Disruptive behavior disorders

Other Childhood Disruptive Disorders. The child with ADHD typically avoids schoolwork that taxes his/her attention. Difficulty completing work can quickly become a frustrating experience independent of one s age. A child with ADHD who complains about an assignment in many respects resembles the defiant refusal of a child with oppositional defiant disorder or conduct disorder. These disorders must be carefully distinguished from ADHD, but it is entirely possible that a child with ADHD may also have a comorbid disruptive behavior disorder. 

Mood Stabilizers. Lithium (Eskalith, Lithobid), valproic acid (Depakene), sodium valproate (Depakote), and carbamazepine (Tegretol) are most often used by psychiatrists to treat the bipolar disorders. These so-called mood stabilizers are also used to treat impulsivity and agitation in a variety of psychiatric disorders including dementia, certain personality disorders, and the disruptive behavior disorders of childhood. 

Starting Treatment in Children. The importance of an accurate diagnosis confirmed by obtaining information from multiple sources cannot be overstated. The mainstay of treatment for ADHD, psychostimulants, are less helpful for the other disruptive behavior disorders of childhood and may worsen the course of bipolar disorder in patients misdiagnosed with ADHD. 

When these measures have failed and impulsivity and aggression remain a problem, additional strategies are available. First, reconsider the diagnosis. Does the patient have bipolar disorder rather than ADHD Is there another disruptive behavior disorder in addition to or instead of ADHD Does (s)he have an impulse control disorder In these more severe cases, other medications such as atypical antipsychot-ics or mood stabilizers are often helpful. 

Geller, D.A., Biederman, J., Griffin, S., Jones, J., and Lefkowitz, T.R. (1996) Comorbidity of juvenile obsessive-compulsive disorder with disruptive behavior disorders. / Am Acad Child Adoles Psychiatry 35 1637-1646. 

Kruesi, M.J.P., Hibbs, E.D., Zahn, T.P., Keysor, C.S., Hamburger, S.D., Bartko, J.J., and Rapoport, J.L. (1992) A 2-year prospective follow-up study of children and adolescents with disruptive behavior disorders prediction by cerebrospinal fluid 5-hydroxyindoleacetic acid, homovanillic acid, and autonomic measures. Arch Gen Psychiatry 49 429 35. 

Kruesi, M.J.P., Rapoport, J.L., Hamburger, S., Hibbs, E., Potter, W.Z., Lenane, M., and Brown, G.L. (1990). Cerebrospinal fluid monoamine metabolites, aggtession, and impulsivity in disruptive behavior disorders of children and adolescents. Arch Gen Psychiatry 47 419 26. 

Stoff, D.M., Pasatiempo, A.P., Yeung, J., Cooper, T.B., Bridger, W.H., and Rabinovich, H. (1992) Neuroendocrine responses to challenge with dl-fenfluramine and aggression in disruptive behavior disorders of children and adolescents. Psychiatry Res 43 263-276. 

Although trazodone has not received an FDA indication for use in children and adolescents, it has enjoyed some success in the treatment of disruptive behavior disorders in this population. An aggressive 15-year-old male inpatient was treated with trazodone at a dosage of 200 mg/day, which resulted in decreased disruptive behavior. Following discharge from the hospital, trazodone was discontinued and the patient s violent behavior resumed. Upon return to his previous dose of 200 mg, the aggressive behavior again remitted (Fras,... 

Zubieta, J.K., and Alessi, N.E. (1992) Acute and chronic administration of trazodone in the treatment of disruptive behavior disorders in children. / Clin Psychopharmacol 12 346-351. 

Abramowicz, M., ed. (1990) Sudden Death in Children Treated with a Tricyclic Antidepressant. Med Lett Drugs Ther 32.53. Abramowitz, A.J. (1994) Classroom interventions for disruptive behavior disorders. Child Adolesc Psychiatr Clin North Am 3 343-360. 

Bauermeister, J., Canino, G., and Bird, H. (1994) Epidemiology of disruptive behavior disorders. Child Adolesc Psychiatr Clini North Am 3 177-194. 

