INTRODUCTION

• ALL YOUNG CHILDREN DISPLAY IMPULSIVE OR DEFIANT BEHAVIOR

OCCASIONALLY. SOMETIMES, THIS IS PART OF A NORMAL EMOTIONAL REACTION.
BUT IF THESE BEHAVIORS ARE EXTREME OR OUTSIDE THE NORM FOR THEIR
LEVEL OF DEVELOPMENT, IT COULD BE A SIGN TO TAKE A STEP.
• SOME CHILDREN HAVE EXTREMELY DIFFICULT AND CHALLENGING BEHAVIOURS
THAT ARE OUTSIDE THE NORM FOR THEIR AGE.
• THESE PROBLEMS CAN RESULT FROM TEMPORARY STRESSORS IN THE CHILD’S
LIFE, OR THEY MIGHT REPRESENT MORE ENDURING DISORDERS.
• BOYS ARE MORE LIKELY THAN GIRLS TO SUFFER FROM BEHAVIOURAL
DISORDERS.
• THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESTRUSTED
SOURCE DESCRIBES BEHAVIORAL DISORDERS AS INVOLVING “A PATTERN OF
DISRUPTIVE BEHAVIORS IN CHILDREN THAT LAST FOR AT LEAST 6 MONTHS AND
CAUSE PROBLEMS IN SCHOOL, AT HOME, AND IN SOCIAL SITUATIONS”.
• THIS IS DIFFERENT FROM THE CHALLENGING BEHAVIORS CHILDREN SOMETIMES
DISPLAY. ALMOST ALL CHILDREN WILL HAVE TANTRUMS, OR ACT IN
AGGRESSIVE, ANGRY, OR DEFIANT WAYS AT SOME POINT.
• WHILE CHALLENGING, THESE BEHAVIORS ARE A NORMAL PART OF CHILDHOOD
DEVELOPMENT. OFTEN, THEY ARE THE RESULT OF STRONG EMOTIONS THAT THE
CHILD IS EXPRESSING IN THE ONLY WAY THEY KNOW HOW.
• AS A RESULT, HEALTHCARE PROFESSIONALS ONLY DIAGNOSE A BEHAVIORAL
DISORDER WHEN THE DISRUPTIVE BEHAVIORS ARE SEVERE, PERSISTENT, AND
OUTSIDE THE NORM FOR THE CHILD’S DEVELOPMENTAL STAGE.
• BEHAVIORAL DISORDERS ARE ALSO DIFFERENT FROM AUTISM SPECTRUM DISORDER
(ASD), WHICH IS AN UMBRELLA TERM FOR NEURODEVELOPMENTAL CONDITIONS
THAT AFFECT HOW SOME CHILDREN COMMUNICATE, SOCIALIZE, AND PROCESS
SENSORY STIMULI.
• ASD MAY CAUSE BEHAVIORS IN CHILDREN THAT CAREGIVERS FIND UNUSUAL OR
CHALLENGING, BUT THESE ARE THE RESULT OF HOW THEY EXPERIENCE THE WORLD.
EVALUATION OF BEHAVIORAL PROBLEMS IN
CHILDREN
• DIAGNOSIS OF BEHAVIORAL PROBLEMS IN CHILDREN CONSISTS OF A MULTISTEP
BEHAVIORAL ASSESSMENT.
• CONCERNS WITH INFANTS AND YOUNG CHILDREN OFTEN INVOLVE BODILY
FUNCTIONS (EG, EATING, ELIMINATING, SLEEPING), WHEREAS IN OLDER
CHILDREN AND ADOLESCENTS INTERPERSONAL BEHAVIORAL CONCERNS (EG,
ACTIVITY LEVEL, DISOBEDIENCE, AGGRESSION) PREDOMINATE.
PROBLEM IDENTIFICATION
• A BEHAVIORAL PROBLEM MAY MANIFEST ALARMINGLY AND ABRUPTLY AS A SINGLE INCIDENT (EG, SETTING A FIRE, FIGHTING AT SCHOOL).
MORE OFTEN, PROBLEMS MANIFEST GRADUALLY, AND IDENTIFICATION INVOLVES GATHERING INFORMATION OVER TIME. BEHAVIOR IS BEST
ASSESSED IN THE CONTEXT OF THE CHILD’S

• PHYSICAL AND MENTAL DEVELOPMENT

• GENERAL HEALTH

• TEMPERAMENT (EG, DIFFICULT, EASYGOING)

• RELATIONSHIPS WITH PARENTS AND CAREGIVERS

• DIRECT OBSERVATION OF PARENT-CHILD INTERACTION DURING AN OFFICE VISIT PROVIDES VALUABLE CLUES, INCLUDING PARENTAL RESPONSE
TO BEHAVIORS. THESE OBSERVATIONS ARE SUPPLEMENTED, WHENEVER POSSIBLE, BY INFORMATION FROM OTHERS, INCLUDING RELATIVES,
TEACHERS, AND SCHOOL NURSES.

