Disruptive Behave-management.docx

CLASSROOM LESSON PLAN COURSE:

MENTAL HEALTH AND PSYCHIATRIC NURSING

TOPIC:

DISRUPTION BEHAVIOURS

AUDIENCE:

3RD YEARS QUARTERED STUDENTS

CLASS SIZE:

18

VENUE:

ROOM 3

DATE :

28/ 03/2019

TEACHING METHOD:

LECTURE/DISCUSSION

AUDIO VISUAL AIDS:

WHITE BOARD, BOARD MARKER, PROJECTOR, LAPTOP

DURATION:

1 HOUR

SUPERVISOR:

MRS. MUNTAMBO

STUDENT/TEACHER:

LUNGU GABRIEL

COMPUTER NUMBER:

2018242806

Introduction Disruptive behaviors of relatedness are a common phenomenon among children but can as well be observed in adults. They are characterized by poorly controlled, impulsive, acting out behavior in situations where self control is expected. The ability to control one’s behavior depends on a number of skills developed overtime. Those who have not developed these skills, who continue to be disruptive, impulsive and aggressive, are at high risk for school adjustment difficulties, learning problems and peer rejection. Among the disruptive behavior disorders, the most important ones are Attention Deficit Hyperactive disorder and conduct disorder.

General objective At the end of the lecture/discussion, students should gain knowledge and understanding and be able to define disruption of relatedness and describe the positive relationships.

`Specific objectives At the end of the lecture/discussion; students should be able to: 1. Describe the characteristics of Disruptive Behaviors. 2. Review the neurobiology of disruptive behavior 3. Mention the conditions associated with disruptive behaviors 4. State the treatment goals in disruptive disorders 5. Discuss the management of disruptive behaviors

Specific Content Ava objectives Describe the According DSM 5. Disruptive behaviors are characterized by the LCD/

Teachers activities Explaining,

Students activities Listening,

Evaluation What

are

the

characteristics following.

Laptop

of disruptive Excessive levels of activity: behaviors.



Fidgeting,

squirming,

and

running

around

when

Distractibility and difficulty concentrating: Makes careless mistakes cannot follow instructions, forgetful. 

May have difficulty with peer interactions



Others behaviors include, temper tantrums, physical aggression such as attacking other children, excessive argumentativeness, stealing, and other forms of defiance or resistance to authority.



Children with conduct disorder engage in severe repeated acts of aggression that can cause physical harm to themselves and others and frequently violate the rights of others.

Children

with

conduct

disorder

and taking notes, characteristics of

answering

asking

and disruptive

questions.

answering questions.

inappropriate, incessant talking. 

asking

usually

have

behaviors

characterized by aggression to persons or animals, destruction of property, deceitfulness or theft, and multiple violations of rules, such as truancy from school. These behavior patterns cause distinct difficulties in school life as

behaviors?

well as in peer relationships. Review

the Neurotransmitters

neurobiology

The major neurotransmitters implicated in the pathophysiology of

LCD/

Explaining,

Laptop

asking

Listening,

What is the role

and taking notes, of

of disruptive ADHD are dopamine, nor epinephrine, and possibly serotonin.

answering

asking

behaviors

questions.

answering

in

questions.

behaviors

Dopamine and nor epinephrine appear to be depleted in ADHD. Serotonin in ADHD has been studied less extensively, but recent evidence suggests that it also is reduced in children with ADHD. Neurotransmitter Functions Nor epinephrine is thought to play a role in the ability to perform executive functions, such as analysis and reasoning, and in the cognitive alertness essential for processing stimuli and sustaining attention and thought (Hunt, 2006). Dopamine is thought to play a role in sensory filtering, memory, concentration, controlling emotions, locomotor activity, and reasoning. Deficits in norepinephrine and dopamine have both been implicated in the inattention, impulsiveness, and hyperactivity associated with ADHD. Serotonin appears to play a role in ADHD, although possibly less significant than norepinephrine and dopamine. It has been suggested that alterations in serotonin may be related to the disinhibition and impulsivity observed in children with ADHD.

and neurotransmitters disruptive

It may play a role in mood disorders, particularly depression, which is a common Comorbid disorder associated with ADHD. Specific Content Ava objectives Mention the Diagnostic and statistical manual of mental disorders 5 (DSM-5) LCD/

Teachers activities Explaining,

conditions

categorizes disruptive behavioral disorders into Disruptive, impulse Laptop

asking

associated

control and conduct disorders which include:

answering

asking

questions.

answering

disruptive

questions.

behaviors.

