Disruptive, Impulse-Control and Conduct Disorders

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.

Julia and her parents were referred to a clinic and seen by both a child and adolescent psychiatrist and a clinical psychologist skilled in parent management training. The team undertook psychoeducation with the parents, explaining that extremely variable child behavior is not uncommon in divorcing families when there are custodial and noncustodial home environments. The team also discussed Julia's possible conflicting emotions, and how her desire to please one parent could manifest in oppositional or defiant behavior with the other.

The team also confirmed the diagnosis of ODD, based on Julia's impairing symptoms in one home environment and after ruling out other possible contributors to her behavior, including ADHD, PTSD or an anxiety disorder. A behavioral treatment plan was set up, with the ongoing consultation of the child and adolescent psychiatrist if medication is needed.

The treatment plan included parent management training, with the parents working together to identify desired behaviors to encourage with positive feedback, learn parental strategies to achieve these goals, and put in place practices in the safe environments to maintain behavioral gains. Following six months of this intervention, Julia's father reported much improved behavior at home; her mother also reported improved interactions, even though she had not complained of any specific behavioral problems previously. At a follow-up visit one year after Julia's family first consulted with the clinic, her symptoms were much improved and approaching typical range.

About This Story

This story is based on a composite of experiences.

Harold Koplewicz, M.D., President, Child Mind Institute

What Are 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.

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Expert Q & A: Disruptive, Impulse-Control and Conduct Disorders

Find answers to your questions about disruptive, impulse-control and conduct disorders written by leading psychiatrists.

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