• INTERVIEWING PARENTS OR CAREGIVERS PROVIDES A CHRONOLOGY OF THE CHILD’S ACTIVITIES DURING A TYPICAL DAY. PARENTS ARE ASKED
WHEN THE BEHAVIOR STARTED AND ARE ASKED TO PROVIDE EXAMPLES OF EVENTS THAT PRECEDED AND FOLLOWED THE SPECIFIC BEHAVIOR.
PARENTS ALSO ARE ASKED FOR THEIR INTERPRETATION OF
• TYPICAL AGE-RELATED BEHAVIORS
• EXPECTATIONS FOR THE CHILD
• THEIR PARENTING STYLE
• SUPPORT (EG, SOCIAL, EMOTIONAL, FINANCIAL) FOR FULFILLING THEIR
PARENTING ROLE
• THE CHILD'S RELATIONSHIP WITH THE REST OF THE FAMILY
CONDITIONS OF BEHAVIORAL PSROBLEMS
• EXTERNALIZING BEHAVIORS INCLUDE (WILLIAMS, 2013): • DEPRESSION

AGGRESSION • ANXIETY

• DISRUPTION • SOCIAL WITHDRAWAL

• ACTING OUT • SUBSTANCE ABUSE

• FEELINGS OF LONELINESS OR GUILT

• DESTRUCTION OF PROPERTY • FEELINGS OF SADNESS

• • NERVOUSNESS AND IRRITABILITY

EXTERNALIZING BEHAVIORS ARE EASILY OBSERVABLE BY OTHERS. • FEARFULNESS

THE MOST FREQUENT PROBLEMS OCCUR WHEN STUDENTS WITH ED
EXHIBIT EXTERNALIZING BEHAVIORS (KAUFMANN, 2009). A • DIFFICULTY CONCENTRATING

STUDENT EXHIBITING THESE TYPES OF BEHAVIORS MAY LASH OUT • NEGATIVE SELF-TALK
AT OTHERS USING AGGRESSION, VIOLENCE, DEFIANT, AND
CRIMINAL BEHAVIORS (LIU, 2004). •
INTERNALIZING BEHAVIORS ARE NOT ALWAYS AS EASY TO OBSERVE. THESE NEGATIVE
BEHAVIORS ARE DIRECTED TOWARDS THE "SELF". A STUDENT EXHIBITING THESE TYPES OF
BEHAVIORS MAY HURT HIM OR HERSELF AND NOT LASH OUT ON OTHERS. THESE STUDENTS
ARE MORE LIKELY TO BE REJECTED BY SAME-AGE PEERS AND ADULTS.
• NERVOUSNESS AND IRRITABILITY
• FEARFULNESS
• DIFFICULTY CONCENTRATING
• NEGATIVE SELF-TALK
•
INTERNALIZING BEHAVIORS ARE NOT ALWAYS AS EASY TO OBSERVE. THESE NEGATIVE
BEHAVIORS ARE DIRECTED TOWARDS THE "SELF". A STUDENT EXHIBITING THESE TYPES OF
BEHAVIORS MAY HURT HIM OR HERSELF AND NOT LASH OUT ON OTHERS. THESE STUDENTS ARE
MORE LIKELY TO BE REJECTED BY SAME-AGE PEERS AND ADULTS.
• ALL YOUNG CHILDREN CAN BE NAUGHTY, DEFIANT AND IMPULSIVE FROM TIME
TO TIME, WHICH IS PERFECTLY NORMAL. HOWEVER, SOME CHILDREN HAVE
EXTREMELY DIFFICULT AND CHALLENGING BEHAVIOURS THAT ARE OUTSIDE THE
NORM FOR THEIR AGE.
•
THE MOST COMMON DISRUPTIVE BEHAVIOUR DISORDERS INCLUDE
OPPOSITIONAL DEFIANT DISORDER (ODD), CONDUCT DISORDER (CD)
AND ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD). THESE THREE
BEHAVIOURAL DISORDERS SHARE SOME COMMON SYMPTOMS, SO DIAGNOSIS
CAN BE DIFFICULT AND TIME CONSUMING. A CHILD OR ADOLESCENT MAY HAVE
TWO DISORDERS AT THE SAME TIME. OTHER EXACERBATING FACTORS CAN
INCLUDE EMOTIONAL PROBLEMS, MOOD DISORDERS, FAMILY DIFFICULTIES AND
SUBSTANCE ABUSE.
OPPOSITIONAL DEFIANT DISORDER