with disruptive

Oppositional defiant disorder (ODD), Conduct Disorders (CD),

behaviors

Antisocial Personality Disorder (APD), Intermittent Explosive Disorders (IED) and Impulse Control Disorder (pyromania and Kleptomania). These conditions are characterized with Impulse behaviors and lack of self control. They begin in Childhood and persist into adulthood. 1. OPPOSITIONAL DEFIANT DISORDER (ODD): Are defined by defiant behaviors which are persistent and willful. Its defining patterns are emotional (resentful and irritable), behavioral (argues, angry, dislikes, authority) and cognitive (vindictive and spiteful). They have enduring patterns of negativistic, disobedient, and hostile behavior toward authority figures, as well as an inability to take responsibility for mistakes, leading to placing blame on

Students activities Listening,

Evaluation Mention

the

and taking notes, conditions and associated

with

others. Children with this disorder frequently argue with adults and become easily annoyed by others, leading to a state of anger and resentment. They may have difficulty in the classroom and with peer relationships, but generally do not resort to physical aggression or significantly destructive behavior. These symptoms must be present for more than 6 months and must disrupt social interactions. 2. CONDUCT DISORDER (CD) This condition is characterized by all the behaviors of ODD plus aggressive behaviors towards people and animals. Such individuals might destroy property, steal things and hurt pets. Aggression to People and Animals 

Often bullies, threatens, or intimidates others.



Often initiates physical fights.



Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, and gun).



Has been physically cruel to people.



Has been physically cruel to animals.



Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).



Has forced someone into sexual activity.

Destruction of Property 

Has deliberately engaged in fire setting with the intention of causing serious damage.



Has deliberately destroyed others’ property (other than by fire setting).

Deceitfulness or Theft 

Has broken into someone else’s house, building, or car.



Often lies to obtain goods or favors or to avoid obligations (i.e., “cons” others).



Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering: forgery).

Serious Violations of Rules 

Often stays out at night despite parental prohibitions, beginning before age 13 years.



Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period.

 The

Is often truant from school, beginning before age 13 years. disturbance

in

behavior

causes

clinically

significant

impairment in social, academic, or occupational functioning. 3. ANTISOCIAL BEHAVIOR (AB)



They destroy property, steal things and hurt pets.

There are two types: 

Childhood onset: start below 10 years.



Adulthood onset: 10-18 years



The earlier the onset, the more SEVERE the problem.

4. ANTISOCIAL PERSONALITY DISORDER (APD) 

They disregards: moral values and societal norms



They lack empathy and impulse control: they hurt others, aggressive, will break laws. They exalt themselves as sociopath or psychopath.



They are often in prison, substance abusers. Do not show remorse or responsibility.

WARNING:

THEY

CAN

BE

CHARMING

AND

MANIPULATIVE. DIAGNOSIS: must be above 18 years old and must have a conduct disorder. 5. INTERMITTENT EXPLOSIVE DISORDER (IED) This disorder is characterized by recurrent explosive out busts which are brief and spontaneous, intense anger, violence, response to real or perceived provocation, out of proportion. Diagnosis: A child should be older than 6 years old and should occur twice a week for 3 months with damage.

Pyromania and kleptomania: Pyromania: 

They are purposefully and repetitively start fires but they are not Arsonists.



They are motivated by destruction and power. Fire is happiness; they hang around fire stations and enjoy playing with fire. It driven by compulsion.

Kleptomania: 

They have strong impulse to steal.



They steal not out of need.



Theft is pleasurable and a sense of relief.



They steal things that have no value as long as they have stolen something for pleasure and relief.

These disorders, which include Oppositional Defiant disorder (ODD), conduct Disorder (CD) and Attention Deficit Hyperactive Disorder (ADHD), they often first attract notice when they interfere with school performance or family and peer relationships, and frequently intensify over time. Behaviors typical of disruptive behavior disorders can closely resemble ADHD particularly where impulsivity and hyperactivity are involved but ADHD, ODD, and CD are considered separate

conditions that can occur independently. About one third of all children with ADHD have coexisting ODD, and up to one quarter have coexisting CD. Children with both conditions tend to have more difficult lives than those with ADHD alone because their defiant behavior leads to so many conflicts with adults and others with whom they interact. State

the The treatment is focused on behavior and not Pharmaceutical and LCD/laptop Explains/asks Listen/take

Treatment goals

include; cognitive behavioral therapy, social skills training, anger

questions

notes/answer of treatment for

in management and parent teaching(teaching parents how to respond)

disruptive

What the focus

and

asks disruptive

questions.

behaviors?

