Does your disruptive child need help?

contributing columnistAugust 24, 2014 

Should I be concerned about my child's disruptive behavior?

It can be difficult to know if your child's problematic behavior falls within the "normal" spectrum or if there's a more severe problem that needs professional attention. Disruptive behavior disorders are serious problems that, if left untreated, can lead to school failure, social problems, substance abuse, poor quality of life, and negative outcomes across the lifespan.

Many behavior disorders appear before age 6, and early diagnosis and intervention are key to helping your child thrive and preventing lifelong challenges. Effective interventions are available, but the longer you wait, the more entrenched the problems may become.

What are some disruptive behavior disorders and warning signs?

Just like children learn to walk and talk in their own time, "normal" behavior varies greatly between children. If your child is more impulsive or defiant than others, it doesn't necessarily indicate a behavior disorder. However, if problematic behavior exists for more than six months, occurs across settings (home, school, etc.), and — most importantly — interferes with your child or family's ability to function, it's time for professional help.

The three (sometimes co-occurring) types of disruptive behavior disorders are believed to be caused by a combination of nature and nurture:

 Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood brain disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, impulsiveness and difficulty controlling behavior, and/or hyperactivity.

 Oppositional defiant disorder (ODD) is characterized by a pattern of developmentally inappropriate defiance, rebelliousness, aggression, and refusal to obey rules across settings.

 Conduct Disorder (CD) is a serious behavioral disorder involving severe violation of social norms and basic rights of others, including lying, stealing, hurting animals, setting fires or destroying property and bullying.

Finding help: If you're concerned that your child might be experiencing a behavioral disorder, consult your child's primary care provider who can help determine the need for further assessment from a licensed mental health professional. You can also directly contact a mental health provider to request evaluation.

The most reliable diagnoses and treatments are from licensed mental health professionals, including clinical psychologists, child psychiatrists, clinical social workers, developmental-behavioral pediatricians, and others. Many primary care providers are able to diagnose ADHD, but ODD and CD are typically beyond the scope of their behavioral expertise.

Effective treatments: Behavioral parent training, in which parents learn strategies to address and reduce their child's behavioral issues, is extremely effective in reducing behavior problems. For ADHD, stimulant medication and behavioral therapy combined have demonstrated effectiveness in reducing symptoms. For CD, more intensive treatment may be required. As the saying goes, "it takes a village" — so it's important that any intervention involve all aspects of a child's life (family, caregivers, school).

Dr. Christina Studts is an assistant professor of health behavior at the University of Kentucky College of Public Health.

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