A PATTERN OF ANGRY/IRRITABLE MOOD, ARGUMENTATIVE/DEFIANT BEHAVIOR, OR

VINDICTIVENESS LASTING AT LEAST 6 MO AS EVIDENCED BY AT LEAST FOUR OUT
OF 8 SYMPTOMS FROM ANY OF THE FOLLOWING CATEGORIES, AND EXHIBITED
DURING INTERACTION WITH AT LEAST ONE INDIVIDUAL WHO IS NOT A SIBLING
• CHILDREN AND ADOLESCENTS WITH ODD DISPLAY AN ONGOING PATTERN OF HOSTILE BEHAVIOR TOWARD AUTHORITY FIGURES, SUCH AS PARENTS,
CAREGIVERS, OR TEACHERS. UNLIKE CONDUCT DISORDER, CHILDREN WITH ODD TEND TO VIOLATE MINOR RULES, RATHER THAN MAJOR RULES AND SOCIAL
NORMS.

• THE POTENTIAL SIGNSTRUSTED SOURCE OF ODD INCLUDE:

• TEMPER TANTRUMS AND IRRITABILITY

• ARGUMENTATIVE BEHAVIOR, SUCH AS CONSTANTLY QUESTIONING RULES

• PERSISTENT STUBBORNNESS, WHICH MAY MANIFEST AS A REFUSAL TO FOLLOW INSTRUCTIONS OR APOLOGIZE FOR BEHAVIOR

• PROVOCATIVE BEHAVIOR, SUCH AS INTENTIONALLY ANNOYING OR UPSETTING OTHERS

• SPITEFUL OR VINDICTIVE ATTITUDE

• IT IS WORTH NOTING THAT SOME CLINICIANS HAVE CRITICIZED THE CONCEPT OF ODD, ARGUING THAT IT MEDICALIZES NORMAL CHILD BEHAVIOR. IT IS
COMMON FOR CHILDREN TO BEHAVE ANGRILY OR DEFIANTLY WHEN THEY ARE UNHAPPY, SO IT CAN BE DIFFICULT TO DISTINGUISH BETWEEN ODD AND
BEHAVIOR THAT IS RELATED TO STRESS.

