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Help With Disruptive, Impulse Control and Conduct Disorders

Disruptive, impulse control and conduct disorders are a group of disorders that are linked by varying difficulties in controlling aggressive behaviors, self-control, and impulses. Typically, the resulting behaviors or actions are considered a threat primarily to others’ safety and/or to societal norms.  Some examples of these issues include fighting, destroying property, defiance, stealing, lying, and rule breaking. These disorders are:

  • Oppositional defiant disorder
  • Intermittent explosive disorder
  • Conduct disorder
  • Pyromania
  • Kleptomania
  • Other specified disruptive, impulse-control and conduct disorder
  • Unspecified disruptive, impulse-control, and conduct disorder

Problematic behaviors and issues with self-control associated with these disorders are typically first observed in childhood and can persist into adulthood. In general, disruptive, impulse-control, and conduct disorders tend to be more common in males than females, with the exception of kleptomania.

See more on symptoms & treatment

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.

Read More 

Editor's Choice

MAY 4, 2021 

New insights into characteristics of Conduct Disorder with "limited prosocial emotions" 
Universiteit Leiden

In a recent study, Dr. Moji Aghajani and colleagues show that adolescents with a severe form of Conduct Disorder (CD) -with limited prosocial emotions- require an unusually large amount of brain capacity to read emotional faces. These effects were found in comparison to CD youth without limited prosocial emotions and healthy control peers. It thus appears that these CD youth recruit additional cognitive processes to compensate for their social-emotional limitations.

APR 27 2021

Clinical and social factors associated with involuntary psychiatric hospitalization in children and adolescents: a systematic review, meta-analysis, and narrative synthesis

Rutgers University

The A diagnosis of behavioral problems, including diagnoses such as ADHD and conduct disorder, was associated with decreased odds of an involuntary rather than voluntary hospitalization, as was a diagnosis of anxiety disorder. Over-representation of involuntary psychiatric hospitalization in certain groups might begin in childhood, potentially establishing a cycle of inequality that continues into adulthood. Further research into the systemic factors underlying these health-care inequalities and the barriers to accessing less coercive psychiatric treatment is urgently required, with specific consideration of racial and ethnic factors. 

APR 15, 202
Common Behavioral Disorders in Children
Medical 1News Today

All young children display impulsive or defiant behavior occasionally. Sometimes, this is part of a normal emotional reaction. But if these behaviors are extreme or outside the norm for their level of development, it could be a sign of a behavioral disorder. The most common behavioral disorders in children are attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).