Disruptive

Behaviour
Disorder
Learning Outcomes

• Discuss the characteristics, risk factors and

family dynamics of disruptive behaviour
disorders.

• Apply the nursing process to the care of clients

with disruptive behaviour disorders.

• Discuss treatment for disruptive behaviour

disorders.
Disruptive behaviour disorders

- characterized by persistent patterns of

behaviour that involve anger, hostility, and/or
aggression toward people and property.

➢ oppositional defiant disorder (ODD)

➢ conduct disorder
➢ intermittent explosive disorder (IED)
Related Disorders

Kleptomania
– characterized by impulsive, repetitive theft
of items not needed by the person, either for
personal use or monetary gain.

Pyromania
- characterized by repeated, intentional fire-
setting.
Oppositional Defiant Disorder

- Consists of an enduring pattern of uncooperative,

defiant, disobedient, and hostile behaviour toward
authority figures.

- Occurs more often in males; 2% up to 15% of the

adolescent population.
Intermittent Explosive Disorder

- Involves repeated episodes of impulsive, aggressive,

violent behaviour, and angry verbal outbursts, usually
lasting less than 30 minutes.

- The intensity of the emotional outburst is grossly out

of proportion to the stressor or situation.

- Common in adolescence and young adulthood; more

common in males than in females.
Intermittent Explosive Disorder

Childhood exposure to Treatment includes lithium,

trauma, neglect, SSRI antidepressant; CBT,
maltreatment; anger management
neurotransmitter imbalance, strategies, avoidance of
frontal lobe dysfunction alcohol and other substances
(etiologic factors) and relaxation techniques.
Conduct Disorder

- Characterized by persistent behaviour that

violates societal norms, rules, laws and the rights
of others.

- Symptoms (4 areas):
✓ aggression to people and animals
✓ destruction of property
✓ deceitful and theft
✓ serious violation of rules
Conduct Disorder

- subtypes:
➢ childhood-onset type
➢ adolescent-onset type

- intensity:
➢ mild – the child has some conduct problems that cause
relatively minor harm to others.
➢ moderate – the number of conduct problems increases as
does the amount of harm to others.
➢ severe – the person has many conduct problems that
cause considerable harm to others.
Conduct Disorder
Treatment:
➢ parental education (pre-school)
➢ parenting education, social skills
training, family therapy (school-aged)
➢ individual therapy, conflict resolution,
anger management, social skills
training (adolescents)
Conduct Disorder
Medications:
➢ methylphinedate (Ritalin)
➢ risperidone (Risperdal)
➢ lithium
➢ carbamazepine (Tegretol)
➢ valproic acid (Depakote)
Nursing Diagnosis

Risk for other-directed violence

Noncompliance

Ineffective coping

Impaired social interaction

Chronic low self-esteem

Intervention

1. Decreasing violence and increasing compliance

with treatment.

➢ inform clients of the rule or limit

➢ explain the consequences if clients exceed the limit
➢ state expected behaviour
➢ use of behavioural contracts
➢ institute time-out
➢ provide a routine schedule of daily activities
 “It is unacceptable to hit another person. If you are
angry, tell a staff person about your anger. If you hit
someone, you will be restricted from recreation time
for 24 hours.”
Intervention

2. Improving coping skills and self-esteem

- must not make judgemental statement about
clients.
- keeping a diary
- enhancing problem solving skills

“John, breaking chairs is unacceptable behaviour. You

need to let staff know you’re upset so you can talk about
it instead of acting out.”
Intervention

3. Promoting social interaction

✓ teach age-appropriate social skills
✓ role model and practice social skills
✓ provide positive feedback for acceptable behaviour
Intervention

4. Providing client and family education

✓ teach parents social and problem-solving skills when
needed
✓ encourage parents to seek treatment for their own
problems
✓ help parents identify age-appropriate activities and
expectations
✓ assist parents with direct, clear communication
✓ help parents avoid “rescuing” the client
✓ teach parents effective limit-setting techniques
✓ help parents identify appropriate discipline strategies
Points to Remember!

• Remember to focus on the

client’s strengths and assets.

• Avoid a blaming attitude toward

clients and/or families ; rather,
focus on positive actions to
improve situations and/ or
behaviors.