• DOCTORS CAN ONLY DIAGNOSE ODD IF THE BEHAVIOR HAS BEEN PERSISTENT FOR 6 MONTHS, CAUSES CONSTANT DISRUPTION AT HOME OR SCHOOL, AND IS NOT
THE RESULT OF ANOTHER MENTAL HEALTH CONDITION.
• PROVOCATIVE BEHAVIOR, SUCH AS INTENTIONALLY ANNOYING OR UPSETTING OTHERS
• SPITEFUL OR VINDICTIVE ATTITUDE
• IT IS WORTH NOTING THAT SOME CLINICIANS HAVE CRITICIZED THE CONCEPT OF ODD,
ARGUING THAT IT MEDICALIZES NORMAL CHILD BEHAVIOR. IT IS COMMON FOR CHILDREN TO
BEHAVE ANGRILY OR DEFIANTLY WHEN THEY ARE UNHAPPY, SO IT CAN BE DIFFICULT TO
DISTINGUISH BETWEEN ODD AND BEHAVIOR THAT IS RELATED TO STRESS.
• DOCTORS CAN ONLY DIAGNOSE ODD IF THE BEHAVIOR HAS BEEN PERSISTENT FOR 6 MONTHS,
CAUSES CONSTANT DISRUPTION AT HOME OR SCHOOL, AND IS NOT THE RESULT OF
ANOTHER MENTAL HEALTH CONDITION.
CONDUCT DISORDER
• THOSE WITH CDNDUCT DISORDER TEND TO VIOLATE BASIC SOCIAL RULES AND THE RIGHTS OF
OTHERS. THIS CAN HAVE A SIGNIFICANT IMPACT ON SOMEONE’S ACADEMIC, SOCIAL, AND HOME
LIFE. IT CAN DEVELOP BOTH IN CHILDHOOD OR IN ADOLESCENCE.
• THE SYMPTOMS OF CD INCLUDE:
• AGGRESSION, WHICH MAY RESULT IN PHYSICAL FIGHTS, BULLYING BEHAVIOR, FORCING
SOMEONE INTO SEXUAL ACTIVITY, OR ANIMAL CRUELTY
• DESTRUCTION OF PROPERTY, SUCH AS SETTING FIRES OR DAMAGING POSSESSIONS
• DECEITFULNESS, SUCH AS LYING OR TRICKING OTHERS
• SIGNIFICANT RULE-BREAKING, SUCH AS NOT GOING TO SCHOOL, RUNNING AWAY, OR STEALING
• MANY YOUNG PEOPLE WITH CD HAVE DIFFICULTY INTERPRETING THE BEHAVIOR OF
OTHERS. FOR EXAMPLE, THEY MAY BELIEVE A PERSON IS BEHAVING IN A HOSTILE
WAY TOWARD THEM WHEN THEY ARE NOT. THIS CAUSES THEM TO ESCALATE
TOWARD AGGRESSIVE OR VIOLENT BEHAVIOR.
• PEOPLE WITH CD MAY ALSO HAVE DIFFICULTY FEELING EMPATHY, OR HAVE ANOTHER
CONDITION, SUCH AS ANXIETY OR POST-TRAUMATIC STRESS DISORDER THAT
AFFECTS THEIR THOUGHTS AND BEHAVIOR.
• ACCORDING TO MENTAL HEALTH AMERICA, CD MAY AFFECT 6–16% OF BOYS IN THE
GENERAL POPULATION, AND 2–9% OF GIRLS. IF CD FIRST MANIFESTS BEFORE AGE
11TRUSTED SOURCE, IT IS MORE LIKELY TO PERSIST INTO EARLY ADULT LIFE.
ATTENTION DEFICIT HYPERACTIVITY
DISORDER
• ADHD IS A DISORDER THAT CAUSES DIFFICULTY FOCUSING ATTENTION. IT CAN ALSO CAUSE
HYPERACTIVITY AND IMPULSIVITY.
• THERE ARE THREE ADHD SUBTYPES,
• WITH THE DIAGNOSIS DEPENDING ON THE SYMPTOMS THE CHILD DISPLAYS MOST OFTEN. THE
SUBTYPES ARE:
• INATTENTIVE TYPE
• HYPERACTIVE-IMPULSIVE TYPE
• COMBINED TYPE
• A CHILD WITH INATTENTIVE TYPE ADHD MAY:
• FIND IT DIFFICULT TO PAY ATTENTION
• BECOME EASILY DISTRACTED
• HAVE DIFFICULTY FOCUSING ON TASKS, PARTICULARLY LONG TASKS SUCH AS
READING
• START TASKS BUT FORGET TO FINISH THEM
• APPEAR NOT TO LISTEN TO INSTRUCTIONS OR TO FORGET THEM
• A CHILD WITH HYPERACTIVE-IMPULSIVE TYPE ADHD MAY:
• FIND IT DIFFICULT TO STAY STILL OR REMAIN SEATED
• FIDGET A LOT BY TAPPING THE HANDS, FEET, OR MOVING AROUND IN THEIR SEAT
• RUN AROUND OR CLIMB THINGS WHEN IT IS NOT APPROPRIATE
• FREQUENTLY INTERRUPT CONVERSATIONS OR GAMES
• HAVE DIFFICULTY WAITING FOR THEIR TURN
• HAVE TROUBLE TALKING OR PLAYING QUIETLY
• A CHILD WITH COMBINED ADHD WILL EXHIBIT A MIXTURE OF THE ABOVE
BEHAVIORS.
• DOCTORS OFTEN DIAGNOSE ADHD AFTER THE AGE OF 6. THIS IS BECAUSE THE
SYMPTOMS CAN BE MORE APPARENT WHEN A CHILD STARTS SCHOOL, AND
STRUGGLES TO ADJUST TO MORE QUIET, SEDENTARY ACTIVITIES.
RISK FACTORS

• BRAIN CHEMISTRY
• LOW SEROTONIN
• HIGH SENSITIVITY TO CORTISOL, A STRESS HORMONE, MAY ALSOTRUSTED
SOURCE PLAY A ROLE IN AGGRESSION.
PREGNANCY COMPLICATIONS

• CHILDREN WITH A LOW BIRTH WEIGHT, OR WHO WERE BORN PREMATURELY.

