Topic:

Behaviour Difficulties/Disorders of Young

People
Muhammad Umer Azim
M.A. English, MA ELT
1
Behaviour Difficulties/Disorders of Young People
In early industrialised countries over the last 50 years, the physical health of children has
improved sustantially, although there are differences et!een socio"economic groups.
#arado$ically, over the same period it appears that their overall mental health has
deteriorated. %epression, conduct disorders, eating disorders, suicidal ehaviour and
sustance misuse have all increased &'utter and (mith 1))5*.
The ehaviour of young people, oth !ithin school and in !ider society, has een a topic
of much deate over the past decade. It has een the focus for a range of recent
developments in policy and legislation.
%isruptive +ehaviour %isorder is an e$pression used to descrie a set of e$ternalising
negativistic ehaviours that co"occur during childhood. There are t!o sugroups of
e$ternalising ehaviours,
-ppositional %efiant disorder &-%%*
.onduct %isorder &.%*
Treatment for -ppositional %efiant and .onduct %isorder at the clinic is ased on the
premise that these ehaviours are the result of a comination of a metaolic dysfunction
and environmental factors.
-##-(ITI-/AL %E0IA/T %I(-'%E' &-%%*
American #sychiatric Association defines oppositional defiant disorder &-%%* as a
recurrent pattern of negativistic, defiant, disoedient, and hostile ehavior to!ard
authority figures that persists for at least 1 months.

+ehaviors included in the definition are the follo!ing,
losing one2s temper
arguing !ith adults
actively defying re3uests
refusing to follo! rules
delierately annoying other people
laming others for one4s o!n mista5es or misehavior
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eing touchy, easily annoyed or angered, resentful, spiteful, or vindictive.
-%% is usually diagnosed !hen a child has a persistent or consistent pattern of
disoedience and hostility to!ard parents, teachers, or other adults. The primary
ehavioral difficulty is the consistent pattern of refusing to follo! commands or re3uests
y adults.

.hildren !ith -%% often are
stuorn
test limits and push oundaries
easily annoyed
lose their temper
argue !ith adults
refuse to comply !ith rules and directions
lame others for their mista5es.
These ehaviors cause significant difficulties !ith family and friends, and the
oppositional ehaviors are the same oth at home and in school. (ometimes, -%% may
e a precursor of a conduct disorder.

'is5 factors for teen ehavior prolems include,
0amily conflict
Academic failure in elementary school
0riends !ho engage in alcohol and drug use, delin3uent ehavior, violence, or
other prolem ehaviors
#eer re7ection
0amily history of a prolem ehavior
0avorale parental attitudes to prolem ehavior
8itnessing family violence
0amily instaility, including economic stress, parental mental illness, harshly punitive
ehaviors, inconsistent parenting practices, multiple moves, and divorce may also
contriute to the development of oppositional and defiant ehaviors.

Drug use
This ecomes mar5edly more common during the adolescent years. In England and
8ales half of all 11 to 1) year"olds have tried drugs. (ince 1)9: the prevalence of drug
use among 1; year"olds has increased fivefold, and eightfold amongst 15 year"olds.
(Policy Action Team 12, 2000)
Depression
There is a pronounced rise in depression among many young people during adolescence.
This is possily lin5ed to hormonal changes !hich <s!itch on2 depressive disorders and
to the emotional upset related to ma7or life changes. In addition, there is thought to e a
lin5 et!een depression and adolescent crises in self"concept and identity.
;
(igns of depression include,
= A demeanour of unhappiness
= .hanges in eating>sleeping patterns
= 0eeling helpless>hopeless>unli5ed
= Everything seeming to e too much effort
= An inaility to concentrate
= .onstantly searching for ne! activities
= Irritating or aggressive ehaviour
= %angerous, ut e$citing>distracting, ris5 ta5ing activity &eg drugs>alcohol>dangerous
driving*.
%epression can e mas5ed in adolescence ecause any of the aove symptoms may occur
in a normal adolescent !ithout indicating depression. It is, therefore, difficult to detect.
%epression is more li5ely to e the cause of the ehaviour if,
= (everal of the signs are present
= They occur fre3uently
= They occur over a prolonged period of time
= They stand in the !ay of development or relationships
= They cause e$treme suffering to the young person.
