Attention Deficit Hyperactivity disorder

Conduct disorder (CD) can be viewed as an expansion of Oppositional Defiant Disorder (ODD).  Children with CD may exhibit behaviors similar to ODD, but when behaviors become more interfering and severe, CD is a more appropriate diagnosis. This behavior must cause significant impairment in one or more areas of social, occupational, or academic functioning.  The key difference between ODD and CD is the violation of basic rights of others or societal norms with a lack of concern, remorse, or empathy.  This can be seen as childhood-onset (before 10 years old) or adolescent-onset (after 10 years old).  For individuals 18 years of older, a differential diagnosis for consideration is Antisocial Personality Disorder.  

A minimum of three of the following characteristics must be present for at least 12 months (1 present within 6 months range) to qualify for a diagnosis of CD:

1. Aggression to people and/or animals that causes or threatens harm, such as bullying, initiating physical fights, cruelty to animals. 

2. Destruction of property such as fire-setting or deliberately ruining others’ belongings.

3. Deceitfulness or theft, such as shop-lifting, trespassing, or conning others.

4. Serious violations of rules, such as “cutting” school, breaking family rules, and running away from home.

What is Oppositional Defiant Disorder?

ODD is a childhood/adolescent disorder characterized as externalized behaviors that interfere with overall functioning. Three key aspects of ODD are irritable mood, hurtful behavior, and vindictiveness.  These are exhibited by aggression, arguing with authority figures, difficulty managing behavior, being intentionally noncompliant, refusing to comply with directions/rules, blaming others for misbehavior/mistakes, spitefulness, and becoming easily annoyed by others. 

All children are oppositional at times; however, the frequency and intensity of ODD behaviors are outside of normal developmental limits.  ODD is most commonly diagnosed in children ages 6-12 years old.  These behaviors must also occur at least once a week for a minimum of 6 months.     

ODD individuals are at risk for underdeveloped emotional regulation skills, low frustration tolerance, poor problem solving skills, difficulty adapting to new situations, and language development impairments.  Some protective factors in the home environment are supportive parenting, close supervision, warmth & nurturance, structure, reasonable expectations, extended family networks.  School protective factors include positive teacher relationships, non-threatening classroom environment, and friendships with pro-social peers.

What are the Symptoms of Oppositional Defiant Disorder?

1. Frequently arguing with adults and authority figures

2. Questioning rules in an insistent and demanding manner

3. Active defiance by refusing to comply with rules and adults’ requests

4. Speaking in a disrespectful manner to others; being mean when upset

5. Frequent temper tantrums

6. Frequent anger, irritability and being easily annoyed by others

7. Acting in a spiteful way to seek revenge or displaying a spiteful attitude

8. Difficulty getting along with others

9. Not taking responsibility for one’s actions; instead blaming others or the situation for their misbehavior

Common intervention approaches include tangible reward systems, clearly defined expectations/rules, and increased structure in non-structured situations, daily positive attention/praise, positive reinforcement, and home-school collaboration to improve the consistency in rules and expectations from one environment to another. 

What is Selective Mutism?

Selective Mutism is characterized by a consistent refusal to speak in specific situations, such as social engagements or school, in which there is an expectation for speaking. This disorder often leads to problems regarding social communication or educational and academic endeavors.

What are Symptoms of Selective Mutism?

Common symptoms among individuals with selective mutism include social isolation, negativism, mild oppositional behavior (particularly among children), excessive shyness, and fear of embarrassment in social situations. Children with this disorder often do not engage in speech within social interactions, but wills sometimes speak at home among immediate family members. This disorder is often associated with high social anxiety.

What is Separation Anxiety Disorder?

Separation Anxiety Disorder is a disorder that reflects developmentally excessive and inappropriate fear and/or anxiety regarding separation from those to whom the individual feels attached. This anxiety or fear is demonstrated by various recurrent behaviors that involve avoidance of separation from major attachment figures or significant anxiety when such separation does occur.

What are the Symptoms of Separation Anxiety?

Common symptoms of separation anxiety disorder include excessive distress when anticipating or experiencing separation from attachment figures, persistent nightmares involving the idea of separation, excessive worry about losing major attachment figures, and persistent refusal to go out due to fear of separation.

Children with separation anxiety disorder often experience generalized anxiety disorder and specific phobia. Adults with separation anxiety may also suffer from specific phobia, PTSD, panic disorder, generalized anxiety disorder, social anxiety disorder, agoraphobia, obsessive-compulsive disorder, personality disorders, depressive and bipolar disorders.