Conduct disorder

1.Definition:
Conduct disorder is a serious behavioral and emotional
disorder that can occur in children and teens. A child with
this disorder may display a pattern of disruptive and violent
behavior and have problems following rules.
It is not uncommon for children and teens to have behavior-
related problems at some time during their development.
However, the behavior is considered to be a conduct disorder
when it is long-lasting and when it violates the rights of
others, goes against accepted norms of behavior and disrupts
the child's or family's everyday life.

2.Causes:
The exact cause of conduct disorder is not known, but it is
believed that a combination of biological, genetic,
environmental, psychological, and social factors play a
role.

 Biological: Some studies suggest that defects or injuries to

certain areas of the brain can lead to behavior disorders.
Conduct disorder has been linked to particular brain regions
involved in regulating behavior, impulse control, and
emotion. Conduct disorder symptoms may occur if nerve cell
circuits along these brain regions do not work properly.
Further, many children and teens with conduct disorder also
have other mental illnesses, such as attention-
deficit/hyperactivity disorder (ADHD), learning
disorders, depression, substance abuse, or an anxiety
disorder, which may contribute to the symptoms of conduct
disorder.
 Genetics: Many children and teens with conduct disorder have
close family members with mental illnesses, including mood
disorders, anxiety disorders, substance use disorders and
personality disorders. This suggests that a vulnerability to
conduct disorder may be at least partially inherited.
 Environmental: Factors such as a dysfunctional family life,
childhood abuse, traumatic experiences, a family history of
substance abuse, and inconsistent discipline by parents may
contribute to the development of conduct disorder.
 Psychological: Some experts believe that conduct disorders
can reflect problems with moral awareness (notably, lack of
guilt and remorse) and deficits in cognitive processing.
 Social: Low socioeconomic status and not being accepted by
their peers appear to be risk factors for the development of
conduct disorder.

3.Characteristics
 Aggressive behavior: These are behaviors that threaten
or cause physical harm and may include fighting, bullying,
being cruel to others or animals, using weapons, and forcing
another into sexual activity.
 Destructive behavior: This involves intentional
destruction of property such as arson (deliberate fire-
setting) and vandalism (harming another person's property).
 Deceitful behavior: This may include repeated lying,
shoplifting, or breaking into homes or cars in order to
steal.
 Violation of rules: This involves going against accepted
rules of society or engaging in behavior that is not
appropriate for the person's age. These behaviors may include
running away, skipping school, playing pranks, or being
sexually active at a very young age.

4.Early Intervention

 Assess severity and refer for treatment with a

subspecialist as needed.
 Treat comorbid substance abuse first.
 Describe the likely long-term prognosis without
intervention to caregiver.
 Structure children's activities and implement consistent
behavior guidelines.

 Emphasize parental monitoring of children's activities

(where they are, who they are with). Encourage the
enforcement of curfews.

 Encourage children's involvement in structured and

supervised peer activities (e. organized sports,
Scouting).
  Discuss and demonstrate clear and specific parental
communication techniques.
 Help caregivers establish appropriate rewards for
desirable behavior.
 Help establish realistic, clearly communicated
consequences for noncompliance.

 Help establish daily routine of child-directed play

activity with parent(s).

 Consider pharmacotherapy for children who are highly

aggressive or impulsive, or both, or those with mood
disorder.

5.Activities and Strategies

 Cognitive-behavioral therapy. A child learns how to better
solve problems, communicate, and handle stress.
 Peer group therapy. A child develops better social and
interpersonal skills.

 Family therapy. This therapy helps make changes in the

family.

 Medicines

Oppositional Defiant disorder

1.Definition:

It's not unusual for children -- especially those in their

"terrible twos" and early teens  -- to defy authority every
now and then. They may express their defiance by arguing,
disobeying, or talking back to their parents, teachers, or
other adults. When this behavior lasts longer than six
months and is excessive compared to what is usual for the
child's age, it may mean that the child has a type of
behavior disorder called oppositional defiant
disorder (ODD).
 ODD is a condition in which a child displays an ongoing
pattern of an angry or irritable mood, defiant or
argumentative behavior, and vindictiveness toward people in
authority. The child's behavior often disrupts the child's
normal daily activities, including activities within the
family and at school.
Many children and teens with ODD also have other behavioral
problems, such as attention deficit disorder, learning
disabilities, mood disorders (such as depression),
and anxiety disorders. Some children with ODD go on to
develop a more serious behavior disorder called conduct
disorder.

2.Causes:
The exact cause of ODD is not known, but it is believed that a combination of biological,
genetic, and environmental factors may contribute to the condition.