.-/%?.T %I(-'%E'
.onduct disorder ehaviours are categori@e into four main groupings, &a* aggressive
conduct that causes or threatens physical harm to other people or animals, &* non"
aggressive conduct that causes property loss or damage, &c* deceitfulness or theft, and &d*
serious violations of rules. .onduct %isorder consists of a repetitive and persistent pattern
of ehaviours in !hich the asic rights of others or ma7or age"appropriate norms or rules
of society are violated. Typically there !ould have een three or more of the
follo!ing ehaviours in the past 16 months, !ith at least one in the past 1 months,
Aggression to people and animals
often ullies, threatens, or intimidates others
often initiates physical fights
has used a !eapon that can cause serious physical harm to others &e.g.,
a at, ric5, ro5en ottle, 5nife, gun*
has een physically cruel to people
has een physically cruel to animals
has stolen !hile confronting a victim &e.g., mugging, purse snatching,
e$tortion, armed roery*
has forced someone into se$ual activity
Destruction of property
A
has delierately engaged in fire setting !ith the intention of causing
serious damage
has delierately destroyed others4 property &other than y fire setting*
%eceitfulness or theft
has ro5en into someone else4s house, uilding, or car
often lies to otain goods or favours or to avoid oligations &i.e.,
BconsB others*
has stolen items of nontrivial value !ithout confronting a victim &e.g.,
shoplifting, ut !ithout rea5ing and enteringC forgery*
(erious violations of rules
often stays out at night despite parental prohiitions, eginning efore
age 1; years
has run a!ay from home overnight at least t!ice !hile living in
parental or parental surrogate home &or once !ithout returning for a
lengthy period*
is often truant from school, eginning efore age 1; years
(utypes of .onduct %isorder
There are t!o sutypes of conduct disorder, and their diagnosis differs primarily
according to the nature of the presenting prolems and the course of their development.
The first, childhood"onset type, is defined y the onset of one criterion characteristic of
conduct disorder efore age 10. .hildren !ith childhood"onset conduct disorder are
usually male, and fre3uently display physical aggressionC they usually have distured
peer relationships, and may have had oppositional defiant disorder during early
childhood. These children usually meet the full criteria for conduct disorder efore
puerty, they are more li5ely to have persistent conduct disorder, and are more li5ely to
develop adult antisocial personality disorder than those !ith the adolescent"onset type
&American #sychiatric Association, 1))A*.
The second, the adolescent"onset type, is defined y the asence of conduct disorder prior
to age 10. .ompared to individuals !ith the childhood"onset type, they are less li5ely to
display aggressive ehaviours. These individuals tend to have more normal peer
relationships, and are less li5ely to have persistent conduct disorders or to develop adult
antisocial personality disorder. The ratio of males to females is also lo!er than for the
childhood"onset type &American #sychiatric Association, 1))A*.
Severity of symptoms
.onduct disorder is classified as BmildB if there are fe!, if any, conduct prolems in
e$cess of those re3uired for diagnosis and if these cause only minor harm to others &e.g.,
lying, truancy and rea5ing parental rules*. A classification of BmoderateB is applied
5
!hen the numer of conduct prolems and effect on others are intermediate et!een
BmildB and BsevereB. The BsevereB classification is 7ustified !hen many conduct prolems
e$ist !hich are in e$cess of those re3uired for diagnosis, or the conduct prolems cause
considerale harm to others or property &e.g., rape, assault, mugging, rea5ing and
entering* &American #sychiatric Association, 1))A*.
#revalence of .onduct %isorder.
According to research cited in #helps D Mc.lintoc5 &1))A*, 1E of children in the ?nited
(tates may have conduct disorder. The incidence of the disorder is thought to vary
demographically, !ith some areas eing !orse than others. 0or e$ample, in a /e! For5
sample, 16E had moderate level conduct disorder and AE had severe conduct disorder.
(ince prevalence estimates are ased primarily upon referral rates, and since many
children and adolescents are never referred for mental health services, the actual
incidences may !ell e higher &#helps D Mc.lintoc5, 1))A* .
.ourse of .onduct %isorder
The onset of conduct disorder may occur as early as age 5 or 1, ut more usually occurs
in late childhood or early adolescenceC onset after the age of 11 years is rare &American
#sychiatric Association, 1))A*. The results of research into childhood aggression have
indicated that e$ternalising prolems are relatively stale over time. 'ichman and
colleagues for e$ample, found that 1:E of children !ho displayed e$ternalising prolems
at age ; !ere still aggressive at age 9 &'ichman, (tevenson, D Graham, 1)96*. -ther
studies have found staility rates of 50":0E. Ho!ever, these staility rates may e higher
due to the elief that the prolems are episodic, situational, and li5ely to change in
character &Loeer, 1))1*.
