In order to better understand problem children and adolescents, professionals working with these children in a rural county in Indiana were individually interviewed. In this report, the interview questions are presented with the respective responses for the purpose of being able to compare the varied professionals' opinions. In addition, comparisons are drawn between these in-the-trenches professionals' observations and existing research findings regarding Disruptive Behavior Disorders.
Although all questions and responses are listed, the echoed (most often verbalized) responses are examined in further detail in the review of the research literature. Echoed responses generally concern the effects on children of inadequate nurturance resulting from instability in the home environment and poor parent-child communication.
TOWARD A DEFINITION: WHAT IS A PROBLEM CHILD?
Although experts do not always agree on what constitutes a "problem child," there is a general consensus that the definition varies according to the age of the child and the responsibilities and personal perceptions of the professional involved. Most of the people interviewed in this survey, while espousing the legal definition of "juvenile delinquency," gave descriptions of problem children that closely parallel DSM-IV definitions of Disruptive Behavior Disorders (American Psychiatric Association, 1994).
Disruptive Behavior Disorders as a Definition
Three syndromes fall under the broad category of Disruptive Behavior Disorders (DBDs), with Rey (1993) noting that comorbidity and overlapping of symptoms exists. One is Attention-Deficit Hyperactivity Disorder (ADHD), which is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is thought to be "normal." Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) are two additional types of childhood conduct problems. The distinction between them is based primarily on the seriousness of the acts or major age-appropriate societal norms or rules that are violated. ODD is defined as a recurrent pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures. It is distinguished from CD by the more serious violations of the basic rights of others found in CD (American Psychiatric Association, 1994).
The place of ODD in the classification system has been controversial from the time of its introduction in DSM-III. It was questioned whether it is sufficiently distinct from normal oppositional behavior to warrant its inclusion as a distinct diagnostic category, and that the criteria for ODD imply a milder form of CD (Rey, 1993). Distinctions and elements shared between ODD and CD were reviewed in papers prepared for the DSM-IV work group, such as those by Lahey, Loeber, Quay, Frick, and Grimm (1992) and Loeber, Lahey, and Thomas (1991). To briefly summarize, the evidence indicates that ODD and CD are strongly related, but differ. The latter is considered more serious than the former. Not all youths with ODD progress to CD, but in clinical samples nearly all youths who develop CD before puberty first meet criteria for ODD. The onset of most ODD symptoms tends to precede the onset of most CD symptoms. As CD emerges in youngsters, symptoms of ODD tend to be retained rather than outgrown. Thus, ODD and CD appear developmentally intertwined, with ODD appearing as a frequent precursor to CD. Although similar risk factors are associated with both, they apply to a greater degree to CD than to ODD (Lahey et al., 1992; Loeber et al., 1991; Loeber, Keenan, Lahey, Green, & Thomas, 1993).
Despite this common backdrop of elements, ODD symptoms appear to be qualitatively different from CD symptoms. Symptoms of ODD are common in young children, but normally decline in prevalence with age. They are considered pathologic only when they are severe or when they persist until ages when most other children have outgrown them (in middle to late childhood). …