Teachers

Students

Evaluation

activities

activities

LCD/

Explaining,

Listening,

Laptop

asking

NOTE: medical treatment is considered in severe case.

behaviors. Specific

Content

Ava

objectives Discus

the Medical management

management of Disruptive

Medications for ADHD CNS Stimulants



behaviors

answering

asking

and mixtures): cause the release of norepinephrine from

questions.

answering

may be released in the mesolimbic system. 

and taking notes, used

Amphetamines (dextroamphetamine, methamphetamine,

central noradrenergic neurons. At higher doses, dopamine

Methylphenidate

and

dexmethylphenidate:

block

the

reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these

Mention the drug

and disruptive

questions.

behaviors

in

monoamines into the extraneuronal space. 

Side effects include restlessness, insomnia, headache, palpitations, weight loss, and suppression of growth in children (with long-term use), increased blood pressure, abdominal pain, anxiety, tolerance, and physical and psychological dependence.

Others 

Atomoxetine:

selectively

inhibits

the

reuptake

of

norepinephrine by blocking the presynaptic transporter. Side effects include headache, upper abdominal pain, nausea and vomiting, anorexia, cough, dry mouth, constipation, increase in heart rate and blood pressure, and fatigue. 

Bupropion: inhibits the reuptake of norepinephrine and dopamine into presynaptic neurons. Side effects include headache, dizziness, insomnia or sedation, tachycardia, increased blood pressure, dry mouth, nausea and vomiting, weight gain or loss, and seizures (dose dependent).

CNS stimulants increase levels of neurotransmitters (probably norepinephrine, dopamine, and serotonin) in the CNS. They

produce CNS and respiratory stimulation, dilated pupils, increased motor activity and mental alertness, diminished sense of fatigue, and brighter spirits. The CNS stimulants include: 

Dextroamphetamine sulfate (Adderall) 5–60



Methamphetamine-5–25mg



Lisdexamphetamine-30–70mg



Methylphenidate (Ritalin)- 10–60mg



Atomoxetine0.5–1.4 mg/kg



Bupropion-3 mg/kg (ADHD); 100–300(depression)

Amphetamine mixtures, methylphenidate, and dexmethylphenidate. Their action in the treatment of ADHD is unclear. Atomoxetine inhibits the reuptake of norepinephrine, and bupropion blocks the neuronal uptake of serotonin, norepinephrine, and dopamine. The exact mechanism by which these drugs produce the therapeutic effect in ADHD is unknown.

Nursing management See the nursing care plan.

SUMMARY

We have looked at disruptive behaviors namely, Oppositional defiant disorder (ODD), Conduct Disorders (CD), Antisocial Personality Disorder (APD), Intermittent Explosive Disorders (IED) and Impulse Control Disorder (pyromania and Kleptomania).These conditions are characterized with Impulse behaviors and lack of self control. They begin in Childhood and persist into adulthood. They are very important to the mental health field as they define the current behavioral pattern. Teachers in school are at a critical point to identify and refer children with conditions to specialized therapeutic centres and placement in special schools. Therefore it is critical and important for the mental health personnel to acquaint themselves with skills to identify behaviors that characterize the abnormality.

REFERENCES Alloy, L., B et al. (2005). Abnormal psychology, Current Perspectives. 9th Edition, McGraw-Hill companies Inc. New York. American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. New school Library, 1000 wilson. Boulevard. Washington DC. Grizenko, N., & Pawliuk, N,. (1994). Risk and protective factors for disruptive behavior disorders in children. American Journal of Orthopsychiatry, 64(4), 534-544. Available at http://dx.doi.org/10.1037/h0079566 https://www.healthychildren.org/English/health-issues/conditions/emotional-problems/Pages/Disruptive-Behavior-Disorders.aspx accessed on 12/02/2019 at 11:15 Kay, J., & Tasma, A. (2006). Essential of Psychiatry. Jhn Willey and Sons Ltd. The atrium, Southern gate, Chichesta, West Sussex PO198SQ-England. ISBN: 13978-0-470-01854-5. McGraw-Hill Concise Dictionary of Modern Medicine. (2002). The McGraw-Hill Companies, Inc. Reddema, K., (2012). A guide to mental health and Psychiatric nursing, 2nd edition, Jaypee Brothers Medical publishers (p) Ltd, New Delhi. Sadock, et al, (2007). Kaplan & Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry2007, Copyright  Lippincott Williams & Wilkins. Townsend, M, C., (2009). Psychiatric Mental Health Nursing, Concepts of care in the evidence based practice.6 th edition.F.A. company. Philadelphia. ISBN: 13:978-0-8036-1917-3. -