 Biological: Some studies suggest that defects in or injuries to certain areas of the brain can lead
to serious behavioral problems in children. In addition, ODD has been linked to abnormal
functioning of certain types of brain chemicals, or neurotransmitters. Neurotransmitters help
nerve cells in the brain communicate with each other. If these chemicals are not working
properly, messages may not make it through the brain correctly, leading to symptoms of ODD,
and other mental illnesses. Further, many children and teens with ODD also have other mental
illnesses, such as ADHD, learning disorders, depression, or an anxiety disorder, which may
contribute to their behavior problems.
 Genetics: Many children and teens with ODD have close family members with mental illnesses,
including mood disorders, anxiety disorders, and personality disorders. This suggests that a
vulnerability to develop ODD may be inherited.
 Environmental: Factors such as a dysfunctional family life, a family history of mental illnesses
and/or substance abuse, and inconsistent discipline by parents may contribute to the
development of behavior disorders.

3.Characteristics

 Throwing repeated temper tantrums

 Excessively arguing with adults, especially those with authority
 Actively refusing to comply with requests and rules
 Deliberately trying to annoy or upset others, or being easily
annoyed by others
 Blaming others for your mistakes
 Having frequent outbursts of anger and resentment
 Being spiteful and seeking revenge
 Swearing or using obscene language
 Saying mean and hateful things when upset

In addition, many children with ODD are moody, easily

frustrated, and have a low self-esteem. They also sometimes
may abuse drugs and alcohol.

4.Early Intervention

Managing oppositional defiant disorder (ODD) in children is

about first accepting that your child will behave in
challenging ways.

The next step is working with health professionals to develop

a behaviour management plan, which can make the behaviour
easier to handle – for you and your child.

A good plan will help your child:

 learn how to improve her behaviour and understand how it

affects other people
 manage strong emotions like anger and anxiety
 improve the way she solves problems, communicates and gets
on with other children.

These things will help your child with making and keeping
friends, saying what he thinks without getting angry,
accepting no for an answer and playing well with others.

A good behaviour management plan will also help you cope with

your child’s challenging behaviour by helping you:

 understand the causes of your child’s behaviour

 work out how you can increase your child’s positive
behaviour and manage her challenging behaviour
 support your child in managing strong emotions and improving
social skills
 work on strengthening your family relationships.

5.Activities and Strategies

 Occupational Therapy approaches and activities that can
support the child with Oppositional Defiance Disorder (ODD)
include:

 Expand abilities: Developing a gradually broadening range of

skill areas.
 Social stories: Providing ideas and education around social
story development.
 School transition: Advocating and professionally supporting
the transition to school and liaising with teachers, as
required.
 Visual cues can be used to support routine and to introduce
new, or a change in tasks.
 Gross and fine motor skills: Determining the current age
level of a child’s gross and fine motor abilities.
 Devise goals: Set functional and achievable goals in
collaboration with the child, parents and teachers so that
therapy has a common focus beneficial to everyone involved.
 Educating parents,teachers and others involved in the
child’s care about ODD and the age appropriate skills a
child should be demonstrating.
 Direct skill teaching through a task based approach.
 Strategies: Providing management strategies/ideas to assist
the child in the home, at school and in the community.
 Task engagement: Providing alternative ways to encourage
task engagement.
 Developing Underlying skills necessary to support whole body
(gross motor) and hand dexterity (fine motor) skills, such
as providing activities to support:
 balance and coordination
 strength and endurance
 attention and alertness
 body awareness
 movement planning

Speech Therapy approaches and activities that can support

the child with Oppositional Defiance Disorder (ODD)
include:

 Speech and language assessment to help the family to

understand how the child is processing, understanding,
learning and using language and communication.
 Communication strategies: Providing the family with
strategies and techniques to increase and enhance
communication with the child.
 Daily activities: Helping the child to understand the
environment, routines and language.
 Developing language: Helping the child to understand and use
richer language and to use language more spontaneously.
 Conversation skills: Developing conversation skills (e.g.
back and forth exchange, turn taking).
 Concept skills: Developing concept skills, especially
abstract concepts, such as time (e.g. yesterday, before,
after).
 Visuals can be used to help with understanding and the
child’s ability to express their needs, wants and thoughts.
 Social skills: Development of social skills (i.e. knowing
when, how to use language in social situations).
 Enhancing verbal and non-verbal communication including
natural gestures, speech, signs, pictures and written words.
 Visual strategies: Using visual information to help
understand, organize and plan the routine for the day.
 Liaising with educational staff regarding the nature of the
difficulties and ways to help the child to access the
curriculum.

JANINE MARIE R. MANZANO

Reporter