influence of attachment disorders. No single factor CD is the commonest reason for CYP referral for
is sufficient to explain the development of aggressive psychological and psychiatric treatment. Roughly 50%
[18] [23]
behaviour . Aggression is commonly diagnosed in of all CYP with a MHD have a CD . About 30%-75% of
association with other mental health problems including children with CD also have ADHD and 50% of them will
ADHD, CD, ODD, depression, head injury, mental also meet criteria for at least one other disorder including

Table 2 DSM-5 definition of conduct disorder and oppositional defiant disorder
Oppositional defiant disorder Conduct disorder

A pattern of angry/irritable mood, argumentative/ A repetitive and persistent pattern of behavior in which the basic rights of others or major
defiant behavior, or vindictiveness lasting at least 6 mo age-appropriate societal norms or rules are violated, as manifested by the presence of at least
as evidenced by at least four out of 8 symptoms from three of the following 15 criteria in the past 12 mo from any of the categories below, with at
any of the following categories, and exhibited during least one criterion present in the past 6 mo
interaction with at least one individual who is not a Aggression to people and animals: (1) Often bullies, threatens, or intimidates others; (2)
sibling Often initiates physical fights; (3) Has used a weapon that can cause serious physical harm to
Angry/irritable mood: (1) Often loses temper; (2) Is others (e.g., a bat, brick, broken bottle, knife, gun); (4) Has been physically cruel to people; (5)
often touchy or easily annoyed; (3) Is often angry and Has been physically cruel to animals; (6) Has stolen while confronting a victim (e.g., mugging,
resentful purse snatching, extortion, armed robbery); (7) Has forced someone into sexual activity
Argumentative/defiant behavior: (4) Often argues Destruction of property: (8) Has deliberately engaged in fire setting with the intention of
with authority figures or, for children and adolescents, causing serious damage; (9) Has deliberately destroyed others’ property (other than by fire
with adults; (5) Often actively defies or refuses to setting)
comply with requests from authority figures or with Deceitfulness or theft: (10) Has broken into someone else’s house, building, or car; (11) Often
rules; (6) Often deliberately annoys others; (7) Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others); (12) Has stolen items
blames others for his or her mistakes or misbehavior of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and
Vindictiveness: (8) Has been spiteful or vindictive at entering; forgery)
least twice within the past 6 mo Serious violations of rules: (13) Often stays out at night despite parental prohibitions,
Note: The persistence and frequency of these behaviors beginning before age 13 yr; (14) Has run away from home overnight at least twice while
should be used to distinguish a behavior that is within living in the parental or parental surrogate home, or once without returning for a lengthy
normal limits from a behavior that is symptomatic and period; (15) Is often truant from school, beginning before age 13 yr
the behavior should occur at least once per week for at The disturbance in behavior causes clinically significant impairment in social, academic, or
least 6 mo occupational functioning
The disturbance in behavior is associated with distress If the individual is age 18 yr or older, criteria are not met for antisocial personality disorder
in the individual or others in his or her immediate social Specify whether: Childhood-onset type (prior to age 10 yr); Adolescent-onset type or
context (e.g., family, peer group, work colleagues), or it Unspecified onset
impacts negatively on social, educational, occupational, Specify if: With limited prosocial emotions: Lack of remorse or guilt; Callous-lack of
or other important areas of functioning empathy; Unconcerned about performance or Shallow or deficient affect
The behaviors do not occur exclusively during the Specify current severity: Mild; Moderate or Severe
course of a psychotic, substance use, depressive, or ICD-10
bipolar disorder. Also, the criteria are not met for It also requires the presence of three symptoms from the list of 15 (above), and duration
disruptive mood dysregulation disorder of at least 6 mo. There are four divisions of conduct disorder: Socialised conduct disorder,
Specify current severity: Mild; moderate or severe unsocialised conduct disorder, conduct disorders confined to the family context and
based on number of settings with symptoms shown oppositional defiant disorder
Mood, Anxiety, PTSD, Substance abuse, ADHD, learning regarded as a disorder when it is disproportionately
[24,25]
problems, or thought disorders . Majority of boys excessive in severity in comparison to the gravity of the
have an onset of CD before the age of 10 years, while triggering circumstances, leading to abnormal disruption
girls tend to present mainly between 14 and 16 years of daily routines. Panic disorder is characterized by
[26]
of age . Most CYP with CD grow out of this disorder, panic attacks untriggered by external stimuli. GAD is
but a minority become more dissocial or aggressive and characterized by generalized worry across multiple life
develop antisocial personality disorder as adults. domains. Separation anxiety disorder is characterized
ODD is considered to be the mildest and commonest by fear related to actual or anticipated separation from
of the DBPs, with prevalence estimates of 6%-9% for a caregiver. Social anxiety disorder (also called social
pre-schoolers and boys outnumbering girls by at least phobia), is characterized by fear of social situations
[27] [12]
two to one . CYP with ODD are typically openly hostile, where peers may negatively evaluate the person .
negativistic, defiant, uncooperative, and irritable. They Common manifestations of Anxiety disorders in
lose their tempers easily and are mean and spiteful clude physical symptoms such as increased heart rate,
towards others (Table 2). They are mostly defiant shortness of breath, sweating, trembling, shaking,
[29]
towards authority figures, but they may also be hostile chest pain, abdominal discomfort and nausea . Other
to their siblings or peers. This pattern of adversarial symptoms include worries about things before they
behaviour significantly negatively impact on their lives at happen, constant concerns about family, school, friends,
home, school, and wider society, and seriously impairs or activities, repetitive, unwanted thoughts (obsessions) or
[28]
all their relationships . actions (compulsions), fears of embarrassment or making
[30]
mistakes, low self-esteem and lack of self-confidence .
Emotional problems Depression often occurs in children under stress,
Emotional problems in later childhood include panic experiencing loss, or having attentional, learning,
disorder, generalized anxiety disorder (GAD), separation conduct or anxiety disorders and other chronic physical
[7-9,31]
anxiety, social phobia, specific phobias, OCD and depres ailments. It also tends to run in families . Symptoms
sion. Mild to moderate anxiety is a normal emotional of depression are diverse and protean, often mimicking
response to many stressful life situations. Anxiety is other physical and neurodevelopmental problems,

Table 3 DSM-5 criteria for autism spectrum disorders
Persistent deficits in social communication and social interaction across multiple contexts, as manifested by 3 out 3 of the following, currently or by
history
Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to
reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
Deficits in nonverbal communicative behaviours used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal
communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions
and nonverbal communication
Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social
contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers
Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two out of 4 of the following, currently or by history
Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia,
idiosyncratic phrases)
Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal nonverbal behavior (e.g., extreme distress at small changes,
difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day)
Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively
circumscribed or perseverative interest)
Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the environment (e.g., apparent indifference to pain/temperature,
adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement)
Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or
may be masked by learned strategies in later life)
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning
Specify if
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
Specify current severity based on social communication impairments and restricted, repetitive patterns of behavior
including low mood, frequent sadness, tearfulness, restricted, stereotyped, repetitive repertoire of interests
crying, decreased interest or pleasure in almost all and activities” affecting “the individual’s functioning in all
activities; or inability to enjoy previously favourite situations”. These included autism, asperger syndrome,
activities, hopelessness, persistent boredom; low energy, childhood disintegrative disorder (CDD), pervasive
social isolation, poor communication, low self-esteem developmental disorder not otherwise specified (PDD-NOS)
and guilt, feelings of worthlessness, extreme sensitivity and Rett syndrome.
to rejection or failure, increased irritability, agitation, Autism and Asperger Syndrome are the most widely
anger, or hostility, difficulty with relationships, frequent recognised and clinically diagnosed among this group of
complaints of physical illnesses such as headaches and disorders. CDD is a term used to describe children who
stomach aches, frequent absences from school or poor have had a period of normal development for the first 2-3
performance in school, poor concentration, a major years before a relatively acute onset of regression and
change in eating and/or sleeping patterns, weight loss emergence of autistic symptoms. PDD-NOS was used,
or gain when not dieting, talk of or efforts to run away particularly in the United States, to describe individuals
from home, thoughts or expressions of suicide or self- who have autistic symptoms, but do not meet the full
[31]
destructive behaviour . criteria for Autism or Asperger’s Syndrome, denote a
Disruptive mood dysregulation disorder (DMDD) milder version of Autism, or to describe atypical autism
is a childhood disorder characterized by a pervasively symptoms emerging after 30 mo of age, and autistic
[34]
irritable or angry mood recently added to DSM-5. The individuals with other co-morbid disorders .
symptoms include frequent episodes of severe temper The category of PDD has been removed from
[12]
tantrums or aggression (more than three episodes a DSM-5 and replaced with Autism Spectrum disorders
week) in combination with persistently negative mood (ASD). ASD (Table 3) is diagnosed primarily from
between episodes, lasting for more than 12 mo in clinical judgment usually by a multidisciplinary team,
multiple settings, beginning after 6 years of age but with minimal support from diagnostic instruments. Most
[32]
before the child is 10 years old . individuals who received diagnosis based on the DSM-
IV should still maintain their diagnosis under DSM-5,
Autistic spectrum and pervasive development disorder with some studies confirming that 91% to 100% of
The definition of Autism has evolved over the years and children with PDD diagnoses from the DSM-IV retained
[33]
has been broadened over time. DSM-IV-TR and the their diagnosis under the ASD category using the new
[13] [35,36]
ICD-10 defined the diagnostic category of pervasive DSM-5 , while a systematic review has found a
[37]
developmental disorders (PDD) as the umbrella terminology slight decrease in the rate of ASD with DSM-5 .
used for a group of five disorders characterized by There are many intervention approaches and
pervasive “qualitative abnormalities in reciprocal social strategies, used alone or in combination, for supporting
interactions and in patterns of communication, and by a individuals with ASD. These interventions need to

Table 4 Summary of common social communication enhancement strategies
Method Description Ref.

[39,129-131]
Augmentative and alternative communication Supplements/replaces natural speech and/or writing with aided [e.g., Picture Exchange
Communication System, line drawings, Blissymbols, speech generating devices, and tangible
objects] and/or unaided (e.g., manual signs, gestures, and finger spelling) symbols
Effective in decreasing maladaptive or challenging behaviour such as aggression, self-injury
and tantrums, promotes cognitive development and improves social communication
[132]
Activity schedules/visual supports Using photographs, drawings, or written words that act as cues or prompts to help individuals
complete a sequence of tasks/activities or behave appropriately in various settings
Scripts are often used to promote social interaction, initiate or sustain interaction
[40]
Computer-/video-based instruction Use of computer technology or video recordings for teaching language skills, social skills, social
understanding, and social problem solving
Table 5 Summary of common behavioural modification strategies for management of childhood emotional and behavioural disorder
Method Description Ref.

