Unit 3: Clinical features and diagnostic criteria for behavioural and

emotional disorders with onset usually occurring in childhood and

adolescence- I

1. Hyperkinetic disorders

ICD-
10
Disorder Code Description

A group of disorders characterized by an early onset, lack of persistence in

activities requiring cognitive involvement, and excessive activity.
Hyperkinetic children may also exhibit recklessness, impulsivity, and
Hyperkinetic Disorders F90 difficulty in social relationships. Cognitive impairments are common.

Hyperkinetic conduct disorder refers to hyperkinetic behavior associated

with conduct disorder, where children exhibit both hyperactivity and
conduct problems such as aggression, defiance, and rule-breaking
Hyperkinetic Conduct behaviors. These individuals may have difficulty controlling impulses and
Disorder F90.0 regulating behavior.

This category includes hyperkinetic disorders that do not fit the criteria for
hyperkinetic conduct disorder. It encompasses a range of conditions
Other Hyperkinetic characterized by hyperactivity, impulsivity, and difficulty sustaining
Disorders F90.8 attention, without the presence of conduct disorder.

This code is used when the specific type of hyperkinetic disorder is not
specified or does not fit the criteria for any other hyperkinetic disorder
Hyperkinetic Disorder, subtype. It is used for cases where there is evidence of hyperkinetic
Unspecified F90.9 behavior but does not meet the criteria for a more specific diagnosis.

This term is used to describe hyperkinetic behavior that does not meet the
Hyperkinetic Reaction criteria for a specific disorder but is observed in childhood or adolescence.
of Childhood or It is a non-specific term used when there are symptoms of hyperactivity,
Adolescence NOS - impulsivity, or attention difficulties without a formal diagnosis.

Similar to hyperkinetic reaction of childhood or adolescence NOS, this term

is used when hyperkinetic symptoms are present but do not meet the criteria
Hyperkinetic Syndrome for a specific diagnosis. It implies the presence of hyperactivity,
NOS - impulsivity, or attention difficulties without a specific underlying cause.
 ICD-
10
Disorder Code Description

A group of disorders characterized by an early onset, lack of persistence in

activities requiring cognitive involvement, excessive activity, impulsivity, and
disorganization. Hyperkinetic children often display recklessness, impulsivity,
Hyperkinetic difficulty in social relationships, and cognitive impairments. They may also
Disorders F90 experience delays in motor and language development.

Panic Disorder Characterized by recurrent episodes of severe anxiety (panic) that are
(Episodic unpredictable and not restricted to any particular situation. Symptoms include
Paroxysmal palpitations, chest pain, choking sensations, dizziness, and feelings of unreality.
Anxiety) F41.0 Secondary fear of dying, losing control, or going mad may also be present.

Involves generalized and persistent anxiety not restricted to specific

environmental circumstances. Symptoms include persistent nervousness,
Generalized trembling, muscular tensions, sweating, palpitations, dizziness, and fears of
Anxiety Disorder F41.1 illness or accidents.

This category is used when symptoms of anxiety and depression coexist, but
Mixed Anxiety and neither is predominant to warrant a separate diagnosis. When both anxiety and
Depressive depressive symptoms are severe, individual diagnoses of both disorders should
Disorder F41.2 be recorded instead of using this category.

Includes symptoms of anxiety mixed with features of other disorders in the F42-
Other Mixed F48 range, but neither symptom type is severe enough to warrant a separate
Anxiety Disorders F41.3 diagnosis.

Other Specified Includes anxiety disorders that do not fit into specific categories. Examples
Anxiety Disorders F41.8 include anxiety hysteria.

Anxiety Disorder, Used when the anxiety disorder does not fit into any specific category or when
Unspecified F41.9 there is not enough information to make a more specific diagnosis.

ICD-
10
Disorder Code Description

A single episode characterized by an abnormally elevated mood, increased energy,

and other symptoms such as overactivity, pressure of speech, decreased need for
Manic Episode F30 sleep, distractibility, inflated self-esteem, and reckless behavior.

