Psychiatric Disorders and Treatments

By Forness, Steven R.; Walker, Hill M. et al. | Teaching Exceptional Children, November/December 2003 | Go to article overview

Psychiatric Disorders and Treatments


Forness, Steven R., Walker, Hill M., Kavale, Kenneth A., Teaching Exceptional Children


A Primer for Teachers

or diagnosis and therapeutic and psychopharmacologic treatment.

Oppositionell Defiant and Conduct Disorders

Diagnosis

Both oppositional defiant and conduct disorders involve disruptive behavior. Oppositional defiant disorder often seems developmentally to precede a later diagnosis of conduct disorder. Both disorders probably occur in at least 4% of children or adolescents (Forness, Kavale, & Walker, 1999). Children with oppositional defiant disorder are those who have persistent patterns of negativistic, hostile, or defiant behavior directed primarily toward adults. Children with conduct disorder show consistent patterns of behavior in which they violate the rights of others or transgress age-appropriate social norms.

In oppositional defiant disorder, symptoms may include

* Persistent temper tantrums.

* Arguing with adults.

* Refusing to comply with reasonable adult requests.

* Annoying others.

* Vindictiveness.

The symptoms of an oppositional defiant disorder bother adults but are not considered as troublesome as conduct disorder, in which symptoms usually cluster into more serious patterns of

* Overt aggression toward people or animals.

* Destruction of property.

* Deceitfulness or theft.

* Serious violations of rules such as staying out all night and truancy from school.

As is the case with all psychiatric disorders, oppositional defiant disorder and conduct disorder are diagnosed in DSM IV when the child meets a set number of symptoms from among a list of several symptoms typical of the disorder. Children must have 4 from a list of 8 symptoms to be diagnosed with oppositional defiant disorder and at least 3 from a list of 15 symptoms to be diagnosed with conduct disorder. These symptoms must also meet the criteria of causing significant impairment in social, academic, or related functioning. In conduct disorder, presence of only 3 symptoms is termed mild conduct disorder, whereas moderate and severe conduct disorder are characterized by increasing numbers of symptoms and increasingly greater harm to others.

Treatment

The primary treatment for both oppositional defiant disorder and conduct disorder is behavioral therapy (Kavale, Forness, & Walker, 1999). Usually this takes the form of a reward or a reinforcement system in which the child earns points for appropriate behavior and is ignored or even given time-outs for inappropriate behavior. Points are usually exchanged for privileges or tangible awards at home or school. A major part of such behavioral therapy is parent or teacher consultation, so that adults can learn how to praise or reward good behavior and ignore inappropriate behavior. Social skills training is also helpful for children who do not seem to know how to behave or interact appropriately.

Unlike most psychiatric disorders, medication is not usually used to control symptoms of oppositional defiant disorder or conduct disorder directly. Both disorders, however, are very likely to co-occur or be comorbid (more than one condition existing at the same time) with a wide range of other psychiatric disorders (Forness, Kavale, & Walker, 1999). Psychopharmacology for these disorders (such as attention deficit hyperactivity disorder, depression, or anxiety disorders) may often improve symptoms of oppositional defiant disorder or conduct disorder, as well.

Attention Deficit/Hypereetivity Disorder

Diagnosis

This disorder is found in 3 %-5 % of children or adolescents (Forness & Kavale, 2002). It is diagnosed when a child has persistent problems in inattentive or in hyperactive-impulsive behavior. At least some of these symptoms must have appeared prior to 7 years of age. The symptoms must also persist to a degree that markedly impairs the child's functioning in two or more settings, such as home and school.

Symptoms of inattention include

* Failing to give close attention to details in school work or related activities. …

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