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Treatments for Disruptive Behavior Disorders

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Despite the high rates of Disruptive Behavior Disorders in the general population, surprisingly little research has been conducted into effective treatments for this condition.

Early Detection and Intervention

One important principle is that interventions for these disorders tend to be more effective the earlier on in the child's life that they are started [ref, ref]. This is because unlearning problematic behaviors is easier when they have not been going on for prolonged periods of time. Identifying children with these conditions in a timely fashion and referring them for prompt evaluation and treatment is thus essential. School teachers are likely to be in a position to identify these children in cases where parents do not recognize the problem.

Individual Therapy

There seems to be a general consensus among experts that individual therapy for a child or adolescent with a Disruptive Behavior Disorder is usually not enough to bring a significant change in their symptoms [ref, ref]. Rather, involving the child's other key figures of authority and guidance, such as parents and teachers, is far more effective. This may be the case because the disruptive behaviors characteristic of these conditions are often used by the child or adolescent to make a statement or get a certain reaction from others, and so having others respond in consistent and effective ways can help to curb those behaviors.

Parent Management Training

Many parents of children with Disruptive Behavior Disorders find themselves at a loss when trying to handle these difficult behaviors. A common pattern is that they will tend to tolerate a considerable amount of unacceptable behaviors, often because they feel powerless to do anything about them, though at times - and usually unpredictably - they can go to the opposite extreme and react very harshly to their child's misbehaviors, which does not help either.

Parent Management Training has been shown to be an effective method for improving children's disruptive behaviors [ref, ref]. The goal of this sort of intervention is to teach parents the most effective ways of handling their child's misbehaviors. These methods are based on the following principles:

  • Good behaviors need to be encouraged and reinforced. This can be accomplished by first acknowledging when the child does these good behaviors, praising them for this, and also giving certain rewards and privileges, which should include fun one-on-one time with the parent.
  • Problematic behaviors need to be addressed with two approaches:
    • Parents should avoid playing into the child's disruptive behaviors by doing things that reinforce these behaviors. Some children learn that it pays to misbehave, because that is when they get the most attention from their parents (albeit negative attention), or because that is how their parents eventually yield to their demands. Parents thus need to learn not to give in to their children's demands in these situations, and to give the child more attention when they are being good than when they are misbehaving.
    • There also needs to be clear consequences for misbehaviors, which can include time-outs, loss of privileges, and punishments.
  • These techniques should become the parents' regular way of parenting. The only way these techniques will be effective is if they are done in a way that is regular, consistent, predictable, and immediate (meaning that the consequences of either good or bad behaviors are experienced right away).

Multimodal Interventions

For more difficult cases of Oppositional Defiant Disorder and Conduct Disorder, combining interventions at various levels tends to be the most effective route. This means including Parent Management Training, school-based interventions such as classroom social skills training and a playground behavior program, and ongoing communication between teachers and parents. These kinds of treatment programs can be expensive and require considerable organization, but some studies suggest that these are ultimately cost-effective ways of managing these conditions [ref, ref].

Medications for Disruptive Behavior Disorders

There are no medications that are known to target the core symptoms of Oppositional Defiant Disorder or Conduct Disorder, and thus medications are not recommended as an intervention in all cases. At most, there a certain medications that may be effective at reducing some of the more aggressive and impulsive behaviors that children with these conditions can perform.

Atypical Antipsychotics can help to curb these sorts of problematic behaviors [ref, ref]. Risperidone has the best evidence in this regard [ref]. Stimulants like Methylphenidate have also shown to be effective, though mainly in children who also suffer from ADHD [ref, ref], and there is the risk that these sorts of medications could be abused. A few studies have found Lithium to be effective, though this medication tends to cause considerable side-effects [ref].

 

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