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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

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.
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

JAN 4, 2021 

Untreated Autism Spectrum Disorder Tied to Alcohol, Drug Abuse 
Medpage Today

A retrospective analysis of nearly 6,600 people found that those with autism had a significantly higher risk for substance use disorder (SUD) than those without autism. And those with comorbid impulse control disorder had over five-fold higher risks for alcohol and drug use disorders. Those on psychotropic agents for autism seemed to attenuate their risk. "In other words, the risk of SUD could be reduced if patients with ASD maintain a stable condition," Liang's group said. "This finding should remind psychiatrists and the families of patients with ASD of the importance of ASD treatment."

NOV 10, 2020

Prescriptions of antipsychotic medications in young children is declining
Rutgers University

The use of antipsychotics in young children is declining but doctors continue to prescribe these medications off-label for conditions not approved by the Food and Drug Administration and without the recommended psychiatric consultation, a Rutgers study found. While results are encouraging that antipsychotic prescribing declined in recent years, the researchers noted that they continued to be prescribed for conditions lacking safety and effectiveness data such as conduct disorder, ADHD, anxiety and depression.

SEPT 15, 2020
Oppositional Defiant Disorder in Young Children: How To Manage It

ODD is a behavioral disorder that causes children to be defiant. It can be managed through therapy for both children and their parents. The therapy involves not only the child, but also the parents and the family to manage the condition. Behavioral therapy will train your child to interact better with people and stay conscious of their actions; accept that they can’t always get what they want; control their temper; and solve problems amicably