• EXPOSED TO TOXINS IN THE WOMB, SUCH AS TOBACCO SMOKE, OR IN CHILDREN
WHOSE PARENTS OR CAREGIVERS HAVE SUBSTANCE ABUSE DISORDERS.
• GENETICS
• SEX OR GENDER
• MALE CHILDREN ARE MORE LIKELY TO HAVE BEHAVIORAL DISORDERS THAN FEMALE
CHILDREN. IT IS UNCLEAR IF THIS IS DUE TO BIOLOGICAL DIFFERENCES, OR WHETHER
DIFFERENCES IN GENDER NORMS AND EXPECTATIONS INFLUENCE HOW MALE
CHILDREN BEHAVE OR DEVELOP.
• FOR EXAMPLE, GIRLS WITH ODD MAY BE MORE LIKELY TO EXPRESS AGGRESSION
THROUGH WORDS, RATHER THAN ACTIONS. THIS MAY MEAN THE BEHAVIOR IS LESS
OBVIOUS, AND SO LESS LIKELY TO RECEIVE A DIAGNOSIS.
TRAUMA
• ANY EXPERIENCE THAT CAUSES SIGNIFICANT DISTRESS CAN BE TRAUMATIC, BUT COMMON
EXAMPLES THAT MAY AFFECT CHILDREN INCLUDE:
• AN UNSTABLE HOME LIFE
• DIFFICULT RELATIONSHIPS WITH PARENTS OR CAREGIVERS
• INCONSISTENT OR HARSH DISCIPLINE
• PHYSICAL OR EMOTIONAL ABUSE
• BEHAVIORAL DISORDERS ARE MORE COMMON IN PEOPLE FROM LOW-INCOME BACKGROUNDS, WHICH
MAY BE DUE TO INCREASED LEVELS OF STRESS.
• IT IS ALSO POSSIBLE TO CONFUSE CHILD TRAUMATIC STRESS WITH A BEHAVIORAL DISORDER, AS
THEY HAVE OVERLAPPING SYMPTOMS.
WHAT COULD HELP?
• PARENT MANAGEMENT TRAINING: THIS HELPS PARENTS AND CAREGIVERS
MANAGE THEIR CHILD’S BEHAVIOR, LEARN EFFECTIVE WAYS OF COMMUNICATING
WITH THEM, AND EFFECTIVE WAYS OF SETTING RULES AND BOUNDARIES. FOR
YOUNG CHILDREN, THIS IS OFTEN THE MAIN APPROACH.
• INDIVIDUAL THERAPY: THIS CAN HELP OLDER CHILDREN AND ADOLESCENTS LEARN
TECHNIQUES FOR MANAGING THEIR EMOTIONS AND RESPONDING TO STRESSFUL
SITUATIONS.
• FAMILY THERAPY: THIS MAY HELP HOUSEHOLD MEMBERS LEARN HOW TO TALK TO
EACH OTHER ABOUT EMOTIONS AND PROBLEMS, AND FIND WAYS TO SOLVE THEM.
• SOCIAL OR SCHOOL-BASED PROGRAMS:
• THESE PROGRAMS HELP CHILDREN
• AND ADOLESCENTS LEARN HOW TO
• RELATE TO PEERS IN A HEALTHY WAY.
• SUPPORT FOR LEARNING DIFFICULTIES OR DISABILITIES: PROFESSIONAL SUPPORT WITH
LEARNING DIFFICULTIES MAY IMPROVE THE CHILD’S WELL-BEING AND HELP THEM GET ON BETTER
AT SCHOOL.
• MEDICATION: IF A CHILD HAS A COEXISTING DISORDER, SUCH AS ADHD OR A MENTAL HEALTH
CONDITION, MEDICATION CAN REDUCE THE SYMPTOMS. BUT MEDICATIONS DO NOT CURE
BEHAVIORAL DISORDERS.
• PATIENCE, EMPATHY, AND ENCOURAGEMENT ARE IMPORTANT FOR HELPING TO BOOST SELF-ESTEEM.
AN AUTHORITATIVE PARENTING STYLE, WHICH INVOLVES LISTENING TO CHILDREN WHILST ALSO
SETTING REASONABLE RULES AND BOUNDARIES, IS ALSO HELPFUL.
• IT IS IMPORTANT TO NOTE THAT BOOTCAMP-STYLE PROGRAMS AND “TOUGH LOVE” ARE NOT
EFFECTIVE FOR BEHAVIORAL DISORDERS. IN FACT, THEY CAN BE VERY DAMAGING.