1. Disruptive Behavioral Disorders Fatima AlHaidar Professor, Child & Adolescent Psychiatrist KSU

2. Oppositional Defiant Disorder

3. Definition: Enduring pattern of negativistic, hostile, and defiant behaviors in the absence of serious violations of social norms or of the rights of others.

4. Epidemiology: Developmentally normal in early childhood and adolescence ( establish autonomy, identity, & inner standards and control ) Prevalence of 2-16 % Boys ≥ Girls

5. Etiology: Temperamental predisposition Psychological theories … …unresolved conflicts …learned behavior Parental factors Social factors Environmental factors

6. Clinical features: Temper outbursts Active refusal to comply with rules Deliberately annoy others Blame others for their mistakes Present at home Cause distress to others Interpersonal difficulties Poor school performance

7. Assessment: Nature & severity Situation & circumstances Who are around ? Parental personality and skills Parent- child relationship. Charts

8. Management: Parental counseling Behavioral modification programs Cognitive behavioral approach Family therapy

9. Outcome: Better prognosis if associated with clear stress 2/3 continues to have the diagnosis during school years Many children with ODD develop CD in adolescence

10. Conduct Disorder

11. Definition: Enduring set of behaviors, characterized by aggression and violation of the rights of others.

12. Epidemiology: Prevalence of 10% Boys : girls 4-12 : 1 Parents with antisocial personality and alcoholism Socioeconomic factors

13. Etiology: Parental factors Sociocultural factors Child abuse & maltreatment CNS dysfunction & damage Temperament

14. Clinical features: Aggression to people & animals Destruction of property & stealing Deceitfulness or theft Serious violations of rules Persistent lying Fire setting Sexual behavior Frequent truancy Tobacco smoking & other substance abuse History of deprivation Family disharmony

15. Comorbidity: ADHD Depression Learning disorders

16. Assessment: Nature & severity Circumstances Family

17. Management: Cognitive behavioral therapy Problem-solving skills training Parent management training Family therapy Medication Community-based centers Residential placement Court reports

18. Outcome: Varies with the nature and extent of antisocial behavior Poor with parental criminality Associate with antisocial personality, substance abuse, & mood disorders Better prognosis with mild form, absence of comrbidity and normal intelligence