Age of onset of -%% seems to e associated !ith the development of severe prolems
later in life, including aggressiveness and antisocial ehaviour. Ho!ever, not all conduct
disordered children have a poor prognosis. (tudies suggest that less than 50E of the most
severe cases ecome antisocial as adults. /evertheless, the fact that this disorder
continues into adulthood for many people conveys that it is a serious and life"long
dysfunction &8ester"(tratton D %ahl, 1))5*.
8hile not all -%% children develop conduct disorder, and not all conduct disorder
children ecome antisocial adults there are certain ris5 factors that have een sho!n to
contriute to the continuation of the disorder. The ris5 factors identified includeC an early
age of onset &preschool years*, the spread of antisocial ehaviours across settings, the
fre3uency and intensity of antisocial ehaviours, the forms that the antisocial ehaviours
ta5e, having covert ehaviours at an early age and also particular parent and family
characteristics. Ho!ever, these ris5 factors do not fully e$plain the comple$ interaction
of variales involved in understanding the continuation of .onduct %isorder in any one
individual.
1
.auses of .onduct %isorder
There is evidence from research into causes of conduct disorders that indicates that
several iological and environmental factors may contriute to the development of the
disorder.
Neurological Dysregulation
The high co"moridity rate of .onduct %isorder !ith A%H%, Tourettes syndrome and
other disorders 5no!n to e due to neurological dysregulation suggests that .onduct
%isorder may e a co"manifestation of the same underlying dysregulation. Although there
are no studies to our 5no!ledge, !hich have directly investigated the neurological asis
for conduct disorder, there is ample clinical evidence indicating that !hen treating A%H%
!ith /eurotherapy, and /utrient supplementation, .onduct %isorder aates. It appears
that /eurotherapy may address the underlying dysregulation and facilitate clinical
treatment using cognitive and ehavioural interventions. More research is needed in this
area to determine !hether /eurotherapy is directly responsile for this aatement or
!hether the resultant improvement in attention, and reduction in hyperactivity promotes
etter self image !hich in turn improves ehaviour.
Child Biological Factors
.ognitions may also influence the development of conduct disorder. .hildren !ith
conduct disorder have een found to misinterpret or distort social cues during interactions
!ith peers. 0or e$ample, a neutral situation may e construed as having hostile intent.
0urther, children !ho are aggressive have een sho!n to see5 fe!er cues or facts !hen
interpreting the intent of others. .hildren !ith conduct disorder e$perience deficits in
social prolem solving s5ills. As a result they generate fe!er alternate solutions to social
prolems, see5 less information, see prolems as having a hostile asis, and anticipate
fe!er conse3uences than children !ho do not have a conduct disorder &8ester"(tratton
D %ahl, 1))5*.
School-elated Factors
A idirectional relationship e$ists et!een academic performance and conduct disorder.
0re3uently children !ith conduct disorder e$hiit lo! intellectual functioning and lo!
academic achievement from the outset of their school years. In particular, reading
disailities have een associated !ith this disorder, !ith one study finding that children
!ith conduct disorder !ere at a reading level 69 months ehind normal peers &'utter,
Ti@ard, Fule, Graham, D 8hitmore, 1):1*.
In addition, delin3uency rates and academic performance have een sho!n to e related
to characteristics of the school setting itself. (uch factors as physical attriutes of the
school, teacher availaility, teacher use of praise, the amount of emphasis placed on
individual responsiility, emphasis on academic !or5, and the student teacher ratio have
een implicated &8ester"(tratton D %ahl, 1))5*.
:
!arent !sychological Factors
It is 5no!n that a child4s ris5 of developing conduct disorder is increased in the event of
parent psychopathology. Maternal depression, paternal alcoholism and>or criminalism
and antisocial ehaviour in either parent have een specifically lin5ed to the disorder.
