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Behaviour Problems in Children and Adolescents1

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Nobody's perfect and all children will have bouts of bad behaviour. They may have temper tantrums, or talk back to their parents or teachers. When things start to get out of hand, however, it may be a clue that something in the child or teen's life needs attention.

Children and teens can seem irritable or even hostile when they are tired or aren't feeling well. They may argue with parents or disobey them. 

Young children may lie because they are too young to understand the difference between the truth and a lie. Sometimes they lie to get themselves out of trouble. This is normal. When they act this way all the time, or when this behaviour gets them into trouble all the time at home, at school, or with other kids in the neighbourhood, they may have what we call a disruptive behaviour disorder.

There are two main types of disruptive behaviour disorders – Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD).

A child who has a lot of temper tantrums, or is disobedient or argues with adults or peers on a regular basis, may have Oppositional Defiant Disorder (ODD). More serious problems like frequent physical aggression, stealing or bullying may be a sign of Conduct Disorder (CD).


TYPES OF BEHAVIOUR PROBLEMS

Oppositional Defiant Disorder (ODD):

Oppositional Defiant Disorder (ODD) is a type of behavior problem in which children are openly hostile, uncooperative, and irritable. They lose their tempers and are mean and spiteful towards others. They often do things to deliberately annoy other people. Most of their defiant behaviour is directed at authority figures, but they also sometimes behave the same way towards their siblings, playmates, or classmates. Their home life, school life, and peer relationships are seriously negatively affected because of the way they think and behave.

Conduct Disorder (CD):

Conduct Disorder (CD) is sometimes a later, more serious, phase of Oppositional Defiant Disorder (ODD). A child with CD is not just a child being "bad"; CD is a serious psychiatric disorder that requires professional help.

Children with this condition are aggressive all the time in a way that causes problems for them and their family. They may threaten or actually harm people or animals, or they may damage or destroy property. They may steal or shoplift, or even be involved in breaking and entering. They often lie or try to "con" other people, and frequently skip school.

Children with Conduct Disorder often have trouble understanding how other people think. They may have trouble talking to others. They may think that other people are being mean to them or wish them harm when that isn't the case at all. Their language skills may be impaired, which means they have trouble using words and may act out instead. They may not know how to make friends with other children, and may feel sad, frustrated, and angry as a result.

What's normal and what's not?

It is important to understand that children can start acting out when there are stresses in their lives. It may be that there has been a death in the family, or their parents are having arguments, or they are being bullied at school. Reassuring the child and providing extra care may help to get them through these stressful times. But if the child doesn't feel better and their behaviour doesn't improve, it is important to seek professional help, particularly if the problems last many months and are severe.

What causes behaviour problems?

Children with ODD are more likely than other children to have a family history of behavior problems, mood problems, or substance abuse. Sometimes if caregiving is poor, supervision is lacking, or there is family discord or exposure to violence, children will respond by developing the symptoms of ODD. Having a mother with untreated depression also makes children more likely to have ODD. Both ODD and CD are associated with harsh parenting practices.

Many children with Oppositional Defiant Disorder (ODD) have other mental health problems like depression, anxiety, or Attention Deficit/Hyperactivity Disorder (AD/HD). Their difficult behaviours are often a reaction to the symptoms of these conditions.

How common are they?

Disruptive behaviour disorders appear to be more common in boys than in girls, and they are more common in urban than in rural areas. Between 5% and 15% of school-aged children have Oppositional Defiant Disorder (ODD). A little over 4% of school-aged children are diagnosed with Conduct Disorder (CD).

How long do they last?

Behaviours that may signal the beginnings of ODD or CD can be identified in preschoolers. Most children with ODD symptoms “grow out of it” but some do not. Some may go on to develop CD. Children and adolescents with CD whose symptoms are not treated early are more likely to fail at school and have difficulty holding a job later in life. They are also more likely to commit crimes as young people and as adults.

What treatment is effective?

Cognitive behavioural therapy (CBT) can help children with Oppositional Defiant Disorder (ODD) improve their mood and control their anger. CBT works by making the child aware of the thinking patterns that fuel their behaviour, and teaching them ways of counteracting that thinking.

Social skills training may also be helpful to the child with ODD. Family therapy that helps change how the family functions can also help.

Many parents of children with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) punish their children harshly and are very critical of them, usually because of their own life experience and because they suffer from depression. Changing these parenting practices can help the child and benefit the family as a whole. If the parents, particularly the mothers, are unable to develop new ways of parenting, their children may go on to develop the more serious condition of Conduct Disorder (CD).

In treatment, it is very important to focus on other conditions the child may have. Children who have AD/HD, depression, or anxiety tend to lose symptoms of Oppositional Defiant Disorder (ODD) when their other problems are successfully treated. These are often easier to treat than ODD.

Conduct Disorder (CD) is harder to treat than Oppositional Defiant Disorder (ODD), and becomes worse as a child gets older. This makes early intervention extremely important. Programs that can be effective include parent training, family therapy, and Multisystemic Therapy (MST), an intensive program that treats the whole family and also involves school and community. Programs that are punitive or threatening in nature are not shown to be effective and may even cause more harm than good.

LEARN MORE

American Academy of Child and Adolescent Psychiatry
Children with oppositional defiant disorder
Conduct Disorder

Canadian Paediatric Society
http://www.caringforkids.cps.ca/handouts/behaviour-index

This information pamphlet was developed by the Centre of Knowledge on Healthy Child Development with support from CIBC World Markets Children's Miracle Foundation. The Centre of Knowledge on Healthy Child Development is a project of the Offord Centre for Child Studies, a leader in helping kids grow and thrive. Go to www.knowledge.offordcentre.com for more information on how to identify, prevent and treat child and youth mental health problems.

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1This webpage is a reproduction of an information pamphlet entitled Behaviour Problems in Children and Adolescents which was developed by the Centre of knowledge on Healthy Child Development. It has been reproduced with their permission.

The Centre of Knowledge on Healthy Child Development is a project of the Offord Centre for Child Studies, a leader in helping kids grow and thrive. Go to www.knowledge.offordcentre.com for more information on how to identify, prevent and treat child and youth mental health problems.


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