Bipolar disorder characterized by a single manic episode without any depressive

Bipolar Disorder, episodes. It involves persistent mild elevation of mood, increased energy and
Single Manic activity, marked feelings of well-being, talkativeness, over-familiarity, and decreased
Episode F30.0 need for sleep, among other symptoms.

A disorder characterized by a persistent mild elevation of mood, increased energy

Hypomania F30.1
and activity, and usually marked feelings of well-being. While similar to mania,
 ICD-
10
Disorder Code Description

hypomania does not lead to severe disruption of work or social rejection. Symptoms
may include increased sociability, talkativeness, irritability, and decreased need for
sleep, among others.

Mania without Mania characterized by an elevated mood, increased energy, overactivity, pressure
Psychotic of speech, decreased need for sleep, distractibility, inflated self-esteem, and reckless
Symptoms F30.1 behavior. However, there are no hallucinations or delusions present.

Mania accompanied by delusions (usually grandiose) or hallucinations (usually of

Mania with voices speaking directly to the patient), or extreme excitement, excessive motor
Psychotic activity, and flight of ideas to the extent that communication becomes
Symptoms F30.2 incomprehensible or inaccessible.

Other Manic
Episodes F30.8 Other specified manic episodes not falling into the previous categories.

Manic Episode,
Unspecified F30.9 Manic episode where the specifics of symptoms are unspecified.

ICD-
10
Disorder Code Description

Characterized by abnormal or impaired development before the age of

three, with qualitative abnormalities in reciprocal social interactions,
communication, and restricted, stereotyped, repetitive behavior. Other
common problems may include phobias, sleeping and eating
Childhood Autism F84.0 disturbances, temper tantrums, and aggression.

Differs from childhood autism either in age of onset or in failing to

fulfill all three diagnostic criteria. May occur after age three with
characteristic abnormalities in one or two areas of psychopathology,
despite not meeting criteria for autism. Often seen in profoundly
Atypical Autism F84.1 retarded individuals or those with specific developmental disorders.

Typically found only in girls, characterized by partial or complete loss

of speech and skills in locomotion and use of hands, along with
deceleration in head growth. Other features include loss of purposive
hand movements, hand-wringing stereotypies, hyperventilation, trunk
ataxia, apraxia, and choreoathetoid movements. Severe mental
Rett Syndrome F84.2 retardation is common.

Defined by a period of normal development followed by a loss of

Other Childhood
previously acquired skills in several areas over a few months.
Disintegrative Disorder F84.3
Symptoms include loss of interest in the environment, stereotyped
 ICD-
10
Disorder Code Description

motor mannerisms, and autistic-like abnormalities in social interaction

and communication. May be associated with encephalopathy.

An ill-defined disorder including children with severe mental

retardation and major problems in hyperactivity, attention, and
Overactive Disorder stereotyped behaviors. Often not responsive to stimulant drugs, and
Associated with Mental may exhibit dysphoric reactions to stimulants. Associated with
Retardation and Stereotyped developmental delays and may have unknown etiology related to IQ or
Movements F84.4 organic brain damage.

Characterized by qualitative abnormalities in reciprocal social

interaction and a restricted, stereotyped, repetitive repertoire of
interests and activities. Differs from autism in that there is no general
delay or retardation in language or cognitive development. May persist
into adolescence and adulthood and is often associated with marked
Asperger Syndrome F84.5 clumsiness.

Other Pervasive Other specified pervasive developmental disorders not falling into the
Developmental Disorders F84.8 previous categories.

Pervasive Developmental
Disorder, Unspecified F84.9 Pervasive developmental disorder with unspecified characteristics.

ICD-
10
Disorder Code Description

Characterized by stable, often paranoid delusions accompanied by hallucinations,

Paranoid particularly auditory. Other symptoms such as affective, volitional, speech
Schizophrenia F20.0 disturbances, and catatonic symptoms are either absent or less prominent.

Prominent affective changes, fleeting delusions and hallucinations, unpredictable

behavior, incoherent speech, and social isolation. Rapid development of "negative"
Hebephrenic symptoms like flattening of affect and loss of volition. Typically diagnosed in
Schizophrenia F20.1 adolescents or young adults.

