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Help With Disruptive, Impulse Control and Conduct Disorders

Disruptive, impulse-control and conduct disorders refer to a group of disorders that include oppositional defiant disorder, conduct disorder, intermittent explosive disorder, kleptomania and pyromania. These disorders can cause people to behave angrily or aggressively toward people or property. They may have difficulty controlling their emotions and behavior and may break rules or laws.

Most kids will act up or become disruptive or defiant sometimes. Disruptive and conduct disorders, however, involve much more severe and longer-lasting behaviors than typical, short-lived episodes.

An estimated 6 percent of children are affected by oppositional defiant disorder or conduct disorder1. Each year, an estimated 2.7 percent of children and adults in the U.S. are affected by intermittent explosive disorder. Kleptomania and pyromania are rare, affecting 1 percent or fewer of people in the U.S. 2,3

See more on symptoms & treatment

Upcoming Events
Apr
2020
01

Council for Children with Behavior Disorders

Apr
2020
01
Behavioral and Emotional Skills Training
  • New York City
  • Wed,  Apr  01 - Thur,  Apr  30

Child Mind Institute

Most children go through the "terrible twos;" isn't it just a phase they will grow out of?

It certainly is a phase. Most kids at 2 are exploring their growing independence. They're noticing they have new motor skills that allow them some freedom to explore their environment, and finding they have strong preferences but little ability to regulate their emotions. One of the reasons why we have the phrase "terrible twos" is that this is commonly when a child's capability for exploring the world is clashing with the rules of the world.

Every family with a 2-year-old may experience acting out - the child doesn't want to put on his shoes, or he doesn't want to go to bed one night a week, so there's a lot of screaming. But if it's happening every morning as you go out, or the house ends up looking like a disaster area, or it happens every night for bedtime, or it takes hours to get the child to bed, and parents are pulling their hair out and no one is sleeping - that is when professional help may be necessary. More

How can I tell if my child's behavior is typical acting out or a more serious disorder?

I often tell parents about a clinical acronym we use to better understand whether a child's symptoms are consistent with a mental health diagnosis: FIDI, for "Frequency, Intensity, Duration and Impairment." When parents come into the office worrying about a child's tantrums, I ask, "How often do the tantrums happen? How intense do things get? How long do these things last and how long have they been going on? How much does it get in the way of you being able to do stuff as a family?" We have diagnostic criteria for certain behavior disorders, but those criteria don't cover every behavior that could impair a child's or family's functioning. So we have to look objectively at the frequency, intensity and duration of these behaviors, and then discuss how they're impairing the child's life and family.

Impairment is the key dividing line between "typical" and clinical, and it isn't always as sharp as we would like it to be. It may be that a child has milder behavioral issues, but they are really getting in the way for a family and causing a lot of conflict between the parents. We don't only treat problem behavior if it is the most severe it can be. We treat because a family needs help. More

Isn't most child misbehavior and defiance because parents don't discipline them enough?

Parents are not necessarily the cause of behavior problems, but they can be the solution. Behavior problems have many different causes. There are biological and genetic reasons why a child might have behavioral difficulties. Some children react more strongly to interruptions in daily rhythms - like overreactions to hunger or irritability related to too little sleep. Some children have real difficulties controlling emotions, difficulties that have been there since infancy as part of a reactive and highly sensitive temperament.

To be sure, there are parent-child interaction patterns that we know lead to a higher instance of behavior problems - usually the techniques we would call "harsh discipline." Parents who end up making threat after threat, who engage in physical discipline, or who frequently criticize their children often see more behavior problems.

But the issue we see most often is parents who believe their child's behavior problems must be the result of their actions or some mistake in discipline, like being too harsh or too permissive. The reality is it can happen to anybody, and we want to re-establish a balance between nurture and structure in effectively managing behavior. We see parents who have what seems to be flawless parenting strategies with one child in a family, and through no fault of their own, the other child has just stumbled upon ways of coping with stress or with their emotions that become impairing and disruptive over time. Parenting is just a part of what goes into a child's behavior patterns; but parent behavior is adjustable, so it's one of the most powerful tools we have. More

About the Experts

Harold Koplewicz, M.D.

Harold Koplewicz, M.D.
President
Child Mind Institute

David Anderson, Ph.D.

David Anderson, Ph.D.
Senior Director of the ADHD and Behavior Disorders Center
Child Mind Institute

Julia's Story

Julia was 8 years old when she was diagnosed with oppositional defiant disorder. Her parents had since divorced when they sought advice and potential treatment for Julia’s continued defiant and aggressive behavior two years later. The parents disagreed on the validity of Julia’s diagnosis, stemming from Julia’s strikingly different behavioral patterns in her two home environments. Her father reported frequent disruptive arguments at home that eroded the relationship and impaired family functioning. Julia’s mother and the school reported no rebellious or defiant behaviors, and limited outbursts when she was frustrated or upset.

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Editor's Choice

MAR 30, 2020

For students with mental health needs, closed schools during the coronavirus crisis means figuring out another way to get services

Hartford Current

Ariana has attention deficit disorder and oppositional defiant disorder, Torza said. She works with a clinician at her New Britain elementary school about once a week and sees another clinician biweekly at a community health center. Since the coronavirus closed down schools, Ariana hasn’t been able to meet with her school-based clinician.

MAR 18, 2020

Disordered aggression and violence in the United States

Journal of Clinical Psychology

Researchers looked at prevalence of DSM-5 intermittent explosive disorder and related aggressive disorders in the United States. As per analysis, there was a pattern of recurrent aggressive outbursts in nearly 17% of adolescents and 8% of adults within at least 1 year indicating commonly encountering to recurrent aggressive behavior in both adolescents and adults. Screening people for such behavior in one’s practice may aid in identification and in providing treatment to individuals with this problem.

FeB 28, 2020

Conduct Disorder in Children 

Everyday Health

Though antisocial personality disorder (ASPD) isn’t diagnosed in childhood, it has its roots there. Children exhibiting severely antisocial behavior may have what's known as conduct disorder. In the United States, researchers estimate that conduct disorder affects about 2 to 10 percent of the population, with a higher rate for boys. (2,3) While some children with conduct disorder go on to develop ASPD in adulthood — maybe in the range of 30 to 40 percent, says Dr. Michalska — most don’t.