Academic journal article International Journal of Child Health and Human Development

Challenging Behavior of Disruption, Violence and Cognitive Abilities

Academic journal article International Journal of Child Health and Human Development

Challenging Behavior of Disruption, Violence and Cognitive Abilities

Article excerpt


There are three groups of pediatric patients that pose substantial clinical challenges for physicians. The first includes those who present with disruptive, aggressive, and even violent behaviors. The second group includes those who have intellectual and functional impairments, often associated with specific developmental disorders. The third group includes individuals with both cognitive disabilities and disruptive behavioral problems. This paper will give an overview of these problem areas, including suggested therapeutic interventions.


Disruptive behavior disorders

What makes a behavior "disruptive?" A behavior is disruptive when its frequency, intensity, setting, and mode of expression is inappropriate, excessive, disturbing to the environment, and associated with negative social, academic, occupational, and/or legal consequences. A disruptive disorder is characterized by a consistent pattern of unruly behaviors that is not attributable to the direct effects of a substance of abuse or to a medical condition. The section titled "Attention-Deficit and Disruptive Behavior Disorders" in the fourth edition, text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (1) includes the diagnoses attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), oppositional defiant disorder (ODD), and disruptive behavior disorder not otherwise specified (DBD-NOS). This chapter will discuss ODD and CD in some detail; ADHD will be addressed briefly, as it is covered in detail elsewhere in this book. The DBD-NOS diagnosis is used when features of ODD or CD are present and cause "clinically significant impairment," but do not meet the full criteria for either disorder.

Oppositional defiant disorder (ODD)

The characteristic feature of ODD is a pattern of angry resistance to rules, requests or expectations initiated by authority figures, of at least 6-months duration. Adolescents with ODD resent being told what to do, and become easily irritated and angry. The anger is often expressed directly through arguments or the intentional aggravation of others; its indirect expression can take the form of retaliation or "payback." The oppositional behaviors are primarily confined to the home, and may never be displayed in other settings, such as at school. However, it is also not uncommon to see ODD children- and even some adolescents- tantrum in public settings when they don't get what they want. Table 1 lists the DSM-IVTR criteria for the diagnosis of ODD (1).

Conduct disorder (CD)

The behaviors seen in CD are fairly chronic (i.e. 1 symptom present for at least 6-months, 3 symptoms for at least 12-months) and are more serious in their intentions and effects than those seen in ODD. In addition to defying rules and authorities, adolescents with CD violate the basic rights of others (including animals) and disregard basic societal norms and laws. Covert symptoms, such as stealing, may go undetected; overt symptoms, such as fighting, are obvious to everyone. Table 2 lists the DSM-IV-TR diagnostic criteria for CD (1).

Developmental disorders (DDs)

Also commonly known as intellectual and developmental disabilities (ID or IDD) and as learning disorders (LD) in the United Kingdom, the DDs are characterized by a combination of cognitive and functional impairments, which can be quite variable in degree (from mild to profound). The intellectual level and adaptive functioning, however, are always below what would normally be expected for the individual's chronologic age and culture.

Included in this diverse category are common and well-known conditions, such as the autism spectrum disorders (ASDs), and less well-known and even rare syndromes, most of which are caused by specific chromosomal and genetic abnormalities. Behavioral disturbances are quite common in this group of disorders, and are often the reason for out-of-home placements or hospitalizations. …

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