Amajor child-rearing goal for parents is the socialization of their children. As part of this process, parents must teach their children to cope with the ongoing and various stresses of life in socially acceptable ways. As children become more autonomous and independent, their desires and frustrations often come into conflict with those of their parents; the result is typically a display of negative or disruptive behavior on the part of the children (and often also the parents!). These disruptive behaviors are usually transient and considered “normal” at certain ages (e.g., toddler temper tantrums or adolescent rebellion). Some children, however, exhibit disruptive behaviors with greater intensity and/or frequency than would be expected. Moreover, these behaviors may persist or escalate throughout childhood and adolescence and even into adult life. Thus a considerable problem for clinicians is determining when disruptive behaviors exhibited by children referred for treatment are “normal” and likely to be transient, and when they are clinically significant and likely to persist or become more severe.
The term “disruptive behavior” embraces a diverse set of behaviors that includes temper tantrums, excessive whining or crying, demanding attention, noncompliance, defiance, aggressive acts against self or others, stealing, lying, destruction of property, and delinquency. Children exhibiting a pattern of these behaviors have been variously labeled as “acting out,” “externalizing,” “oppositional,” “noncompliant,” “antisocial,” or “conduct-disordered.” Disruptive behaviors of one sort or another are the most frequent causes for concern among parents of normally developing children. In a random sample of parents from a primary health care setting, for example, negative behavior (defined as “won't listen to parents, doesn't obey, has tantrums, bossy and demanding, cries, whines”) was found to be a significant problem by 50–80% of parents of children ages 2–4 and 7–10 (Schroeder, Gordon, Kanoy, & Routh, 1983). Moreover, some form of disruptive behavior is the primary problem for a substantial percentage of the children referred for mental health services. This chapter focuses on research related to the classification and diagnosis of disruptive behavior disorders; their prevalence, comorbidity, persistence, and etiology; the normal developmental course and correlates of disruptive behavior; and issues and methods for assessment and treatment (including prevention). In the section on treatment, research on the efficacy of parent–child interaction training and other approaches to disruptive behavior is reviewed, and the program used in our clinic for young children with disruptive behavior problems is described.