There are t!o vie!s as to !hy maternal depression has this effect. The first considers that
mothers !ho are depressed misperceive their child4s ehaviour as malad7usted or
inappropriate. The second considers the influence depression can have on the !ay a
parent reacts to!ard misehaviour. %epressed mothers have een sho!n to direct a
higher numer of commands and criticisms to!ards their children, !ho in turn respond
!ith increased noncompliance and deviant child ehaviour. 8ester"(tratton and %ahl
suggested that depressed and irritale mothers indirectly cause ehaviour prolems in
their children through inconsistent limit setting, emotional unavailaility, and
reinforcement of inappropriate ehaviours through negative attention &8ester"(tratton D
%ahl, 1))5*.
Familial Contri"utions
Divorce# Marital Distress# and $iolence
The inter"parental conflicts surrounding divorce have een associated !ith the
development of conduct disorder. Ho!ever, it has een noted that although some single
parents and their children ecome chronically depressed and report increased stress levels
after separation, others do relatively !ell. 0orgatch suggested that for some single
parents, the events surrounding separation and divorce set off a period of increased
depression and irritaility !hich leads to loss of support and friendship, setting in place
the ris5 of more irritaility, ineffective discipline, and poor prolem solving outcomes.
The ineffective prolem solving can result in more depression, !hile the increase in
irritale ehaviour may simultaneously lead the child to ecome antisocial.
More detailed studies into the effects of parental separation and divorce on child
ehaviour have revealed that the intensity of conflict and discord et!een the parents,
rather than divorce itself, is the significant factor. .hildren of divorced parents !hose
homes are free from conflict have een found to e less li5ely to have prolems than
children !hose parents remained together ut engaged in a great deal of conflict, or those
!ho continued to have conflict after divorce. 8ester noted that half of all those children
referred to their clinic !ith conduct prolems !ere from families !ith a history of marital
spouse ause and violence.
In addition to the effect of marital conflict on the child, conflict can also influence
parenting ehaviours. Marital conflict has een associated !ith inconsistent parenting,
higher levels of punishment !ith a concurrent reduction in reasoning and re!ards, as !ell
as !ith parents ta5ing a negative perception of their child4s ad7ustment.
9
Family Adversity and %nsularity
Life stressors such as poverty, unemployment, overcro!ding, and ill health are 5no!n to
have an adverse effect on parenting and to e therefore related to the development of
conduct disorder. The presence of ma7or life stressors in the lives of families !ith conduct
disordered children has een found to e t!o to four times greater than in other families.
Mothers4 perception of the availaility of supportive and social contact has also een
implicated in child contact disorder. Mothers !ho do not elieve supportive social
contact is availale are termed BinsularB and have een found to use more aversive
conse3uences !ith their children than non"insular mothers &8ester"(tratton D %ahl,
1))5*
!arent Child %nteractions
'esearch has suggested that parents of children !ith conduct disorder fre3uently lac5
several important parenting s5ills. #arents have een reported to e more violent and
critical in their use of discipline, more inconsistent, erratic, and permissive, less li5ely to
monitor their children, as !ell as more li5ely to punish pro"social ehaviours and to
reinforce negative ehaviours. A coercive process is set in motion during !hich a child
escapes or avoids eing criticised y his or her parents through producing an increased
numer of negative ehaviours. These ehaviours lead to increasingly aversive parental
reactions !hich serve to reinforce the negative ehaviours.
%ifferences in affect have also een noted in conduct disordered children. In general their
affect is less positive, they appear to e depressed, and are less reinforcing to their
parents. These attriutes can set the scene for the cycle of aversive interactions et!een
parents and children.
&ther Family Characteristics
+irth order and si@e of the family have oth een implicated in the development of
conduct disorder. Middle children and male children from large families have een found
to e at an increased ris5 of delin3uency and antisocial ehaviours.
!sychophysiological and 'enetic %nfluences
(tudies have found that neurological anormalities are inconsistently correlated !ith
conduct disorder &Ia@din, 1)9:*. 8hile there has een interest in the implication of the
frontal loe limic system partnership in the deficits of aggressive children, these
prolems may e the conse3uence of the increased li5elihood for children !ith conduct
disorder to e$perience ause and suse3uent head in7uries &8ester"(tratton D %ahl,
1))5*.
)
8hile t!in studies have found greater concordance of antisocial ehaviour among
mono@ygotic rather than di@ygotic t!ins, and adoption studies have sho!n that
criminality in the iological parent increases the li5elihood of antisocial ehaviour in the
child, genetic factors alone do not account for the development of the disorder.
