Characteristics Interventions and Needs for Disruptive of Children with Disruptive Behavior Behavior Disorders and Disorders Their Families Characteristics Interventions and Needs for Disruptive of Children with Disruptive Behavior Behavior Disorders and Disorders Their Families U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration Acknowledgments This document was produced for the Substance Abuse and Mental Health Services Administration (SAMHSA) by Abt Associates, Inc., and the National Association of State Mental Health Program Directors (NASMHPD) Research Institute (NRI) under contract number 280‑2003‑00029 with SAMHSA, U.S. Department of Health and Human Services (HHS). Sylvia Fisher and Pamela Fischer, Ph.D., served as the Government Project Officers. Disclaimer The views, opinions, and content of this publication are those of the authors and contributors and do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), SAMHSA, or HHS. Public Domain Notice All material appearing in this document is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization from the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be downloaded or ordered at http://store.samhsa.gov. Or, please call SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1‑877‑726‑4727) (English and Español). Recommended Citation Substance Abuse and Mental Health Services Administration. Interventions for Disruptive Behavior Disorders: Characteristics and Needs of Children with Disruptive Behavior Disorders and Their Families. HHS Pub. No. SMA‑11‑4634, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2011. Originating Office Center for Mental Health Services Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Rockville, MD 20857 HHS Publication No. SMA‑11‑4634 Printed 2011 Characteristics and Needs of Children with Disruptive Behavior Disorders Interventions and Their Families for Disruptive This booklet addresses the first step in selecting evidence‑based Behavior practices: understanding the population of interest. It identifies risk factors, protective factors, behavioral manifestations across Disorders three developmental stages, diagnostic criteria, co‑occurring conditions, and the course of these disorders. For additional references on interventions for disruptive behavior disorders, see the booklet, Evidence-Based and Promising Practices. This KIT is part of a series of Evidence‑Based Practices KITs created by the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services. This booklet is part of the Interventions for Disruptive Behavior Disorders KIT, which includes six booklets: How to Use the Evidence-Based Practices KITs Characteristics and Needs of Children with Disruptive Behavior Disorders and their Families Selecting Evidence-Based Practices for Children with Disruptive Behavior Disorders to Address Unmet Needs: Factors to Consider in Decisionmaking Implementation Considerations Evidence-Based and Promising Practices Medication Management What’s in Characteristics and Needs of Children with Disruptive Behavior Disorders and Their Families Interventions Introduction .......................................................................1 for Disruptive Risk Factors ........................................................................2 Protective Factors ...............................................................2 Behavior Behavioral Manifestations of Risk Factors Disorders by Developmental Stage .....................................................2 Diagnostic Criteria ..............................................................3 Prevalence of Condition ......................................................4 Co‑Occurring Conditions .....................................................4 Course of Condition ............................................................4 References .........................................................................5 Characteristics and Needs Introduction effectiveness of usual care—normally, individual therapy. Previously, access to This KIT focuses on evidence-based interventions with an evidence base was interventions for children and adolescents limited, but such interventions are now with disruptive behavior disorders, becoming more widely available. specifically, Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). The opportunity to intervene early is now These diagnostic categories basically feasible with new treatments that have mean that a child’s or adolescent’s been developed and tested for all three behavior is causing trouble at home, developmental stages. at school, or in the community. Such behavior may first appear in any of three Characteristics and Needs of Children developmental stages: early childhood, with Disruptive Behavior Disorders school age, or adolescence. and Their Families identifies risk factors, protective factors, behavioral These behavioral problems have manifestations across three historically been considered difficult to developmental stages, diagnostic treat effectively, and many professionals criteria, co-occurring conditions, have been pessimistic about the and the course of these disorders. Characteristics and Needs of Children 1 Risk Factors Behavioral Manifestations of Risk Factors by Considerable research has identified family, Developmental Stage neighborhood, school, and societal factors that may place a youth at risk for long-term negative Risk factors may result in behavioral difficulties, outcomes. Although these factors do not fully which increase in severity as a child ages. explain why disruptive behavior emerges in a See Table 3. child, they may point to areas for intervention (Walker and Sprague, 1999). See Table 1. Table 3: Behavioral Manifestations of Risk Factors by Developmental Stage Table 1: Risk Factors Early on, such behaviors include the following n Poverty (Walker and Sprague, 1999): n Abuse and neglect n Defiance of adults n Harsh and inconsistent parenting n Lack of school readiness n Drug and alcohol use by caregivers n Coercive interactive styles (for example, threatening, manipulation) n Emotional and physical or sexual abuse n Aggression toward peers n Modeling of aggression n Lack of problem‑solving skills n Media violence n Negative attitude toward school Behavior that is more problematic is observed in elementary and early secondary school age youth n Family transitions (death or divorce) (Walker and Sprague, 1999): n Parent criminality n Truancy n Peer and teacher rejection n Low academic achievement n High number of school discipline referrals Protective Factors n Large number of different schools attended n Early involvement with drugs and alcohol A report from the Surgeon General (2001) outlined n Early age of first arrest (under 12 years) protective factors that may buffer or lower the risks By adolescence and early adulthood, long-term of antisocial behavior or general delinquency. See and severe consequences include the following Table 2. (Walker and Sprague, 1999): n School failure and dropout Table 2: Protective Factors n Delinquency n Drug and alcohol use Individual domain n Gang membership n High IQ n Violent acts n Being born female n Adult criminality n A positive social orientation n Lifelong dependence on welfare system Family domain n Higher death and injury rate n A warm supportive relationship with parents or older adults n Parental monitoring or supervision activities School domain n Extracurricular activities n Encouragement from teachers toward their future Peer domain n Having friends who behave conventionally n Associating with peers who disapprove of violence 2 Characteristics and Needs of Children