[122,123]
ABA Uses principles of learning theory to bring about meaningful and positive change in behaviour, to help
individuals build a variety of skills (e.g., communication, social skills, self-control, and self-monitoring) and
help generalize these skills to other situations
[40]
Discrete trial training A one-to-one instructional approach based on ABA to teach skills in small, incremental steps in a
systematic, controlled fashion, documenting stepwise clearly identified antecedent and consequence (e.g.,
reinforcement in the form of praise or tangible rewards) for desired behaviours
[124]
Functional communication training Combines ABA procedures with communicative functions of maladaptive behaviour to teach alternative
responses and eliminate problem behaviours
[125]
Pivotal response treatment A play-based, child-initiated behavioural treatment, designed to teach language, decrease disruptive
behaviours, and increase social, communication and academic skills, building on a child’s initiative and
interests
[126]
Positive behaviour support Uses ABA principles with person-centred values to foster skills that replace challenging behaviours with
positive reinforcement of appropriate words and actions. PBS can be used to support children and adults
with autism and problem behaviours
[127]
Self-management Uses interventions to help individuals learn to independently regulate, monitor and record their behaviours
in a variety of contexts, and reward themselves for using appropriate behaviours. It’s been found effective
for ADHD and ASD children
[40]
Time delay It gradually decreases the use of prompts during instruction over time. It can be used with individuals
regardless of cognitive level or expressive communication abilities
[128]
Incidental teaching Utilizes naturally occurring teaching opportunities to reinforce desirable communication behaviour
Anger management Various strategies can be used to teach children how to recognise the signs of their growing frustration
and learn a range of coping skills designed to defuse their anger and aggressive behaviour, teach them
alternative ways to express anger, including relaxation techniques and stress management skills
ABA: Applied behaviour analysis; ADHD: Attention deficit hyperactivity disorder; ASD: Autistic spectrum disorder.
individualized and be closely tailored to the level of with using verbal and nonverbal communication for
social and linguistic abilities, cultural background, family social purposes, which can interfere with interpersonal
resources, learning style and degree of communication relationships, academic achievement and occupational
[38]
skills . performance, in the absence of restricted and repetitive
Various communication enhancement strategies have interests and behaviours (Table 6). Some authors
[39]
been designed to manage ASD , including augmenta consider that CYP with SCD present with similar but less
tive and alternative communication (AAC), Facilitated severe restricted and repetitive interests and behaviours
Communication, computer-based instruction and video- (RRIBs) characteristic of children on the autistic
[41]
based instruction (Table 4). Several behavioural and spectrum . SCD is thought to occur more frequently in
[42]
psychological interventions (Table 5) have also been family members of individuals with autism .
used successfully in managing ASD children, including The term “pragmatic” has been used previously
applied behaviour analysis (ABA) and functional com to describe the communication skills that are needed
[40]
munication training (FCT) . in normal social intercourse and the rules that govern
routine interpersonal interactions, including ability to
Social (pragmatic) communication disorder pay at least some attention to the other person in a
Social (pragmatic) communication disorder (SCD) is a conversation, take turns, not interrupting the other
new diagnosis included under Communication Disorders speaker unless there is a very good reason, match langu
[43]
in the Neurodevelopmental Disorders section of the age and volume to the situation and the listener, etc .
[12]
DSM-5 . It is characterized by persistent difficulties Social and pragmatic deficit are known to also occur in

Table 6 DSM-5 criteria for social (pragmatic) communication disorder
Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following
Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for social context
Impairment in the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a
playground, talking differently to a child than to an adult, and avoiding use of overly formal language
Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how
to use verbal and nonverbal signals to regulate interaction
Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meaning of language (e.g., idioms, humor,
metaphors, multiple meanings that depend on the context for interpretation)
The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational
performance, individually or in combination
The onset of the symptoms is in the early developmental period (but deficits may not become fully manifest until social communication demands exceed
limited capacities)
The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar,
and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or
another mental disorder
diverse clinical populations, including ADHD, William’s activities and relationships are negatively impaired. Unlike
syndrome, CD, closed head injury and spina bifida/hy typically autistic children, people with PDA tend to have
[44]
drocephalus . much better social communication and interaction
Treatment modalities that have been used for su skills, and are consequently able to use these abilities
pporting children with SCD are similar to those that to their advantage. They often have highly developed
have been used for several years in children with ASD social mimicry and role play, sometimes becoming
(Tables 4 and 5). The first randomized controlled trial of different characters or personas. The people with PDA
social communication interventions designed primarily appear to retain a keen awareness of how to “push
for children with SCD was reported in 2012 . The
[45]
people’s buttons”, suggesting a level of social insight
Social Communication Intervention Project (http://www. when compared to CYP with Autism. On the other hand,
psych-sci.manchester.ac.uk/scip/) targets development children with PDA exhibit higher levels of emotional
in social understanding and interaction, verbal and non- symptoms compared to those with ASD or CD. They
verbal pragmatic skills and language processing among also often experience excessive mood swings and
children with SCD. impulsivity. While the prevalence of ASD in boys is more
than four times higher compared to that of girls, the risk
of developing PDA appears to be the same for both boys
Pathological demand avoidance or Newson’s syndrome [47]
Pathological demand avoidance (PDA) or Newson’s and girls .
[48]
Syndrome is increasingly being accepted as part of O’Nions et al have recently reported on the de
the autism spectrum. PDA was first used in 2003
[46] velopment and preliminary validation of the “Extreme
for describing some CYP with autistic symptoms who Demand Avoidance Questionnaire” (EDA-Q), designed
showed some challenging behaviours. It is characterized to quantify PDA traits based on parent-reported
by exceptional levels of demand avoidance requested information, with good sensitivity (0.80) and specificity
by others, due to high anxiety levels when the individuals (0.85). EDA-Q is available online (https://www.
pdasociety.org.uk/resources/extreme-demand-avoi
feel that they are losing control. Avoidance strategies
dance-questionnaire).
can range from simple refusal, distraction, giving ex
cuses, delaying, arguing, suggesting alternatives and
withdrawing into fantasy, to becoming physically incapaci PREVALENCE OF BEHAVIOURAL AND
tated (with an explanation such as “my legs don’t
work”) or selectively mute in many situations. If they EMOTIONAL DISORDERS IN CHILDHOOD
feel threatened to comply, they may become verbally Accurate estimation of various childhood EBPs is difficult
or physically aggressive, best described as a “panic due to the problems of research methodologies relying
[46]
attack”, apparently intended to shock . They tend to on subjective assessments and varying definitions used.
resort to “socially manipulative” behaviours. The out According to most studies, between 10% and 20% of
rageous acts and lack of concern for their behaviour CYP are affected annually by MHDs, and the rates are
appears to draw parallels with conduct problems (CP) very similar across different racial and ethnic groups
and callous-unemotional traits (CUT), but reward- after controlling for income, resident status, education,
based techniques, effective with CP and CUT, seem not and neighbourhood support. However, poverty and low
[47]
to work in people with PDA . PDA is currently neither socioeconomic status are risk factors that appear to
[12] [13] [49]
part of the DSM-5 nor the ICD-10 . increase the rate of MHDs across populations . A 2001
[50]
Though demand avoidance is a common characteristic WHO report indicated the 6-mo prevalence rate for
of CYP with ASD, it becomes pathological when the any MHD in CYP, up to age 17 years, to be 20.9%, with
levels are disproportionately excessive, and normal daily disruptive behaviour disorders (DBD) at 10.3%, second

only to Anxiety disorders at 13%. About 5% of CYP in

the general population suffer from Depression at any
NEUROBIOLOGY OF CHILDHOOD
given point in time, which is more prevalent among girls BEHAVIOURAL AND EMOTIONAL
[31,51]
(54%) .
DISORDERS
A previous British Child and Adolescent Mental
Health (CAMH) survey carried out by the office of Conflicting findings have been reported in the brain
National Statistics (ONS) in 1999 and 2004, comprising structural variations among CYP with EBPs using
7977 interviews from parents, children and teachers, magnetic resonance imaging (MRI) studies. The most
found the prevalence of MHD among CYP (aged consistently reported structural abnormalities associated
5-16 years) to be 6% for conduct problems, 4% for with the DBD include reduced grey matter volume (GMV)
emotional problems (Depression or Anxiety) and 1.5% in the amygdala, frontal cortex, temporal lobes, and the
[51]
for Hyperkinetic disorders . A similar survey in the anterior insula, which is involved in part of a network
United States between 2005 and 2011, the National related to empathic concern for others. Reduced GMV
survey of children’s health (NSCH) involving 78042 along the superior temporal sulcus has also been found,
[77]
particularly in girls . A decreased overall mean cortical
households, indicated that 4.6% of CYP aged 3-17
thickness, thinning of the cingulate and prefrontal
years had a history DBD, with prevalence twice as high
cortices; and decreased grey matter density in different
among boys as among girls (6.2% vs 3.0%), Anxiety [78]
[24] brain regions have been reported .
(4.7%), Depression (3.9%), and ASD (1.1%) .
Subtle neurobiological changes in different parts of
Reported prevalence rates for DMDD range from 0.8%
[52] the brain of CYP with EBPs have been reported from
to 3.3% with the highest rate in preschool children .
many research studies of functional scans. Peculiar brain
changes have been found in the hypothalamus, inferior
AETIOLOGY AND RISK FACTORS FOR and superior parietal lobes, right amygdala and anterior
[79]
insula . Functional MRI studies have demonstrated
CHILDREN’S BEHAVIOURAL AND less activation in the temporal cortex in violent adult
[80]
EMOTIONAL DISORDERS offenders
[81]
and in antisocial and psychopathic indivi
duals compared to non-aggressive offenders.
The exact causes of various childhood EBPs are unknown.
Reduced basal Hypothalamic-Pituitary-Adrenal (HPA)
Several studies have identified various combinations
axis activity has been reported in relation to childhood
of genetic predisposition and adverse environmental [82]
DBDs and exposure to abuse and neglect . It has
factors that increase the risk of developing any of these
been hypothesized that high levels of prenatal testo
disorders. These include perinatal, maternal, family,
[53] sterone exposure appears to be part of the complex
parenting, socio-economic and personal risk factors .
aetiology of EBDs, providing possible explanation for
Table 7 summarizes the evidence for various risk factors
the higher prevalence in males for DBDs, by increasing
associated with development of childhood EBPs.
susceptibility to toxic perinatal environments such
There is ample evidence supporting the genetic
as exposure to maternal nicotine and alcohol in preg
inheritability of many EBDs in CYP from their parents. nancy .
[83]
From a prospective study of 209 parents along with

their 331 biological offsprings, moderate inheritability (r
= 0.23, P < 0.001) between parental and offspring CD COMPLICATIONS OF CHILDHOOD
[74]
was found . Anxiety seems to be transmissible from
BEHAVIOURAL AND EMOTIONAL
mothers to their preschool children, through both genetic
factors and also through behaviour modelling and an DISORDERS
[6]
anxious style of parenting . EBDs in childhood, if left untreated, may have negative
A developmental taxonomy theory has been proposed short-term and long-term effects on an individual’s
[75]
by Patterson et al to help understand the mechanisms personal, educational, family and later professional life.
underlying early onset and course of CPs. They described CD has been linked to failure to complete schooling,
the vicious cycle of non-contingent parental responses attaining poor school achievement, poor interpersonal
to both prosocial and antisocial child behaviour leading relationships, particularly family breakup and divorce,
to the inadvertent reinforcement of child behaviour and experience of long-term unemployment. DBPs in
problems. Parents’ engagement in “coercive cycles” lead parents have been linked to the abuse of their offspring,
to children learning the functional value of their aversive thereby increasing their risk of developing CD
[84,85]
.
behaviours (e.g., physical aggression) for escape and Children presenting with hyperactivity-inattention be
avoidance from unwanted interactions, ultimately leading haviours are more likely to have a more favourable edu
to the use of heightened aversive behaviours from both cational outcome compared with those with aggression
the child and parents to obtain social goals. This adverse or oppositional behaviours
[86,87]
.
child behavioural training combined with social rejection A high prevalence of sleep disturbances is associated
often lead to deviant peer affiliation and delinquency in with various childhood EBPs. Sleep problems in early
[76]
adolescence . childhood is associated with increased prevalence of

Table 7 Summary of common risk factors for development of childhood emotional and behavioural disorder
Domain Characteristic examples Ref.