(hat might drive un)anted "ehaviour*
.orrectly identifying !hat a ehaviour achieves for a young person !ill help in
understanding !hy a young person is ehaving in a certain !ay. If !e can find out !hat
triggers a ehaviour and !hat ma5es it so re!arding, !e may e ale to avoid responding
in !ays !hich reinforce the ehaviour. ?nderstanding the reasons ehind certain
ehaviour can also enale adults to provide opportunities to allo! young people to
achieve the same ends in more acceptale !ays. #sychologists such as Adler and
%rei5urs point to four main purposes for misehaviour. These are,
= (ee5ing attention
o Foung people misehave to attract attention to themselves
o (ome young people may elieve that they are more acceptale to others if they are
eing noticed.
= 'evenge
o Foung people may see5 revenge through spiteful or harmful !ords or action
o (ome young people !ho have suffered re7ection may feel they cannot e li5ed, so
mistrust those !ho are friendly to them. They may in turn inflict hurt on adults as a form
of revenge.
= #o!er see5ing
o Foung people !ill often challenge parents>teachers>adults in authority to satisfy their
desire for po!er and control o (ome young people may elieve they are only acceptale
!hen they are in control and so have to prove that they can get their o!n !ay and that no
one can ma5e them do anything.
= Helplessness
o Foung people may thin5 of themselves as incompetent or unale to perform tas5s,
especially if they are overprotected or discouraged
o (ome young people may elieve they !ill elong only y convincing others not to
e$pect too much of them
o They may construct an identity of someone !ho does not 7oin in !ith others and !ants
to e alone
o They may feel less capale than their peers and so avoid participating in activities !ith
them.
Conclusion
A !ide range of factors have een associated !ith causing or contriuting to ehaviour
prolems and there is ongoing deate aout the relative importance of each factor.
%ifferent theorists !ill argue aout the causes, ut there is general agreement that
10
emotional and ehavioural prolems are associated !ith the follo!ing factors, often in
comination,

References
American #sychiatric Association. &1))A*. Diagnostic and Statistical Manual of Mental Disorders (DSM-
IV). &0ourth ed.*. 8ashington %., American #sychiatric Association.
+iederman, J., /e!corn, J., D (prich, (. &1))1*. .omoridity of attention deficit hyperactivity disorder
!ith conduct, depressive, an$iety, and other disorders. American Journal of Psychiatry, 1A9&5*, 51A"5::.
+ar5lay, '.A., D 0ischer, M., Edelroc5, E.(. D (mallish, L. &1))0* The adolescent outcome of
hyperactive children diagnosed y research criteria, I, An eight year prospective follo!"up study. Journal
of the American Academy of Child and Adolescent Psychiatry, 6), 5A1"55:.
+ird, H. '., Gould, M. (., D (taghe@@a Jaramillo, +. M. &1))A*. The comoridity of A%H% in a
community sample of children aged 1 through 11 years. Journal of Child and amily Studies, ;&A*, ;15"
;:9.
0orgatch, M. &1)9)*. #atterns and outcome in family prolem solving, The disrupting effect of negative
emotions. Journal of Marriage and the amily, 51, 115"16A.
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Ia@din, A. &1)9:*. Treatment of antisocial ehaviour in children, .urrent status and future directions.
Psychological !ulletin, 106, 19:"60;.
Ia@din, A. &1))0*. Pre"ention of conduct disorder. #aper presented at the /ational .onference on
#revention 'esearch, /IMH, +ethesda, M%.
Ilein, '.G. D Mannu@@a, (. &1))1*. Long Term outcome of hyperactive children, A revie! . Journal of the
American Academy of Child and Adolescent Psychiatry, #$, #%#-#%&'
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Academy of Child and Adolescent Psychiatry, ;0, ;0;";):.
#helps, L., D Mc.lintoc5, I. &1))A*. .onduct %isorder. Journal of Psycho(athology and !eha"ioural
Assesment, 11&1*, 5;"11.
'ichman, /., (tevenson, L., D Graham, #. J. &1)96*. Pre-school to school) A *eha"ioural study. London,
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'utter, M., Ti@ard, J., Fule, 8., Graham, #., D 8hitmore, I. &1):1*. 'esearch report, Isle of 8ight studies.
Psychological Medicine, 1, ;1;";;6.
8ester"(tratton, .., D %ahl, '. 8. &1))5*. .onduct disorder. In M. Hersen D '. T. Ammerman &Eds.*,
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