Dominated by prominent psychomotor disturbances including extremes such as

hyperkinesis and stupor, automatic obedience, negativism, catalepsy, and flexibilitas
Catatonic cerea. Episodes of violent excitement may occur, along with dream-like states and
Schizophrenia F20.2 vivid scenic hallucinations.

Psychotic conditions meeting general diagnostic criteria for schizophrenia but not
Undifferentiated conforming to any specific subtype or exhibiting features of more than one subtype
Schizophrenia F20.3 without clear predominance. Also referred to as atypical schizophrenia.
 ICD-
10
Disorder Code Description

Depressive episode occurring after a schizophrenic illness. Some residual

schizophrenic symptoms must still be present, but depression dominates the clinical
Post-Schizophrenic picture. Associated with an increased risk of suicide. If no schizophrenic symptoms
Depression F20.4 remain, diagnosis should be depressive episode (F32.-).

Chronic stage characterized by long-term "negative" symptoms such as psychomotor

slowing, blunting of affect, passivity, poor speech and nonverbal communication, and
Residual social performance decline. Represents progression from earlier stages of
Schizophrenia F20.5 schizophrenia, but symptoms may not be irreversible.

Insidious development of oddities of conduct, inability to meet societal demands, and

Simple decline in total performance without preceding overt psychotic symptoms. Negative
Schizophrenia F20.6 features like blunting of affect and loss of volition are prominent.

Includes various subtypes and manifestations of schizophrenia not falling into specific
categories mentioned above, such as cenesthopathic schizophrenia, schizophreniform
Other Schizophrenia F20.8 disorder not otherwise specified, and psychosis not otherwise specified.

Schizophrenia,
Unspecified F20.9 Schizophrenia with unspecified characteristics.

Hyperkinetic Hyperkinetic disorder associated with conduct disorder, characterized by symptoms of

Conduct Disorder F90.1 hyperactivity and impulsivity along with conduct problems.

Includes hyperkinetic disorders other than hyperkinetic conduct disorder, such as

Other Hyperkinetic attention deficit disorder with hyperactivity, hyperkinetic syndrome not otherwise
Disorders F90.8 specified, and disturbances of activity and attention.

Hyperkinetic
Disorder,
Unspecified F90.9 Hyperkinetic disorder with unspecified characteristics.

2. Conduct disorders
CONDUCT DSORDER HAS TWO TYPES- ODD AND CONDUCT DSSOCAL DSORDER

Oppositional Defiant Disorder (ODD): A Comprehensive Explanation with Tables

Essential Features and Diagnostic Criteria:
ODD is characterized by a persistent pattern of negative and defiant behavior that significantly impacts
daily life. To be diagnosed with ODD, an individual must exhibit several of the following features for
at least 6 months and to a degree that is greater than expected for their age and developmental level:
Table 1: Essential Features of ODD
Feature Description Example

This includes frequently arguing

Markedly A child argues with their
with authority figures, refusing to
noncompliant, teacher about classroom rules
comply with requests or rules,
defiant, and and refuses to complete their
and deliberately doing things to
disobedient behavior assigned work.
annoy others.

This includes deliberately trying A teenager spreads rumors

Provocative, spiteful,
to upset or anger others, often about a classmate online to
or vindictive
through teasing, name-calling, or get revenge for a perceived
behavior
social media attacks. slight.

This includes being easily A child throws a tantrum and

Extreme irritability annoyed, losing one's temper yells at their parent because
or anger frequently, and having angry they are not allowed to have
outbursts. dessert before dinner.

The oppositional behavior must A child's constant arguing

cause significant problems in at with their teachers and
Impairment in
least one important area of life, classmates leads to them
functioning
such as school, home, or social being isolated and struggling
relationships. academically.

Specifiers:
In addition to the essential features, there are several specifiers that can be used to further describe the
presentation of ODD:
Table 2: Specifiers for ODD

Specifier Description Example

A child becomes easily

This specifier indicates that the
With chronic frustrated and throws frequent
individual experiences frequent and
irritability- tantrums, often accompanied
intense anger or irritability in addition
anger by yelling and aggressive
to the other features of ODD.
behavior.