[4,54]
Maternal psychopathology (mental health status) Low maternal education, one or both parents with depression, antisocial behaviour,
smoking, psychological distress, major depression or alcohol problems, an antisocial
personality, substance misuse or criminal activities, teenage parental age, marital conflict,
disruption or violence, previous abuse as a child and single (unmarried status)
[55,56]
Adverse perinatal factors Maternal gestational moderate alcohol drinking, smoking and drug use, early labour
onset, difficult pregnancies, premature birth, low birth weight, and infant breathing
problems at birth
[57,58]
Poor child-parent relationships Poor parental supervision, erratic harsh discipline, parental disharmony, rejection of the
child, and low parental involvement in the child’s activities, lack of parental limit setting
[59]
Adverse family life Dysfunctional families where domestic violence, poor parenting skills or substance
abuse are a problem, lead to compromised psychological parental functioning, increased
parental conflict, greater harsh, physical, and inconsistent discipline, less responsiveness
to children’s needs, and less supportive and involved parenting
[60,61]
Household tobacco exposure Several studies have shown a strong exposure–response association between second-
hand smoke exposure and poor childhood mental health
[62-66]
Poverty and adverse socio-economic environment Personal and community poverty signs including homelessness, low socio-economic
status, overcrowding and social isolation, and exposure to toxic air, lead, and/or
pesticides or early childhood malnutrition often lead to poor mental health development
Chronic stressors associated with poverty such as single-parenthood, life stress, financial
worries, and ever-present challenges cumulatively compromise parental psychological
functioning, leading to higher levels of distress, anxiety, anger, depressive symptoms and
substance use in disadvantaged parents.
Chronic stressors in children also lead to abnormal behaviour pattern of ‘reactive
responding’ characterized by chronic vigilance, emotional reacting and sense of
powerlessness
[67-69]
Early age of onset Early starters are likely to experience more persistent and chronic trajectory of antisocial
behaviours
Physically aggressive behaviour rarely starts after age 5
[70-72]
Child’s temperament Children with difficult to manage temperaments or show aggressive behaviour from an
early age are more likely to develop disruptive behavioural disorders later in life
Chronic irritability, temperament and anxiety symptoms before the age of 3 yr are
predictive of later childhood anxiety, depression, oppositional defiant disorder and
functional impairment
[15,73]
Developmental delay and Intellectual disabilities Up to 70% of preschool children with DBD are more than 4 times at risk of developmental
delay in at least one domain than the general population
Children with intellectual disabilities are twice as likely to have behavioural disorders as
normally developing children
Rate of challenging behaviour is 5% to 15% in schools for children with severe learning
disabilities but is negligible in normal schools
[24,25,27,47,51]
Child’s gender Boys are much more likely than girls to suffer from several DBD while depression tends
to predominantlyaffect more girls than boys
Unlike the male dominance in childhood ADHD and ASD, PDA tends to affect boys and
girls equally
ADHD: Attention deficit hyperactivity disorder; ASD: Autistic spectrum disorder; DBD: Disruptive behaviour disorder; PDA: Pathological demand
avoidance.
[88,89]
later Anxiety disorders and ODD . punishment and lower levels of parental warmth and
[74,84,93,94]
Several studies have confirmed a strong relationship sensitivity . Approximately 40%-50% of CYP with
between early childhood EBPs and poor future long-term CD are at the risk of developing antisocial personality
[84]
physical and mental health outcomes. Chronic irritability disorder in adulthood . Other potential complications
in preschool children, CD and ODD in older children include adverse mental and physical health outcomes,
each may be predictive of any current and lifetime social justice system involvement including incarceration,
Anxiety, Depression and DBDs in later childhood, Mania, substance use and abuse, alcoholism, homelessness,
[95,96]
Schizophrenia, OCD, major depressive disorder and panic poverty and domestic abuse .
[84,90-92]
disorder . Individuals on the adolescent-onset CP An analysis of several Scandinavian studies up to
path often consume more tobacco and illegal drugs and the 1980s has shown higher rates of violent death,
engage more often in risky sexual behaviour, self-harm, estimated to be almost five times higher than expected
and have increased risk of PTSD, than individuals without among young people with previous MHD, with common
childhood conduct problems. They also frequently associated predictive factors including behavioural
experience parenting difficulties, including over- problems, school problems, and co-morbid alcohol or
[97]
reactivity, lax and inconsistent discipline, child physical drug abuse and criminality .

combination with psychological and other environmental

ASSESSMENT AND DIAGNOSIS OF interventions .
[15]
CHILDHOOD BEHAVIOURAL AND Holistic management strategies will include various

combinations of several interventions such as child- and
EMOTIONAL DISORDERS family-focused psychological strategies including Cognitive
Assessment through detailed history taking as well as Behavioural Therapy (CBT), behavioural modification
observation of a child’s behaviour are indispensable and social communication enhancement techniques,
sources of information required for clinical diagnosis of parenting skills training and psychopharmacology. These
[1]
EBPs . This should include general medical, develop strategies can play significant roles in the management
mental, family, social, educational and emotional history. of children with a wide range of emotional, behavioural
Physical and neurological examination should include and social communication disorders. Effective alternative
assessment of vision, hearing, dysmorphic features, educational procedures also need to be implemented for
neuro-cutaneous stigmata, motor skills and cognitive the school age children and adolescents.
assessment. Condition-specific and generic observer In early childhood, similar parenting strategies
feedback on screening rating scales and questionnaires have been found useful to manage several apparently
can be used to complement direct clinical observations. dissimilar EBPs (e.g., infant feeding or sleeping problems,
There is no single gold-standard diagnostic tool preschool tantrums, disruptive and various emotional
available for the diagnosis of EBDs, which largely depends problems). This may suggest there is a common
on the clinical skills of an integrated collaboration of multi- maintaining mechanism, which is probably related to
professional experts. Diagnosis relies on interpretation of poor self-regulation skills, involving the ability to control
subjective multi-source feedback from parents or carers, impulses and expressions of emotion .
[101]
teachers, peers, professional or other observers provided Several studies have confirmed the effectiveness of
through a number of psychometric questionnaires or various psychological and pharmacologic therapies in
[98]
screening tools . Significant discrepancies between the management of childhood EBDs. A meta-analysis
various respondents are quite common and clinical of thirty-six controlled trials, involving 3042 children
diagnosis cannot rely on the psychometric tools alone. (mean sample age, 4.7 years), evaluating the effect of
There is evidence from the literature suggesting that psychosocial treatments including parenting programmes
parents have a tendency to over-report symptoms of on early DBPs, demonstrated large and sustained
[99]
ODD and CD in children compared to the teachers . effects (Hedges’g = 0.82), with the largest effects
There are several screening tools that are used for for general externalizing symptoms and problems of
assessing the risk of MHD among CYP. The tools help oppositionality and non-compliance, and were weakest,
to identify which individuals would require more in- relatively speaking, for problems of impulsivity and
[100]
depth clinical interventions . Supplement material [102]
hyperactivity .
shows a list of common Mental Health screening and The treatment of CD among CYP with callous-
assessment tools, summarizing their psychometric unemotional traits is still at early stages of research. The
testing properties, cultural considerations and costs. mainstay of management for CDs includes individual
The commonest behaviour screening tools include the behavioural or cognitive therapy, psychotherapy, family
Behavioral and Emotional Screening System (BESS; therapy and medications .
[103]
ages 3-18 years), the Behavior Assessment System for

nd
Children-2 edition, Pediatric Symptom Checklist (PSC),
Parental skills training
the Ages and Stages Questionnaire-Social Emotional
Any challenging behaviour from CYP is likely to elicit
(ASQ-SE, Ages 0 to 5 years) and the Achenbach
persistent negative reactions from many parents,
System of Empirically Based Assessment (ASEBA), for
using ineffective controlling strategies and a decrease
children aged 1.5 years through adulthood. [104]
in positive responses . There is evidence from
published research that social-learning and behaviourally
MANAGEMENT OF BEHAVIOURAL AND based parent training is capable of producing lasting
improvement in children with callous-unemotional traits
EMOTIONAL DISORDERS IN CHILDREN or CD, reducing externalizing problems for children
Identification of appropriate treatment strategies depend with DBDs, leading to significant parent satisfaction,
[84,105-107]
on careful assessment of the prevailing symptoms, particularly when delivered early in childhood .
the family and caregiver’s influences, wider socio- These interventions are typically delivered in a group
economic environment, the child’s developmental level format, one 2-h session per week for 4-18 wk, by trained
and physical health. It requires multi-level and multi- leaders, with the focus on improving parenting skills to
disciplinarian approaches that include professionals such manage child behaviour, where parents typically learn to
as Psychologists, Psychiatrists, Behavioural Analysts, identify, define and observe problem behaviours in new
Nurses, Social care staff, Speech and language ways, as well as learn strategies to prevent and respond
[108,109]
Therapists, Educational staff, Occupational Therapists, to oppositional behaviour .
Physiotherapists, Paediatricians and Pharmacists. Pooled estimates from a review of 37 randomised
Use of pharmacotherapy is usually considered only in controlled studies identified a statistically significant

