Understanding Disruptive Behavior Disorders

Disruptive behavior by Filip Emanuel Dreamstime As the AOCC All Ohio Counselors Conference program guide describes it, ‘Disruptive behaviors in youth frequently interfere with their ability to access the curriculum and adversely affects their ability to function at home and succeed in the community. Low grades, truancy, school dropout, family problems, substance use, and legal problems are but a few of the consequences of untreated disruptive behavior disorders.’ [Pomegranate Health Systems treats a fair percentage of teens with behavior and conduct disorders. Looking at a recent diagnostic pie chart, behavior disorders accounted for –% of total residential admissions.] Workshop presenters Eric Beltrinic MA, Ed, PCC-S, Tom Newman, MA, Ed, PCCS and Lynne Guillot-Miller PhD of Kent State University shared in presenting this workshop topic in a dynamic fashion.

Beltrinic began, ‘Disruptive behavior disorders account for 75% of combined prevalence of all psychiatric pathology discovered in childhood/adolescence.’ (Quincy Quay & Hogan ’99) This is the most common reason for treatment referrals (Kazdin ’95). He continued, ‘Often disruptive behavior disorders that persist into adulthood lead to criminal behaviors, psychiatric concerns, family problems and substance abuse. (Hill & Vaughn) DBD can co-occur with ADHD, depression and substance abuse, and can often be associated with trauma and abuse, and with learning disabilities and cognitive impairment. DBD can be seen with traumatic brain injury and can be associated with autism spectrum disorders.‘ He peppered his slides with stories.

The DSM V (Diagnostic manual) adds intermittent explosive disorder, pyromania and kleptomania to a group of disorders including oppositional defiant disorder (ODD), conduct disorder (CD), behavior disorder non-specific (BBD-NOS), and ADHD which it often co-occurs with, as more of a neuro-developmental issue. There are three types of manifestations of this class of disorders which is characterized by low frustration tolerance and volitional acts of disruption: 1. angry, irritable mood, 2. argumentative/defiant behavior, and 3. vindictiveness. Conduct disorder might include aggression to people and animals, destruction of property, deceitfulness, theft, and serious rule violations. [Slides covered them all.]

Disruptive behavior treatment should include parent family considerations, individual interventions and/or school based interventions. This might include functional family therapy FFT, intensive home based behavior therapy IHBT, or multi-systemic therapy MST. There has often been a stigma to having parental involvement in the counseling process because fear of blame, fear of (perceived threat of) children service involvement, and previous counseling may not have worked out or been followed through with. Parents disagree with the diagnosis of the clinician 80% of the time. It’s important to identify and build on small victories first: the client is no longer punching holes in the wall, vs. he/she stopped drugs and has resumed going to school regularly. (Which might be the next step.) The adolescent often uses threats like suicide, failure in school, to control an outcome.

Guillot-Miller, the second speaker said the research shows that character-based programs work and there needs to be more advocacy for school counseling across school levels which focus on students unique qualities; not a cookie cutter approach. It’s important to assess where the student is at in the change process. ‘Every effective intervention involves parent and teachers.’ Have a client come up with reasons why they need to change. Use motivational interviewing. Key features of effective interventions: well enforced, school-wide behavior code, social skills training, adult praise or encouragement, reinforcement of good behavior, time- out, and contingencies & response cost (Walker, Ramsey & Gresham ’04).

Newman, the third speaker, stressed collaborative problem solving, that often challenging behaviors show lagging cognitive skills and point to unsolved problems. Disruptive behavior is not a function of poor parenting as is so widely assumed. This circumvents the parents blame trap in moving a teen from plan A to B in a conceptual model where A =imposing will, default and function of parenting/power and B=empathy, define and inviting change. By the full room workshop, this was clearly a ‘hot’ topic for school counselors and counseling practitioners alike.

Speaker book recommendation ‘Treating the Tough Adolescent’ by Scott Sells PhD.
Read more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2538459/
There’s a guide for parents: http://www.barnesandnoble.com/w/treating-the-tough-adolescent-scott-p-sells/1110902643

Sells has also written “Three Main Reasons Why Good Kids Go Bad And How to Stop it!’
http://www.strugglingteens.com/archives/2003/5/goodkidsbad.html
MacMillan has an excerpt from: “Parenting your Out of Control Teenager”
http://us.macmillan.com/parentingyouroutofcontrolteenager/ScottSells

There’s also a curriculum, “Parenting with Love and Limits” PLL listed on SAMHSA’s registry of evidence-based practices at http://www.gopll.com/

Workbooks: http://www.gopll.com/browsetheaisle.asp?did=46
Article: Journal of Juvenile Justice http://www.gopll.com/pdf/Journal%20of%20Juvenile%20Justice%20Article.pdf

[photo credit FilipEmanuel/Dreamstime 18447221 Angry Bully]

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About Communications

Communications and Social Media @ Sequel-Pomegranate Health Systems
This entry was posted in adolescent psychiatry, behavioral health, behavioral health disorders and tagged , , , , . Bookmark the permalink.

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