Without This specifier indicates that the A teenager occasionally argues

chronic individual experiences anger and with their parents but does not
 irritability- irritability less frequently and severely experience frequent outbursts
anger than those with the "with chronic of anger.
irritability-anger" specifier.

This specifier indicates that the

A child bullies another child
With limited individual has difficulty understanding
and shows no empathy or
prosocial or responding to the emotions of others
concern for the other child's
emotions and shows little remorse or guilt for
feelings.
their behavior.

This specifier indicates that the

With typical A teenager argues with their
individual does not experience
prosocial parent but later apologizes for
significant difficulties with empathy or
emotions their behavior.
remorse.

Additional Clinical Features:

While not part of the diagnostic criteria, ODD often presents with several additional features that can
impact the individual's life:
Table 3: Additional Clinical Features of ODD

Feature Description Example

A child's constant arguing

ODD can lead to difficulties with
with their parents leads to
Negative impact peers, family members, and other
frequent conflict and strained
on relationships individuals due to the negative and
relationships within the
oppositional behavior.
family.

A teenager deliberately
Individuals with ODD may often
Provocative ignores their teacher's
initiate confrontations and be seen as
quality instructions and disrupts the
excessively rude and uncooperative.
classroom environment.

Decreased Younger children may exhibit

A preschooler frequently
frequency of oppositional behaviors more
argues with their parents about
behaviors with frequently as they receive more direct
bedtime routines, but this
age demands from adults. However, the
behavior becomes less
diagnosis is still valid if the behavior is
 atypical for the individual's age and frequent as they enter
development. elementary school.

An adult with ODD struggles

Adults with ODD may continue to
to maintain friendships and
Impact on experience difficulties in relationships
employment due to their
adulthood and at work due to their persistent
frequent arguments and
negative behavior patterns.
confrontational behavior.

ODD can occur alongside other mental

A child with ODD also
health disorders, such as Attention
Co-occurring exhibits symptoms of ADHD,
Deficit Hyperactivity Disorder
disorders such as hyperactivity and
(ADHD), Conduct Disorder, and
impulsivity.
depression.

Detailed Explanation of ODD: Additional Information

Table 1: Boundary with Normality

Feature Description Example

Occasional noncompliance,
Transient defiance, and disobedience, A child occasionally argues with a parent
behaviors including irritability or anger, about bedtime but ultimately complies.
can be normal.

These behaviors can be part of

A child throws a tantrum when they are
Typical typical development,
separated from their parents for the first
development especially during challenging
time at daycare.
situations or transitions.

Anxiety in specific situations A child becomes argumentative and

Normative
can lead to temporary refuses to go on stage during a school play
anxiety
oppositional behavior. due to stage fright.
 ODD diagnosis requires
a persistent
A child argues with their parents and
pattern of markedly
teachers frequently and intensely,
Diagnosis of noncompliant, defiant, and
deliberately disobeys rules, and shows this
ODD disobedient behavior that
behavior consistently across different
is atypical for the individual's
settings.
age, gender, and cultural
context.

Table 2: Course Features

Feature Description Prognostic Implication

The specific presentation can

Heterogeneity of ODD can vary in severity and
influence the potential course
presentations presentation.
of the disorder.

ODD, especially with severe Early intervention for ODD

Precursor to defiance or spitefulness, can may help prevent the
Conduct Disorder increase the risk of developing development of Conduct
Conduct Disorder. Disorder.

Comorbidity with
other disorders
Addressing co-occurring
ODD can co-occur with other
disorders is important for
mental health conditions.
comprehensive treatment.

Table 3: Developmental Presentations

Feature Description

Typical age of onset Middle childhood (preschool age)

Symptoms emerge Rarely after early adolescence

Prevalence rates 3.3% among children and adolescents (aged 6-18)

Sex differences Higher rates observed among school-aged boys (ratio of 1.4:1)
 Possible decrease in Some evidence suggests a decrease beginning in adolescence and
prevalence young adulthood

Disrupted caregiving relationships, harsh or inconsistent

Risk factors
parenting practices

Can lead to peer rejection, interpersonal conflict, and other

Impact on development
difficulties

Table 4: Culture-Related Features

Feature Description Implication

Cultural norms influence

Variation in
Across cultures perception of noncompliant
prevalence
behavior.