improvement on several rating scales among children widely used non-pharmacologic treatments for individuals
[23]
with CD up to the age of 18 years . A previous meta- with emotional disorders, especially depression, and with
[119]
analysis of 24 studies confirmed that Parent-Child individuals with behavioural problems including ASD .
Interaction Therapy (PCIT) demonstrated significantly CBT integrates a combination of both cognitive and
larger effect sizes for reducing negative parent be behavioural learning principles to encourage desirable
haviours, negative child behaviours, and caregiver behaviour patterns. Research evidence from several
[120]
reports of child behaviour problems than did most or trials provide strong support for the effectiveness of
[110]
all forms of Positive Parenting Programme (Triple P) . cognitive–behavioural interventions among CYP with
A recent Cochrane review of 13 studies confirmed the Anxiety and Depression. A recent study of child-focused
efficacy and cost-effectiveness of group-based parenting CBT programme introduced at schools has shown that
interventions for alleviating child conduct problems, it produces significant improvement in disruptive be
[121]
enhancing parental mental health and parenting skills, at haviours among children .
[111]
least in the short term . Self-esteem building strategies can help many
children with EBDs, who often experience repeated
Differentiated educational strategies failures at school and in their interactions with others.
Research has focused on identifying alternative educa These children could be encouraged to identify and excel
tional strategies that can be used to improve learning in their particular talents (such as sports) to help build
opportunities for children presenting with challenging their self-esteem.
behaviours from various causes. Supportive school
strategies for children with EBDs have traditionally Behavioural modification and social communication
focused on classroom management, social skills and enhancement strategies
anger management, but many researchers have more Behavioural interventions and techniques are designed
recently argued that academically-focused interventions to reduce problem behaviours and teach functional
[112]
may be most effective . Traditional school policies alternative strategies using the basic principles of
of suspending or expelling children with EBD can be behaviour change. Most interventions are based on the
harmful to them. Researchers have developed “step- principles of Applied Behaviour Analysis (ABA) which is
by-step” guidelines for teachers to guide them in grounded on behavioural learning theory. Table 5 sum
the selection and implementation of evidence-based marizes the common behavioural modification strategies
strategies that have been identified as effective in for management of childhood EBDs.
increasing levels of engagement and achievement by Several strategies have been designed to help
children with EBD, including peer-assisted learning children acquire important social skills, such as how to
procedures, class-wide peer tutoring, self-management have a conversation or play cooperatively with others,
interventions and tiered intervention systems - most using social group settings and other platforms to teach
notably Response to Intervention (RtI) and Positive peer interaction skills and promote socially appropriate
[113,114]
Behavioural Interventions and Supports (PBIS) . behaviours and communication. There is ongoing re
There is increasing evidence to confirm that school- search in the development of social communication treat
[45]
based interventions to address emerging DBPs produce ment approaches . Table 4 summarizes common social
significant reductions in both parent-, self- and teacher- communication enhancement strategies.
[114,115]
reported internalizing and externalizing symptoms .
Treatment and Education of Autistic and Related
Communication Handicapped Children (TEACCH) is PSYCHOPHARMACOLOGY OF
an educational system designed for the management CHILDHOOD BEHAVIOURAL AND
of children with Autism and related communication
disorders
[116,117]
. There is some evidence that TEACCH EMOTIONAL DISORDERS
programmes also lead to some improvements in motor Medications are often prescribed as part of a compre
[117]
skills and cognitive measures . hensive plan for the management of childhood EBDs
Best practice management strategies for children that includes other therapies. The greatest level of
with PDA are known to differ from those with Autism. evidence for pharmacotherapy of childhood EBDs is
[118]
Specific guidelines for children with PDA have been available for their use in the management of childhood
published by the British institute for Learning Disabilities. and adolescent ADHD. There is less evidence of any
Educational support for CYP with PDA relies on highly efficacy for medications in the management of other
individualized strategies that allows them to feel in DBPs including ODD and CD. Table 8 lists the common
control. They would respond much better to more classes of medications used in the management of
indirect and negotiative approaches. For example, “I childhood EBD.
wonder how we might…” is likely to be more effective Psychostimulants (including different formulations
[118]
than “Now let’s get on with your work” . of Methylphenidate and Dexamphetamines) remain
the primary medication of choice for management
Child-focused psychological interventions of ADHD in CYP for more than 60 years. About 75%
Cognitive behavioural therapy (CBT) is one of the most to 80% of children with ADHD will benefit from the

Table 8 Major classes of medications used in management of childhood emotional and behavioural disorders
Common examples Indications for use Common Side-effects Follow up monitoring

Traditional antipsychotics Haloperidol, Schizophrenia, Tremors, Muscle spasms, Frequent blood tests
Chlorpromazine, Bipolar disorder, Abnormal movements, (Clozapine),
Thiotixene, Schizoaffective, Stiffness, Blurred vision, Blood pressure checks,
Perphenazine, Disorder, Constipation Cholesterol testing,
Trifluoperazine Obsessive-compulsive Heart Rate checks,
disorder, Blood Sugar testing,
Atypical antipsychotics Aripiprazole, Depression, Low white blood cell count Electrocardiogram,
Clozapine, Aggression, (Agranulocytosis - with Height,
Olanzapine, Mood instability, Clozapine), Diabetes, Lipid Weight and blood chemistry
Quetiapine, Irritability in ASD abnormalities, Weight gain, tests
Risperidone, Other medication-specific
Ziprasidone side effects
Tricyclic antidepressants Amytriptyline, Depression, Anxiety, Dry mouth, Constipation, Watch for worsening of
Desipramine, Seasonal Affective, Blurry vision, depression and thoughts
Doxepin, Disorder, Urinary retention, Dizziness, about suicide,
Imipramine, OCD, Drowsiness Watch for unusual bruises,
Nortriptyline Posttraumatic Stress bleeding from the gums when
Selective Serotonin Reuptake Citalopram, Disorder, Headache, brushing teeth, especially if
Inhibitors Escitalopram, Social Anxiety, Nervousness, taking other medications,
Fluoxetine, Bed-wetting and pre- Nausea Insomnia, Blood tests and Blood pressure
Fluvoxamine, menstrual syndrome Weight Loss checks may be needed
Sertraline
Serotonin-norepinephrine Venlafaxine,
reuptake inhibitor Levomilnacipran,
Duloxetine,
Desvenlafaxine
Other antidepressants Bupropion,
Mirtazepine,
Trazodone
Stimulants Methylphenidate Immediate ADHD Decreased appetite/ weight Blood pressure and heart
Release and Modified Release loss, Sleep problems, rate will be checked before
(e.g., Concerta XL, Equasym Jitteriness, restless, treatment and periodically
XL), Headaches, Dry mouth, during treatment.
Dexamfetamines Immediate Dysphoria, feeling sad, Child’s height and weight are
Release and Modified Release Anxiety, Increased heart rate, monitored
(e.g., Lisdexamfetamine) Dizziness
Non-stimulants Atomoxetine
Alpha-2 agonists Clonidine, Drowsiness, Dizziness,
Guanfacine Sleepiness
Benzodiazepines Lorazepam, Anxiety, Drowsiness, Dizziness, Do not stop these medications
Clonazepam, Panic disorder, Sleepiness, Confusion, suddenly without slowly
Diazepam, Alcohol withdrawal, Memory loss, Blurry vision, reducing (tapering) the dose
Alprazolam, PTSD, Balance problems, Worsening as directed by the clinician.
Oxazepam, OCD behaviour While taking buspirone, avoid
Chlordiazepoxide grapefruit juice,
Antihistamines Hydroxyzine HCl, Sleepiness, Drowsiness, Avoid alcohol,
Hydroxyzine, Dizziness, Dry mouth, Blood tests may be needed
Pamoate, Confusion, Blurred Vision, prior to the start of treatment
Alimemazine Balance problems, Heartburn and during treatment
Other anxiolytics Buspirone Dizziness, Nausea,
Headache, Lightheadedness,
Nervousness
Sleep-enhancement Zolpidem, Insomnia (short-term) Headache, Dizziness, Blood tests may be needed
Zaleplon, Weakness, Nausea, Memory before the start of treatment.
Diphenhydramine, loss, Daytime sleepiness, Avoid alcohol
Trazodone Hallucinations, Dry mouth,
Confusion, Blurred Vision,
Balance problems, Heartburn
Modified from “Medications used for behavioral and emotional disorders. A guide for parents, foster parents, families, youth, caregivers, guardians,
and social workers.” May 2010. Available Online: URL: http://www.ct.gov/dcf/lib/dcf/ccmu/pdf/cmcu_-_educational_booklet_5-7-2010.pdf. ADHD:
Attention deficit hyperactivity disorder; ASD: Autistic spectrum disorder; PTSD: Post traumatic stress disorder; OCD: Obsessive-compulsive disorder.
use of psychostimulants. Non-stimulant therapy with and Guanfacine) are also effective second-line alternative
[133]
Atomoxetine or alpha 2-adrenergic agonists (Clonidine options . A recent analysis of 16 randomized trials

