Childhood Disorders: Attention-deficit and Disruptive Behavior Disorders
Attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD) and oppositional defiant disorder (ODD) form the attention-deficit and disruptive behavior disorders (AD-DBDs) in DSM-IV-TR (American Psychiatric Association, 2000). As a group, these are the most common disorders of childhood and among the most researched areas of childhood psychopathology. There is also in-creasing recognition that these disorders continue into adulthood.
Children with ADHD are challenged in their ability to mod-ulate impulsivity, hyperactivity and inattention. Some children, however, can present with either predominate hyperactivity or in-attention, the latter more likely to go undiagnosed since they are often less disruptive within the classroom. To establish the diag-nosis of ADHD, DSM-IV TR requires that children must have, be-fore the age of seven, at least six signs of hyperactivity/impulsivity and an equal number of signs demonstrating inattention. Children often are diagnosed after the age of seven, however, a carefully elicited history generally reveals symptoms of ADHD earlier in the child’s development that clearly distinguish them from their peers. Functional impairment must be present in at least two sec-tors of the child’s life. For younger children, problems at home and at school are the rule. Common symptoms include hyperactivity, as manifested by fidgetiness, excessive talking, inability to par-ticipate in leisure activities quietly, inability to remain seated in the classroom or social settings, frequent inappropriate running or climbing, Teachers and parents describe children with ADHD as “always on the go” or seem to be “driven by a motor”.
The essential feature of CD is a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate societal norms or rules are violated. Behaviors are categorized within the following four groups
· destruction of property;
· theft and or deceitfulness;
· serious violations of rules;
· aggression directed at animals and people.
Similar to ADHD, symptoms of CD are seen in more than one setting and cause significant impairment in functioning. The diagno-sis of CD requires that symptoms be present for at least one year, with one or more symptoms occurring within the previous six months. Adults with conduct problems, whose behavior does not meet criteriafor antisocial personality disorder, may have symptoms that meet cri-teria for CD and thus qualify for the diagnosis. Subtypes of CD are determined on the basis of age of onset. The childhood onset subtype is diagnosed in children who show at least one of the behaviors be-fore the age of 10 years, while the adolescent onset subtype is charac-terized by the absence of any CD behaviors before 10 years of age.
The essential feature of ODD is a recurrent pattern of neg-ativistic, defiant, disobedient and hostile behavior toward author-ity figures that persists for at least 6 months and results in social and academic impairment. Typical behaviors include excessive
· arguing with and disobeying adults;
· loss of temper;
· annoying others;
· blaming of others for poor behavior and mistakes
The rationale for grouping ADHD, CD and ODD is that simi-lar areas of difficulty are present in children with these disorders. Academic difficulties, poor social skills and overrepresentation of boys are among the shared characteristics. Further, the three disor-ders demonstrate a commonality of core symptoms, with impulsivity being prominent in all three conditions. Not surprisingly, there is a high degree of comorbidity among the three disorders. In part related to this, there has been extensive debate as to whether these conditions are truly distinct from each other. While there is now a consensus that ADHD and CD are separable diagnoses with distinct correlates and outcome, the relationship of ODD to both disorders is less clear.