Disruptive Behaviors- Types & Managment.pptx

DISRUPTIVE BEHAVIORS By G. Lungu-MSc Student Supervisor: Mrs. Muntambo

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.

Intro cont..d • 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 on specific disruptive behaviors and its management.

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

Characteristics of disruptive behaviors • Excessive levels of activity: – Fidgeting, – squirming, and running around when inappropriate, – incessant talking.

Xristics cont..d • Distractibility and difficulty concentrating: – Makes careless mistakes cannot follow instructions, forgetful. – difficulty with peer interactions – temper tantrums, – physical aggression such as attacking other children, – excessive argumentativeness, – stealing, and other forms of defiance or resistance to authority.

Xristic cont..d • 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.

Xristics cont..d • Children with Conduct disorder 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.

Neurobiology • Neurotransmitters: – 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: ability to perform executive functions, e.g. analysis and reasoning, and in the cognitive alertness essential for processing stimuli and sustaining attention and thought (Hunt, 2006). • Dopamine: Play a role in sensory filtering, memory, concentration, controlling emotions, locomotor activity, and reasoning.

Types of disruptive behavioral disorders • (DSM-5) categorizes disruptive behavioral disorders into Disruptive, impulse control and conduct disorders which include: Oppositional defiant disorder (ODD), Conduct Disorders (CD), Antisocial Personality Disorder (APD), Intermittent Explosive Disorders (IED) and Impulse Control Disorder (pyromania and Kleptomania).

1. OPPOSITIONAL DEFIANT DISORDER (ODD): • defined by defiant behaviors which are persistent and willful. • emotional (resentful and irritable), behavioral (argues, angry, dislikes, authority) and cognitive (vindictive and spiteful). • 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 others.

ODD cont..d • Have difficulties in 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) – 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).

Xristics cont..d – 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.

Xistics cont..d • 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).

Xristics cont..d • 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. – Is often truant from school, beginning before age 13 years.

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.

Cont..d • 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) • 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.

6. Pyromania and kleptomania: • Pyromania – They 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.

Cont..d • 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.

Cont...d These disorders often first attract notice when they interfere with school performance or family and peer relationships, and frequently intensify over time.

Treatment • Goal: – The treatment is focused on behavior and not Pharmaceutical and include; cognitive behavioral therapy, social skills training, anger management and parent teaching(teaching parents how to respond)

• NOTE: medical treatment is considered in severe case.

Medical management • CNS Stimulants – Amphetamines (dextroamphetamine, methamphetamine, and mixtures): cause the release of nor epinephrine from central noradrenergic neurons. – At higher doses, dopamine may be released in the mesolimbic system. – Methylphenidate and dexmethylphenidate: block the reuptake of nor epinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extra neuronal space.

Med mgt cont..d • Side effects: restlessness, insomnia, headache, palpitations, weight loss, and suppression of growth in children (with longterm use), increased blood pressure, abdominal pain, anxiety, tolerance, and physical and psychological dependence.

Med mgt cont..d • 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.

Med mgt cont..d • 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).

• Dextroamphetamine sulfate (Adderall) 5– 60mg • Methamphetamine-5–25mg • Lisdexamphetamine-30–70mg • Methylphenidate (Ritalin)- 10–60mg • Atomoxetine0.5–1.4 mg/kg • Bupropion-3 mg/kg (ADHD); 100– 300(depression)

Nursing management • NURSING CARE PLAN

CONCLUSION • 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.

Concl cont..d • 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/healthissues/conditions/emotional-problems/Pages/Disruptive-BehaviorDisorders.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.