and one meta-analysis, involving 2668 participants with

ADHD, showed that both stimulant and non-stimulant
CONCLUSION
medications led to clinically significant reductions in Childhood EBDs have significant negative impacts on the
core symptoms with consistently high effect sizes. The society, in the form of direct behavioural consequences
psychosocial treatments alone combining behavioural, and costs, and on the individual, in the form of poor
cognitive behavioural and skills training techniques academic, occupational and psychosocial functioning
demonstrated small- to medium-sized improvements for and on the family. The costs to society include the
parent-rated ADHD symptoms, co-occurring emotional or trauma, disruption and psychological problems caused
behavioural symptoms and interpersonal functioning .
[134]
to the victims of crime or aggression in homes, schools
The use of pharmacological treatments for symptoms and communities, together with the financial costs of
of ASD is common but challenging, as there are no services to treat the affected individuals, including youth
medications that directly treat the social and language justice services, courts, prison services, social services,
impairments present in individuals with ASD. The foster homes, psychiatric services, accident and
medications used most frequently include antipsychotics emergency services, alcohol and drug misuse services,
(e.g., Risperidone) and Selective Serotonin Reuptake in addition to unemployment and other required state
[23]
Inhibitors (SSRI) to treat mood and repetitive behaviour benefits .
problems, and stimulants and other medications used Prevention and management of EBD is not easy
to treat ADHD-related symptoms. The evidence base is and it requires an integrated multidisciplinary effort by
good for using atypical antipsychotics to treat challenging healthcare providers at different levels to be involved
and repetitive behaviours, but they also have significant in the assessment, prevention and management of
[119,135]
side effects . Naltrexone is an opioid antagonist affected individuals, and also to provide social, economic
that has been shown from a systematic review (involving and psycho-emotional support to the affected families.
155 children from 10 studies) to significantly improve There is increasing evidence base for several psy
symptoms of self-injury, irritability, restlessness and hy chosocial interventions but less so for pharmacological
peractivity in autistic children, with minimal side effects treatment apart from the use of stimulants for ADHD.
and generally good tolerance, although long-term data Preventive measures that have been researched for
[136]
are lacking . controlling the risk of childhood emotional and behaviour
Medication use in preschool children for control of problems include breastfeeding
[142]
, avoiding second-
ASD and ADHD symptoms is still largely controversial. hand smoke exposure in non-smoker youths
[143]
and
Stimulant medications for treatment of ADHD are not intensive parenting interventions.
uniformly licensed for pre-schoolers as there is limited
available research evidence to confirm efficacy and safety.
Moreover, the effectiveness of parenting interventions REFERENCES
in this age group are comparable to the effects of using 1 Parry TS. Assessment of developmental learning and behavioural
stimulant drugs among the older CYP
[137,138]
. problems in children and young people. Med J Aust 2005; 183:
43-48 [PMID: 15992341]
Research evidence from two systematic reviews and
2 Hong JS, Tillman R, Luby JL. Disruptive behavior in preschool
20 randomized controlled trials has recently documented children: distinguishing normal misbehavior from markers of
the efficacy of psychopharmacology in the management current and later childhood conduct disorder. J Pediatr 2015; 166:
of childhood DBP. Psychostimulants have have been 723-730.e1 [PMID: 25598304 DOI: 10.1016/j.jpeds.2014.11.041]
shown to have a moderate-to-large effect on oppositional 3 Wakschlag LS, Choi SW, Carter AS, Hullsiek H, Burns J,
McCarthy K, Leibenluft E, Briggs-Gowan MJ. Defining the
behaviour, conduct problems, and aggression in youths
developmental parameters of temper loss in early childhood:
with ADHD, with and without ODD or CD, while Ato implications for developmental psychopathology. J Child Psychol
moxetine has only a small effect. There is very-low- Psychiatry 2012; 53: 1099-1108 [PMID: 22928674 DOI: 10.1111/
quality evidence that Clonidine and Guanfacine have a j.1469-7610.2012.02595.x]
small-to-moderate effect on oppositional behaviour and 4 Bagner DM, Rodríguez GM, Blake CA, Linares D, Carter AS.
[139] Assessment of behavioral and emotional problems in infancy: a
conduct problems in youths with ADHD .
systematic review. Clin Child Fam Psychol Rev 2012; 15: 113-128
Other behavioural disorders in children could also [PMID: 22262040 DOI: 10.1007/s10567-012-0110-2]
be successfully treated by medications. Traditional and 5 El-Radhi AS. Management of common behaviour and mental
the newer atypical antipsychotics can be used for OCD, health problems. Br J Nurs 2015; 24: 586, 588-590 [PMID:
Depression, aggression and mood instability .
[140] 26067793 DOI: 10.12968/bjon.2015.24.11.586]
6 Gardner F, Shaw DS. Behavioral Problems of Infancy and Preschool
The commonest antidepressants in used in children
Children (0–5). Chapter 53 in Rutter’s Child and Adolescent
are the SSRI and Serotonin-Norepinephrine Reuptake Psychiatry Fifth Edition, 2009 [DOI: 10.1002/9781444300895.ch53]
Inhibitor (SNRI) medications as they work well and 7 Lu Y, Mak KK, van Bever HP, Ng TP, Mak A, Ho RC. Prevalence
usually have fewer side effects compared to the older of anxiety and depressive symptoms in adolescents with asthma: a
Tricyclic Antidepressants. Antidepressants can be used in meta-analysis and meta-regression. Pediatr Allergy Immunol 2012;
23: 707-715 [PMID: 22957535 DOI: 10.1111/pai.12000]
the management of Major Depression, Anxiety, Seasonal
8 Chernyshov PV, Ho RC, Monti F, Jirakova A, Velitchko SS,
Affective Disorder (SAD), OCD, PTSD and Social Anxiety. Hercogova J, Neri E. Gender Differences in Self-assessed Health-
They may also be used to treat enuresis and pre-men related Quality of Life in Children with Atopic Dermatitis. J Clin
[141]
strual syndrome . Aesthet Dermatol 2016; 9: 19-24 [PMID: 27672414]

9 Quek YH, Tam WWS, Zhang MWB, Ho RCM. Exploring 2013; 62 (Suppl 2): 1-35. Available from: URL: https://www.cdc.
the association between childhood and adolescent obesity and gov/mmwr/pdf/other/su6202.pdf
depression: a meta-analysis. Obes Rev 2017; 18: 742-754 [PMID: 25 State of Victoria Australia Better Health Channel. Conduct
28401646 DOI: 10.1111/obr.12535] Disorder. 2014. Available from: URL: https://www.betterhealth.
10 Kolko DJ, Perrin E. The integration of behavioral health vic.gov.au/health/conditionsandtreatments/conduct-disorder
interventions in children’s health care: services, science, and 26 American Academy of Child and Adolescent Psychiatry
suggestions. J Clin Child Adolesc Psychol 2014; 43: 216-228 (AACAP). Conduct Disorder. 2103c. Available from: URL: http://
[PMID: 24588366 DOI: 10.1080/15374416.2013.862804] www.rpsych.com/docs/Conduct_Disorder.pdf
11 American Academy of Child and Adolescent Psychiatry 27 Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence,
(AACAP). A Guide to Building Collaborative Mental Health Care correlates, and persistence of oppositional defiant disorder: results
Partnerships. In: Pediatric Primary Care, 2010: 1-27 Available from the National Comorbidity Survey Replication. J Child
from: URL: https://www.aacap.org/App_Themes/AACAP/docs/ Psychol Psychiatry 2007; 48: 703-713 [PMID: 17593151 DOI:
clinical_practice_center/guide_to_building_collaborative_mental_ 10.1111/j.1469-7610.2007.01733.x]
health_care_partnerships.pdf 28 Bradley MC, Mandell D. Oppositional defiant disorder: a
12 American Psychiatric Association (APA). Diagnostic and systematic review of evidence of intervention effectiveness. J Exp
Statistical Manual of Mental Disorders 5th Edition. Washington Criminol 2005; 1: 343-365 [DOI: 10.1007/s11292-005-0062-3]
(DC): APA, 2013. Available from: URL: https://tinyurl.com/ 29 Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders
y82f6kyj in pediatric medical settings: prevalence, phenomenology, and a
13 World Health Organization (WHO). International Statistical research agenda. Arch Pediatr Adolesc Med 2010; 164: 965-972
Classification of Diseases and Related Health Problems [PMID: 20921356 DOI: 10.1001/archpediatrics.2010.170]
10th Revision (ICD-10) Geneva Switzerland: World Health 30 American Academy of Child and Adolescent Psychiatry
Organization, 1990. Available from: URL: https://tinyurl.com/ (AACAP). The Anxious Child. 2013b. Available from:
neayazp URL: https://www.aacap.org/App_Themes/AACAP/docs/
14 Emerson E. Challenging Behaviour: Analysis and intervention facts_for_families/47_the_anxious_child.pdf
in people with learning disabilities. 2nd edition. Cambridge 31 American Academy of Child and Adolescent Psychiatry
University Press, 2001: 2-4 [DOI: 10.1017/CBO9780511543739] (AACAP). The Depressed Child. 2013. Available from:
15 National Institute for Health and Clinical Excellence (NICE). URL: https://www.aacap.org/App_Themes/AACAP/docs/
Challenging behaviour and learning disabilities: Prevention and facts_for_families/04_the_depressed_child.pdf
interventions for people with learning disabilities whose behaviour 32 Stringaris A. Irritability in children and adolescents: a challenge
challenges. 2015. Available from: URL: https://www.nice.org.uk/ for DSM-5. Eur Child Adolesc Psychiatry 2011; 20: 61-66 [PMID:
guidance/ng11 21298306 DOI: 10.1007/s00787-010-0150-4]
16 Langridge D. Health and Challenging Behaviour information 33 American Psychiatric Association (APA). Diagnostic and
sheet. The Challenging Behaviour Foundation. 2007. Available Statistical Manual of Mental Disorders 4th Edition. Washington
from: URL: http://www.challengingbehaviour.org.uk/learning- (DC): APA, 2000: 866. [DOI: 10.1176/appi.books.9780890420249.
disability-files/14_WHealth-and-Challenging-Behaviour.pdf dsm-iv-tr]
17 Tremblay RE, Nagin DS, Séguin JR, Zoccolillo M, Zelazo PD, 34 McPartland J, Volkmar FR. Autism and related disorders. Handb
Boivin M, Pérusse D, Japel C. Physical aggression during early Clin Neurol 2012; 106: 407-418 [PMID: 22608634 DOI: 10.1016/
childhood: trajectories and predictors. Pediatrics 2004; 114: B978-0-444-52002-9.00023-1]
e43-e50 [PMID: 15231972 DOI: 10.1542/peds.114.1.e43] 35 Huerta M, Bishop SL, Duncan A, Hus V, Lord C. Application
18 Reebye P. Aggression during early years - infancy and preschool. of DSM-5 criteria for autism spectrum disorder to three samples
Can Child Adolesc Psychiatr Rev 2005; 14: 16-20 [PMID: of children with DSM-IV diagnoses of pervasive developmental
19030496] disorders. Am J Psychiatry 2012; 169: 1056-1064 [PMID:
19 Gurnani T, Ivanov I, Newcorn JH. Pharmacotherapy of 23032385 DOI: 10.1176/appi.ajp.2012.12020276]
Aggression in Child and Adolescent Psychiatric Disorders. J Child 36 Kim YS, Fombonne E, Koh YJ, Kim SJ, Cheon KA, Leventhal BL.
Adolesc Psychopharmacol 2016; 26: 65-73 [PMID: 26881859 A comparison of DSM-IV pervasive developmental disorder and
DOI: 10.1089/cap.2015.0167] DSM-5 autism spectrum disorder prevalence in an epidemiologic
20 Bolhuis K, Lubke GH, van der Ende J, Bartels M, van Beijsterveldt sample. J Am Acad Child Adolesc Psychiatry 2014; 53: 500-508
CEM, Lichtenstein P, Larsson H, Jaddoe VWV, Kushner SA, [PMID: 24745950 DOI: 10.1016/j.jaac.2013.12.021]
Verhulst FC, Boomsma DI, Tiemeier H. Disentangling Heterogeneity 37 Kulage KM, Smaldone AM, Cohn EG. How will DSM-5 affect
of Childhood Disruptive Behavior Problems Into Dimensions and autism diagnosis? A systematic literature review and meta-analysis.
Subgroups. J Am Acad Child Adolesc Psychiatry 2017; 56: 678-686 J Autism Dev Disord 2014; 44: 1918-1932 [PMID: 24531932 DOI:
[PMID: 28735697 DOI: 10.1016/j.jaac.2017.05.019] 10.1007/s10803-014-2065-2]
21 National Institute for Health and Care Excellence (NICE). 38 Maggin DM, Johnson AH, Chafouleas SM, Ruberto LM,
Attention deficit hyperactivity disorder: diagnosis and Berggren M. A systematic evidence review of school-based group
management. [updated 2008 Sept 24]. Available from: URL: contingency interventions for students with challenging behavior. J
https://www.nice.org.uk/guidance/cg72 Sch Psychol 2012; 50: 625-654 [PMID: 23040760 DOI: 10.1016/
22 Campbell SB, Shaw DS, Gilliom M. Early externalizing behavior j.jsp.2012.06.001]
problems: toddlers and preschoolers at risk for later maladjustment. 39 Iacono T, Trembath D, Erickson S. The role of augmentative and
Dev Psychopathol 2000; 12: 467-488 [PMID: 11014748 DOI: alternative communication for children with autism: current status
10.1017/S0954579400003114] and future trends. Neuropsychiatr Dis Treat 2016; 12: 2349-2361
23 Dretzke J, Frew E, Davenport C, Barlow J, Stewart-Brown [PMID: 27703354 DOI: 10.2147/NDT.S95967]
S, Sandercock J, Bayliss S, Raftery J, Hyde C, Taylor R. The 40 American Speech-Language-Hearing Association (ASHA).
effectiveness and cost-effectiveness of parent training/education Autism (Practice Portal). Available from: URL: http://www.asha.
programmes for the treatment of conduct disorder, including org/Practice-Portal/Clinical-Topics/Autism/
oppositional defiant disorder, in children. Health Technol Assess 41 Reisinger LM, Cornish KM, Fombonne E. Diagnostic
2005; 9: iii, ix-ix, 1-233 [PMID: 16336845] differentiation of autism spectrum disorders and pragmatic
24 Centers for Disease Control and Prevention (CDC). Perou language impairment. J Autism Dev Disord 2011; 41: 1694-1704
RH, Bitsko SJ, Blumberg P, Pastor RM, Ghandour JC, Gfoerer [PMID: 21416199 DOI: 10.1007/s10803-011-1196-y]
SL. Mental Health Surveillance among Children - United States 42 Miller M, Young GS, Hutman T, Johnson S, Schwichtenberg
2005-2011. Morbidity and Mortality Weekly Report (MMWR), AJ, Ozonoff S. Early pragmatic language difficulties in