Birmaher, B., McCafferty, J.P., Bellow, K.M., and Beebe, K.L. (2000b) Comorbid ADHD and disruptive behavior disorders as predictors of response in adolescents treated for major depression. Presented at the American Psychiatric Association Annual Meeting, Chicago, IL. 

Managing disruptive behavior disorders in juvenile OCD also presents challenges, because, as with tics and OCD, the pharmacological approaches to ADHD and OCD diverge. These children with OCD are more globally impaired than non-comorbid children and carry the full psychoeducational burden of both dis-... 

Recently, Janssen Pharmaceutica launched several studies of risperidone in children with borderline IQ or MR and a diagnosis of disruptive behavior disorder (usually oppositional defiant disorder or conduct disorder). To be admissible into the study, subjects needed to be 5 to 12 years old, inclusive, and score above 24 on the Conduct Problem subscale of the Nisonger Child Behavior Rating Form (NCBRF). One 6-week acute trial (n = 118) was conducted in the United States (Aman et al., in press), whereas the other n = 110) was based in Canada (Snyder et al., in press). The findings of the two studies were virtually identical, with... 

Snyder, R., Turgay, A., Aman, M.G., Binder, C., Fisman, S., Carroll, A., and The Risperidone Conduct Study Group. (In press) Effects of risperidone on conduct and disruptive behavior disorders in children with subaverage IQs. / Am Acad Child Adoles Psychiatry. 

There were no significant adverse effects on growth or sexual maturation in a retrospective study based on a sample of 700 children aged 5-15 years who had been taking risperidone (0.02-0.06 mg/kg/day) for 11 or 12 months because of disruptive behavior disorders (1035). 

Along with conduct disorder and oppositional defiant disorder, ADHD was originally considered one of the disruptive behavior disorders in the DSM-III-R (APA, 1987). In the DSM-IV, an attempt is made to separate ADHD from the other two disruptive disorders, at least when ADHD manifests itself primarily as inattention, rather than hyperactivity. The DSM committee found that while disruptive behavior and attention problems often occur together, some ADHD children are not hyperactive and disruptive (Fasnacht, 1993). 

The DSM-IV does not discuss the definition of disruptive behavior disorder. The DSM-III-R stated that DBD children are characterized by behavior that is socially disruptive and is often more distressing to others than to the people with the disorders. The so-called illness consists of being disruptive to the lives of adults—a definition tailored for controlling children, while exonerating adults. 

Breeding, J. (1996). The udldest colts make the best ponies The truth about Ritalin, ADHD, and other disruptive behavior disorders. Austin, TX Bright Books. 

Risperidone has been used in children with severe disruptive behavior disorders (SEDA-27, 62 SEDA-28, 74). In 107 children, aged 5-12 years (86 boys) who entered a 48-week open study and received risperidone (mean dose... 

Social workers and other mental health professionals frequently get referrals of children with disruptive behavior disorders diagnosed with either... 

The diagnosis of ADHD frequently occurs when other disruptive behavior disorders are diagnosed. As in many other diagnoses in pediatric psychiatry, the ambiguities involved in ADHD diagnosis mean that estimates of prevalence are loose at best. The high end of prevalence estimates is 10 percent, the low end 3 percent. 

Observational studies In an open study, 232 children and adolescents (mean age 11 years) with disruptive behavioral disorders were followed during 1 year in an extension period with risperidone, having been previously randomized to risperidone... 

Haas M, Karcher K, Pandina GJ. Treating disruptive behavior disorders with risperidone a 1-year, open-label safety study in children and adolescents. J Child Adolesc Psychopharmacol 2008 18(4) 337-45. 

There is considerable evidence that children s schooling plays a critical role in their adjustment. For example, children evidencing disruptive behavior disorders are at high risk for poor school adjustment (Willcutt Pennington, 2000), and low participation in academic tasks is predictive of oppositional behavior (Finn Cox, 1992). Intensive educational interventions have been shown to reduce aggression as a function of increased achievement (Kellam et al., 1998). In addition, in a study of urban, African American families, academic self-esteem and academic achievement were protective factors for negative life events and for youth perceptions of family conflicts (Spencer et al., 1993). Thus, success in school is clearly associated... 

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