siblings of children with autism: implications for DSM-5 social 58 Smeekens S, Riksen-Walraven JM, van Bakel HJ. Multiple
communication disorder? J Child Psychol Psychiatry 2015; 56: determinants of externalizing behavior in 5-year-olds: a
774-781 [PMID: 25315782 DOI: 10.1111/jcpp.12342] longitudinal model. J Abnorm Child Psychol 2007; 35: 347-361
43 Rapin I. Historical data. In Rapin I (Ed). Preschool Children with [PMID: 17243016 DOI: 10.1007/s10802-006-9095-y]
Inadequate Communication: Developmental Language Disorder, 59 Brody GH, Murry VM, Kim S, Brown AC. Longitudinal pathways
Autism, Low IQ. Clinics in Developmental Medicine. Cambridge to competence and psychological adjustment among African
University Press, New York, 1996; 139: 57-97 American children living in rural single-parent households.
44 Norbury CF. Practitioner review: Social (pragmatic) Child Dev 2002; 73: 1505-1516 [PMID: 12361315 DOI:
communication disorder conceptualization, evidence and clinical 10.1111/1467-8624.00486]
implications. J Child Psychol Psychiatry 2014; 55: 204-216 [PMID: 60 Padrón A, Galán I, García-Esquinas E, Fernández E, Ballbè
24117874 DOI: 10.1111/jcpp.12154] M, Rodríguez-Artalejo F. Exposure to secondhand smoke in the
45 Adams C, Lockton E, Freed J, Gaile J, Earl G, McBean K, Nash M, home and mental health in children: a population-based study.
Green J, Vail A, Law J. The Social Communication Intervention Tob Control 2016; 25: 307-312 [PMID: 25808665 DOI: 10.1136/
Project: a randomized controlled trial of the effectiveness of speech tobaccocontrol-2014-052077]
and language therapy for school-age children who have pragmatic 61 Royal College of Physicians Royal College of Psychiatrists
and social communication problems with or without autism (RCP/RCPsy). Smoking and mental health. London: RCP, 2013.
spectrum disorder. Int J Lang Commun Disord 2012; 47: 233-244 Available from: URL: http://www.ncsct.co.uk/usr/pub/Smoking%2
[PMID: 22512510 DOI: 10.1111/j.1460-6984.2011.00146.x] 0and%20mental%20health.pdf
46 Newson E, Le Maréchal K, David C. Pathological demand 62 McLoyd V. How money matters for children’s socioemotional
avoidance syndrome: a necessary distinction within the pervasive adjustment: Family processes and parental investment. In: Carlo
developmental disorders. Arch Dis Child 2003; 88: 595-600 [PMID: G, Crockett L, Caranza M editors. In: Motivation and health:
12818906 DOI: 10.1136/adc.88.7.595] Addressing youth health disparities in the twenty first century.
47 O’Nions E, Viding E, Greven CU, Ronald A, Happé F. Based on 57th Annual Nebraska Symposium on motivation.
Pathological demand avoidance: exploring the behavioural profile. Springer; New York, 2011: 33-72
Autism 2014; 18: 538-544 [PMID: 24104509 DOI: 10.1177/13623 63 Odgers CL, Caspi A, Russell MA, Sampson RJ, Arseneault
61313481861] L, Moffitt TE. Supportive parenting mediates neighborhood
48 O’Nions E, Christie P, Gould J, Viding E, Happé F. Development socioeconomic disparities in children’s antisocial behavior from
of the ‘Extreme Demand Avoidance Questionnaire’ (EDA-Q): ages 5 to 12. Dev Psychopathol 2012; 24: 705-721 [PMID:
preliminary observations on a trait measure for Pathological 22781850 DOI: 10.1017/S0954579412000326]
Demand Avoidance. J Child Psychol Psychiatry 2014; 55: 758-768 64 Galler JR, Bryce CP, Waber DP, Hock RS, Harrison R, Eaglesfield
[PMID: 24117718 DOI: 10.1111/jcpp.12149] GD, Fitzmaurice G. Infant malnutrition predicts conduct problems
49 National Research Council/ Institute of Medicine (NHRC/ in adolescents. Nutr Neurosci 2012; 15: 186-192 [PMID: 22584048
IOM). Adolescent Health Services: Highlights and Considerations DOI: 10.1179/1476830512Y.0000000012]
for State Health Policymakers, 2009: 1-25. Available from: URL: 65 Conger RD, Donnellan MB. An interactionist perspective on the
http://www.nashp.org/sites/default/files/AdolHealth.pdf socioeconomic context of human development. Annu Rev Psychol
50 World Health Organization (WHO). Mental health: new 2007; 58: 175-199 [PMID: 16903807 DOI: 10.1146/annurev.
understanding new hope [report] Geneva (CH): WHO, 2001. psych.58.110405.085551]
Available from: URL: http://www.who.int/whr/2001/en/whr01_en. 66 Taylor SE, Seeman TE. Psychosocial resources and the SES-
pdf?ua=1 health relationship. Ann N Y Acad Sci 1999; 896: 210-225 [PMID:
51 Green H, McGinnity A, Meltzer H, Ford T, Goodman R. Mental 10681899 DOI: 10.1111/j.1749-6632.1999.tb08117.x]
health of children and young people in Great Britain 2004. NY: 67 Shaw DS, Hyde LW, Brennan LM. Early predictors of boys’
Palgrave Macmillan, 2005. Available from: URL: http://content. antisocial trajectories. Dev Psychopathol 2012; 24: 871-888 [PMID:
digital.nhs.uk/catalogue/PUB06116/ment-heal-chil-youn-peop-gb- 22781860 DOI: 10.1017/S0954579412000429]
2004-rep1.pdf 68 Waller R, Dishion TJ, Shaw DS, Gardner F, Wilson MN, Hyde
52 Copeland WE, Angold A, Costello EJ, Egger H. Prevalence, LW. Does early childhood callous-unemotional behavior uniquely
comorbidity, and correlates of DSM-5 proposed disruptive mood predict behavior problems or callous-unemotional behavior in late
dysregulation disorder. Am J Psychiatry 2013; 170: 173-179 childhood? Dev Psychol 2016; 52: 1805-1819 [PMID: 27598253
[PMID: 23377638 DOI: 10.1176/appi.ajp.2012.12010132] DOI: 10.1037/dev0000165]
53 Boden JM, Fergusson DM, Horwood LJ. Risk factors for conduct 69 Shaw DS, Bell RQ, Gilliom M. A truly early starter model of
disorder and oppositional/defiant disorder: evidence from a New antisocial behavior revisited. Clin Child Fam Psychol Rev 2000; 3:
Zealand birth cohort. J Am Acad Child Adolesc Psychiatry 2010; 155-172 [PMID: 11225751 DOI: 10.1023/A:1009599208790]
49: 1125-1133 [PMID: 20970700 DOI: 10.1016/j.jaac.2010.08.005] 70 Fischer M, Rolf JE, Hasazi JE, Cummings L. Follow-up of a
54 Plant DT, Barker ED, Waters CS, Pawlby S, Pariante CM. preschool epidemiological sample: cross-age continuities and
Intergenerational transmission of maltreatment and psychopathology: predictions of later adjustment with internalizing and externalizing
the role of antenatal depression. Psychol Med 2013; 43: 519-528 dimensions of behavior. Child Dev 1984; 55: 137-150 [PMID:
[PMID: 22694795 DOI: 10.1017/S0033291712001298] 6705616 DOI: 10.2307/1129840]
55 Murray J, Burgess S, Zuccolo L, Hickman M, Gray R, Lewis SJ. 71 Mian ND, Wainwright L, Briggs-Gowan MJ, Carter AS. An
Moderate alcohol drinking in pregnancy increases risk for children’ ecological risk model for early childhood anxiety: the importance
s persistent conduct problems: causal effects in a Mendelian of early child symptoms and temperament. J Abnorm Child
randomisation study. J Child Psychol Psychiatry 2016; 57: 575-584 Psychol 2011; 39: 501-512 [PMID: 21153696 DOI: 10.1007/
[PMID: 26588883 DOI: 10.1111/jcpp.12486] s10802-010-9476-0]
56 Owens EB, Hinshaw SP. Perinatal problems and psychiatric 72 Dougherty LR, Smith VC, Bufferd SJ, Stringaris A, Leibenluft
comorbidity among children with ADHD. J Clin Child Adolesc E, Carlson GA, Klein DN. Preschool irritability: longitudinal
Psychol 2013; 42: 762-768 [PMID: 23581554 DOI: 10.1080/1537 associations with psychiatric disorders at age 6 and parental
4416.2013.785359 DOI: 10.1080/15374416.2013.785359] psychopathology. J Am Acad Child Adolesc Psychiatry 2013; 52:
57 Webster-Stratton C, Reid MJ, Hammond M. Treating children 1304-1313 [PMID: 24290463 DOI: 10.1016/j.jaac.2013.09.007]
with early-onset conduct problems: intervention outcomes 73 Szczepaniak D, McHenry MS, Nutakki K, Bauer NS, Downs SM.
for parent, child, and teacher training. J Clin Child Adolesc The prevalence of at-risk development in children 30 to 60 months
Psychol 2004; 33: 105-124 [PMID: 15028546 DOI: 10.1207/ old presenting with disruptive behaviors. Clin Pediatr (Phila) 2013;
S15374424JCCP3301_11] 52: 942-949 [PMID: 23836809 DOI: 10.1177/0009922813493832]

74 Raudino A, Woodward LJ, Fergusson DM, Horwood LJ. Psychiatry 2015; 56: 999-1007 [PMID: 26259142 DOI: 10.1111/
Childhood conduct problems are associated with increased jcpp.12403]
partnership and parenting difficulties in adulthood. J Abnorm Child 91 Stringaris A, Lewis G, Maughan B. Developmental pathways
Psychol 2012; 40: 251-263 [PMID: 21904828 DOI: 10.1007/ from childhood conduct problems to early adult depression:
s10802-011-9565-8] findings from the ALSPAC cohort. Br J Psychiatry 2014; 205:
75 Patterson GR, DeBaryshe BD, Ramsey E. A developmental 17-23 [PMID: 24764545 DOI: 10.1192/bjp.bp.113.134221]
perspective on antisocial behavior. Am Psychol 1989; 44: 329-335 92 Luby JL, Gaffrey MS, Tillman R, April LM, Belden AC.
[PMID: 2653143 DOI: 10.1037/0003-066X.44.2.329] Trajectories of preschool disorders to full DSM depression
76 Brennan LM, Shaw DS. Revisiting data related to the age of at school age and early adolescence: continuity of preschool
onset and developmental course of female conduct problems. Clin depression. Am J Psychiatry 2014; 171: 768-776 [PMID: 24700355
Child Fam Psychol Rev 2013; 16: 35-58 [PMID: 23076722 DOI: DOI: 10.1176/appi.ajp.2014.13091198]
10.1007/s10567-012-0125-8] 93 Kretschmer T, Hickman M, Doerner R, Emond A, Lewis G,
77 Michalska KJ, Decety J, Zeffiro TA, Lahey BB. Association of Macleod J, Maughan B, Munafò MR, Heron J. Outcomes of
regional gray matter volumes in the brain with disruptive behavior childhood conduct problem trajectories in early adulthood: findings
disorders in male and female children. Neuroimage Clin 2014; 7: from the ALSPAC study. Eur Child Adolesc Psychiatry 2014; 23:
252-257 [PMID: 25610787 DOI: 10.1016/j.nicl.2014.12.012] 539-549 [PMID: 24197169 DOI: 10.1007/s00787-013-0488-5]
78 Fahim C, He Y, Yoon U, Chen J, Evans A, Pérusse D. Neuroanatomy 94 van der Molen E, Blokland AA, Hipwell AE, Vermeiren RR,
of childhood disruptive behavior disorders. Aggress Behav 2011; 37: Doreleijers TA, Loeber R. Girls’ childhood trajectories of disruptive
326-337 [PMID: 21538379 DOI: 10.1002/ab.20396] behavior predict adjustment problems in early adolescence. J Child
79 Sebastian CL, McCrory EJ, Cecil CA, Lockwood PL, De Brito Psychol Psychiatry 2015; 56: 766-773 [PMID: 25302849 DOI:
SA, Fontaine NM, Viding E. Neural responses to affective and 10.1111/jcpp.12339]
cognitive theory of mind in children with conduct problems 95 Burke JD, Waldman I, Lahey BB. Predictive validity of childhood
and varying levels of callous-unemotional traits. Arch Gen oppositional defiant disorder and conduct disorder: implications
Psychiatry 2012; 69: 814-822 [PMID: 22868935 DOI: 10.1001/ for the DSM-V. J Abnorm Psychol 2010; 119: 739-751 [PMID:
archgenpsychiatry.2011.2070] 20853919 DOI: 10.1037/a0019708]
80 Raine A, Yang Y, Narr KL, Toga AW. Sex differences in 96 Fergusson DM, Horwood LJ, Ridder EM. Show me the child
orbitofrontal gray as a partial explanation for sex differences in at seven: the consequences of conduct problems in childhood
antisocial personality. Mol Psychiatry 2011; 16: 227-236 [PMID: for psychosocial functioning in adulthood. J Child Psychol
20029391 DOI: 10.1038/mp.2009.136] Psychiatry 2005; 46: 837-849 [PMID: 16033632 DOI: 10.1111/
81 Kiehl KA, Smith AM, Mendrek A, Forster BB, Hare RD, Liddle j.1469-7610.2004.00387.x]
PF. Temporal lobe abnormalities in semantic processing by 97 Engqvist U, Rydelius PA. Death and suicide among former child
criminal psychopaths as revealed by functional magnetic resonance and adolescent psychiatric patients. BMC Psychiatry 2006; 6: 51
imaging. Psychiatry Res 2004; 130: 27-42 [PMID: 14972366 DOI: [PMID: 17081290 DOI: 10.1186/1471-244X-6-51]
10.1016/S0925-4927(03)00106-9] 98 Ogundele MO. The Influence of Socio-Economic Status on the
82 Kohrt BA, Hruschka DJ, Kohrt HE, Carrion VG, Waldman Prevalence of School-Age Childhood Behavioral Disorders in
ID, Worthman CM. Child abuse, disruptive behavior disorders, a Local District Clinic of North West England. J Fam Med and
depression, and salivary cortisol levels among institutionalized and Health Care 2016; 2: 98-107 [DOI: 10.11648/j.jfmhc.20160204.22]
community-residing boys in Mongolia. Asia Pac Psychiatry 2015; 99 Strickland J, Hopkins J, Keenan K. Mother-teacher agreement on
7: 7-19 [PMID: 24890783 DOI: 10.1111/appy.12141] preschoolers’ symptoms of ODD and CD: does context matter? J
83 Martel MM, Roberts BA. Prenatal testosterone increases Abnorm Child Psychol 2012; 40: 933-943 [PMID: 22661105 DOI:
sensitivity to prenatal stressors in males with disruptive behavior 10.1007/s10802-012-9622-y]
disorders. Neurotoxicol Teratol 2014; 44: 11-17 [PMID: 24819590 100 American Academy of Pediatrics (APA). Mental Health
DOI: 10.1016/j.ntt.2014.05.001] Screening and Assessment Tools for Primary Care. 2012. Available
84 National Institute for Health and Clinical Excellence (NICE). from: URL: https://www.aap.org/en-us/advocacy-and-policy/aap-
Parent-training/education programmes in the management of health-initiatives/Mental-Health/Documents/MH_ScreeningChart.
children with conduct disorders. 2006. Available from: URL: http:// pdf
www.nice.org.uk/nicemedia/pdf/TA102guidance.pdf 101 Shaw DS, Bell RQ. Developmental theories of parental
85 Smith JD, Dishion TJ, Shaw DS, Wilson MN, Winter CC, contributors to antisocial behavior. J Abnorm Child Psychol 1993;
Patterson GR. Coercive family process and early-onset conduct 21: 493-518 [PMID: 8294650 DOI: 10.1007/BF00916316]
problems from age 2 to school entry. Dev Psychopathol 2014; 26: 102 Comer JS, Chow C, Chan PT, Cooper-Vince C, Wilson LA.
917-932 [PMID: 24690305 DOI: 10.1017/S0954579414000169] Psychosocial treatment efficacy for disruptive behavior problems
86 Lynch RJ, Kistner JA, Allan NP. Distinguishing among disruptive in very young children: a meta-analytic examination. J Am Acad
behaviors to help predict high school graduation: does gender Child Adolesc Psychiatry 2013; 52: 26-36 [PMID: 23265631 DOI:
matter? J Sch Psychol 2014; 52: 407-418 [PMID: 25107411 DOI: 10.1016/j.jaac.2012.10.001]
10.1016/j.jsp.2014.05.001] 103 Hawes DJ, Price MJ, Dadds MR. Callous-unemotional traits and
87 Serra-Pinheiro MA, Mattos P, Regalla MA, de Souza I, Paixão the treatment of conduct problems in childhood and adolescence:
C. Inattention, hyperactivity, oppositional-defiant symptoms and a comprehensive review. Clin Child Fam Psychol Rev 2014; 17:
school failure. Arq Neuropsiquiatr 2008; 66: 828-831 [PMID: 248-267 [PMID: 24748077 DOI: 10.1007/s10567-014-0167-1]
19099120 DOI: 10.1590/S0004-282X2008000600010] 104 Cunningham CE, Boyle MH. Preschoolers at risk for attention-
88 Spruyt K, Gozal D. Sleep disturbances in children with attention- deficit hyperactivity disorder and oppositional defiant disorder:
deficit/hyperactivity disorder. Expert Rev Neurother 2011; 11: family, parenting, and behavioral correlates. J Abnorm Child
565-577 [PMID: 21469929 DOI: 10.1586/ern.11.7] Psychol 2002; 30: 555-569 [PMID: 12481971 DOI: 10.1023/
89 Shanahan L, Copeland WE, Angold A, Bondy CL, Costello EJ. A:1020855429085]
Sleep problems predict and are predicted by generalized anxiety/ 105 Gardner F, Burton J, Klimes I. Randomised controlled trial of a
depression and oppositional defiant disorder. J Am Acad Child parenting intervention in the voluntary sector for reducing child
Adolesc Psychiatry 2014; 53: 550-558 [PMID: 24745954 DOI: conduct problems: outcomes and mechanisms of change. J Child
10.1016/j.jaac.2013.12.029] Psychol Psychiatry 2006; 47: 1123-1132 [PMID: 17076751 DOI:
90 Dougherty LR, Smith VC, Bufferd SJ, Kessel E, Carlson GA, 10.1111/j.1469-7610.2006.01668.x]
Klein DN. Preschool irritability predicts child psychopathology, 106 Hutchings J, Gardner F, Bywater T, Daley D, Whitaker C, Jones
functional impairment, and service use at age nine. J Child Psychol K, Eames C, Edwards RT. Parenting intervention in Sure Start

services for children at risk of developing conduct disorder: Evidence-Based Practice Review Group. 2013. Available from:
pragmatic randomised controlled trial. BMJ 2007; 334: 678 [PMID: URL: http://autismpdc.fpg.unc.edu/sites/autismpdc.fpg.unc.edu/
17350966 DOI: 10.1136/bmj.39126.620799.55] files/2014-EBP-Report.pdf
107 Perrin EC, Sheldrick RC, McMenamy JM, Henson BS, Carter AS. 123 Reichow B, Volkmar FR. Social skills interventions for individuals
Improving parenting skills for families of young children in pediatric with autism: evaluation for evidence-based practices within a best
settings: a randomized clinical trial. JAMA Pediatr 2014; 168: evidence synthesis framework. J Autism Dev Disord 2010; 40:
16-24 [PMID: 24190691 DOI: 10.1001/jamapediatrics.2013.2919] 149-166 [PMID: 19655240 DOI: 10.1007/s10803-009-0842-0]
108 Shaw DS, Dishion TJ, Supplee L, Gardner F, Arnds K. 124 Carr EG, Durand VM. Reducing behavior problems through
Randomized trial of a family-centered approach to the prevention functional communication training. J Appl Behav Anal 1985; 18:
of early conduct problems: 2-year effects of the family check-up 111-126 [PMID: 2410400 DOI: 10.1901/jaba.1985.18-111]
in early childhood. J Consult Clin Psychol 2006; 74: 1-9 [PMID: 125 Koegel RL, Koegel LK. Pivotal response treatments for autism:
16551138 DOI: 10.1037/0022-006X.74.1.1] Communication social and academic development. Baltimore
109 Funderburk BW, Eyberg SM. Parent-Child Interaction Therapy. MD: Brookes, 2006: 312. Available from: URL: http://products.
In: History of Psychotherapy: Continuity and Change. Norcross brookespublishing.com/Pivotal-Response-Treatments-for-
JC VandenBos GR Freedheim DK editors. 2nd ed. Washington Autism-P63.aspx
DC: American Psychological Association, 2011: 415-420 [DOI: 126 Carr EG, Dunlap G, Horner RH, Koegel RL, Turnbull AP, Sailor
10.1037/12353-021] W, Fox L. Positive behavior support: evolution of an applied
110 Thomas R, Zimmer-Gembeck MJ. Behavioral outcomes of Parent- science. J Pos Beh Interv 2002; 4: 4-16 [DOI: 10.1177/109830070
Child Interaction Therapy and Triple P-Positive Parenting Program: 200400102]
a review and meta-analysis. J Abnorm Child Psychol 2007; 35: 127 Reid R, Trout AL, Schartz M. Self-Regulation Interventions for
475-495 [PMID: 17333363 DOI: 10.1007/s10802-007-9104-9] Children with Attention Hyperactivity Disorder. Exceptional
111 Furlong M, McGilloway S, Bywater T, Hutchings J, Smith Children 2005; 71: 361-377
SM, Donnelly M. Cochrane review: behavioural and cognitive- 128 Schepis MM, Reid DH, Ownbey J, Parsons MB. Training support
behavioural group-based parenting programmes for early-onset staff to embed teaching within natural routines of young children
conduct problems in children aged 3 to 12 years (Review). Evid with disabilities in an inclusive preschool. J Appl Behav Anal 2001;
Based Child Health 2013; 8: 318-692 [PMID: 23877886 DOI: 34: 313-327 [PMID: 11678526 DOI: 10.1901/jaba.2001.34-313]
10.1002/ebch.1905] 129 Beukelman DR, Mirenda P. Augmentative and alternative
112 Lane KL. Identifying and Supporting Students at Risk for communication: Supporting children and adults with complex
Emotional and Behavioral Disorders within Multi-level Models: communication needs. Baltimore MD: Brookes, 2013: 616.
Data Driven Approaches to Conducting Secondary Interventions Available from: URL: http://products.brookespublishing.com/
with an Academic Emphasis. Education & Treatment of Children Augmentative-and-Alternative-Communication-P626.aspx
2007; 30: 135-164 [DOI: 10.1353/etc.2007.0026] 130 Drager K, Light J, McNaughton D. Effects of AAC interventions
113 Farley C, Torres C, Wailehua C-UT, Cook L. Evidence-Based on communication and language for young children with complex
Practices for Students with Emotional and Behavioral Disorders: communication needs. J Pediatr Rehabil Med 2010; 3: 303-310
Improving Academic Achievement. Beyond Behavior 2012; 21: [PMID: 21791864 DOI: 10.3233/PRM-2010-0141]
37-43 131 Mirenda P. Supporting individuals with challenging behavior
114 Winther J, Carlsson A, Vance A. A pilot study of a school-based through functional communication training and AAC: Research
prevention and early intervention program to reduce oppositional review. Augment Altern Commun 1997; 13: 207-225 [DOI: 10.108
defiant disorder/conduct disorder. Early Interv Psychiatry 2014; 8: 0/07434619712331278048]
181-189 [PMID: 23734628 DOI: 10.1111/eip.12050] 132 Hart JE, Whalon KJ. Promote academic engagement and
115 Horner RG, Sugai G, Vincent C. School-wide Positive Behavior communication of students with autism spectrum disorder in
Support: Investing in Student Success. Impact 2005; 18: 4 inclusive settings. ISC 2008; 44: 116-120 [DOI: 10.1177/10534512
116 Mesibov GB, Shea V, Schopler E. The TEACCH approach to 07310346]
autism spectrum disorders. New York NY: Springer-Verglag, 133 Briars L, Todd T. A Review of Pharmacological Management of
2007: 211 Available from: URL: http://www.springer.com/gb/ Attention-Deficit/Hyperactivity Disorder. J Pediatr Pharmacol
book/9780306486463 Ther 2016; 21: 192-206 [PMID: 27453697 DOI: 10.5863/1551-67
117 Warren Z, Veenstra-VanderWeele J, Stone W, Bruzek JL, Nahmias 76-21.3.192]
AS, Foss-Feig JH, Jerome RN, Krishnaswami S, Sathe NA, 134 Chan E, Fogler JM, Hammerness PG. Treatment of Attention-
Glasser AM, Surawicz T, McPheeters ML. Therapies for Children Deficit/Hyperactivity Disorder in Adolescents: A Systematic
With Autism Spectrum Disorders, 2011 Review. JAMA 2016; 315: 1997-2008 [PMID: 27163988 DOI:
118 Christie P. The Distinctive Clinical and Educational Needs 10.1001/jama.2016.5453]
of Children with Pathological Demand Avoidance Syndrome: 135 McPheeters ML, Warren Z, Sathe N, Bruzek JL, Krishnaswami
Guidelines for Good Practice. Good Autism Practice 2007; 8: 3-11 S, Jerome RN, Veenstra-Vanderweele J. A systematic review of
119 Lindgren S, Doobay A. Evidence-Based Interventions for Autism medical treatments for children with autism spectrum disorders.
Spectrum Disorders. 2011. Available from: URL: http://www. Pediatrics 2011; 127: e1312-e1321 [PMID: 21464191 DOI:
interventionsunlimited.com/editoruploads/files/Iowa%20DHS%20 10.1542/peds.2011-0427]
Autism%20Interventions%206-10-11.pdf 136 Roy A, Roy M, Deb S, Unwin G, Roy A. Are opioid antagonists
120 Ollendick TH, King NJ. Empirically supported treatments for effective in attenuating the core symptoms of autism spectrum
children with phobic and anxiety disorders: current status. J Clin conditions in children: a systematic review. J Intellect Disabil Res
Child Psychol 1998; 27: 156-167 [PMID: 9648033 DOI: 10.1207/ 2015; 59: 293-306 [PMID: 24589346 DOI: 10.1111/jir.12122]
s15374424jccp2702_3] 137 Sonuga-Barke EJ, Daley D, Thompson M, Laver-Bradbury C,
121 Liber JM, De Boo GM, Huizenga H, Prins PJ. School-based Weeks A. Parent-based therapies for preschool attention-deficit/
intervention for childhood disruptive behavior in disadvantaged hyperactivity disorder: a randomized, controlled trial with a
settings: a randomized controlled trial with and without active community sample. J Am Acad Child Adolesc Psychiatry 2001; 40:
teacher support. J Consult Clin Psychol 2013; 81: 975-987 [PMID: 402-408 [PMID: 11314565 DOI: 10.1097/00004583-200104000-0
23834227 DOI: 10.1037/a0033577] 0008]
122 Wong C, Odom SL, Hume K, Cox AW, Fettig A, Kucharczyk S. 138 Doyle CA, McDougle CJ. Pharmacologic treatments for the
Evidence-based practices for children youth and young adults with behavioral symptoms associated with autism spectrum disorders
Autism Spectrum Disorder. Chapel Hill: The University of North across the lifespan. Dialogues Clin Neurosci 2012; 14: 263-279
Carolina Frank Porter Graham Child Development Institute Autism [PMID: 23226952]

139 Pringsheim T, Hirsch L, Gardner D, Gorman DA. The 141 Gledhill J, Hodes M. Management of depression in children
pharmacological management of oppositional behaviour, and adolescents. Prog Neurol Psychiatry 2015; 19: 28-33 [DOI:
conduct problems, and aggression in children and adolescents 10.1002/pnp.375]
with attention-deficit hyperactivity disorder, oppositional 142 Shelton KH, Collishaw S, Rice FJ, Harold GT, Thapar A. Using a
defiant disorder, and conduct disorder: a systematic review and genetically informative design to examine the relationship between
meta-analysis. Part 1: psychostimulants, alpha-2 agonists, and breastfeeding and childhood conduct problems. Eur Child Adolesc
atomoxetine. Can J Psychiatry 2015; 60: 42-51 [PMID: 25886655 Psychiatry 2011; 20: 571-579 [PMID: 22028070 DOI: 10.1007/
DOI: 10.1177/070674371506000202] s00787-011-0224-y]
140 Kodish I, Rockhill C, Varley C. Pharmacotherapy for 143 Bandiera FC, Richardson AK, Lee DJ, He JP, Merikangas KR.
anxiety disorders in children and adolescents. Dialogues Clin Secondhand smoke exposure and mental health among children
Neurosci 2011; 13: 439-452 [PMID: 22275849 DOI: 10.1016/ and adolescents. Arch Pediatr Adolesc Med 2011; 165: 332-338
j.pcl.2010.10.002] [PMID: 21464381 DOI: 10.1001/archpediatrics.2011.30]
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WJ CP World Journal of

DOI: 10.5409/wjcp.v7.i1.9 ISSN 2219-2808 (online)

Behavioural and emotional disorders in childhood: A brief

Key words: Childhood behavioural disorders; Disruptive

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Table 1 Subtypes of attention deficit hyperactivity disorder (based on DSM-5)

Subtypes Predominantly inattentive (ADD) Predominantly hyperactivity/ impulsivity Combined ADHD

ADHD: Attention deficit hyperactivity disorder.

Some environmental factors have been identified [13]

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Table 2 DSM-5 definition of conduct disorder and oppositional defiant disorder

Oppositional defiant disorder Conduct disorder

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Table 3 DSM-5 criteria for autism spectrum disorders

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Table 4 Summary of common social communication enhancement strategies

Method Description Ref.

Method Description Ref.

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Table 6 DSM-5 criteria for social (pragmatic) communication disorder

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only to Anxiety disorders at 13%. About 5% of CYP in

From a prospective study of 209 parents along with

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Domain Characteristic examples Ref.

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combination with psychological and other environmental

CHILDHOOD BEHAVIOURAL AND Holistic management strategies will include various

ages 3-18 years), the Behavior Assessment System for

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Common examples Indications for use Common Side-effects Follow up monitoring

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and one meta-analysis, involving 2668 participants with

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P- Reviewer: Ho RCM, Yellanthoor RB, Yucel O S- Editor: Ji FF

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WJCP|www.wjgnet.com February 8, 2018|Volume 7|Issue 1|