Behaviors should be
A diagnosis shouldn't solely rely on
Cultural context evaluated within the
comparing behavior to a different
evaluation individual's cultural
cultural standard.
framework.

Possible
Family structure, disciplinary These factors can influence the
explanations for
practices, and cultural values prevalence of ODD across cultures.
differences

Table 5: Sex- and/or Gender-Related Features

Feature Description

Prevalence Higher among school-aged boys

Gender difference at other No significant difference in prevalence at other points in the

points lifespan

Conduct-Dissocial Disorder (ICD-11): Detailed Explanation with Tables

Table 1: Essential Features
Feature Description Example

A child repeatedly
Repetitive and A consistent pattern of violating the basic rights
bullies classmates,
persistent of others or major age-appropriate societal
steals from their peers,
pattern of norms, rules, or laws. This behavior is not
and destroys school
behavior simply occasional or situational.
property.

Multiple
The individual exhibits at least one or more of
behaviors
the following types of behaviors:
involved

* Aggression towards people or

animals: This can include threatening,
intimidating, or bullying others; initiating A teenager threatens
physical fights; using weapons that can cause classmates with a knife
serious harm; inflicting physical cruelty on and steals their
people or animals; aggressive forms of stealing belongings.
(e.g., mugging, extortion); or forcing someone
into sexual activity.

* Destruction of property: This includes

deliberately setting fires with the intention of A child repeatedly sets
causing serious damage or deliberately fires in their
destroying the property of others (e.g., breaking neighborhood, causing
windows, slashing tires, vandalizing damage to property.
buildings).

* Deceitfulness or theft: This includes An adolescent lies to

stealing items of value (e.g., shoplifting, car their parents about their
theft), lying to obtain goods or favors or to whereabouts and steals
avoid obligations (e.g., "conning" others), or money from their
breaking into someone's house, building, or car. family to buy drugs.

* Serious violations of rules: This includes A child consistently

repeated defiance of parental rules (e.g., stays out past curfew,
staying out all night despite prohibitions), runs away from home
repeatedly running away from home, or often multiple times, and
skipping school or work without permission. skips school frequently.
 The pattern of behavior must be persistent and The individual exhibits
Persistence recurrent, including multiple incidents of the these behaviors
and types described above over an extended period consistently for a year
recurrence of time (typically at least 1 year). Isolated acts or more, not just
of delinquency are not sufficient for diagnosis. occasionally.

The individual's behavior pattern results in

significant impairment in at least one important
The individual's
area of their life, such as personal functioning
behavior negatively
(e.g., difficulty managing emotions), family
Significant impacts their ability to
relationships (e.g., constant conflict with
impairment function effectively in
parents), social relationships (e.g., rejection by
various aspects of their
peers), educational functioning (e.g., failing
life.
grades), or occupational functioning (e.g., job
loss).

Table 2: Specifiers for Age of Onset

Specifier Description

Meets all diagnostic criteria for Conduct-Dissocial Disorder and one

6C91.0 Conduct-
or more features of the disorder have clearly been present and
Dissocial Disorder,
persistent during childhood prior to adolescence (e.g., before 10
childhood onset
years of age).

6C91.1 Conduct- Meets all diagnostic criteria for Conduct-Dissocial Disorder, but
Dissocial Disorder, none of the features of the disorder were present prior to adolescence
adolescent onset (e.g., before 10 years of age).

6C91.Z Conduct-
Dissocial Disorder, Insufficient information is available to determine the age of onset.
unspecified

Table 3: Specifiers for Prosocial Emotions

Specifier Description Example

6C91.y0 with This is a less common and more severe An individual with this specifier
limited presentation of Conduct-Dissocial may show little empathy or
 prosocial Disorder. It is characterized by a concern for others' feelings, lack
emotions pattern of limited prosocial emotions, remorse or guilt for their actions,
sometimes referred to as "callous and and display a shallow or insincere
unemotional traits." expression of emotions.

This is the more common presentation An individual with this specifier

6C91.y1 with of Conduct-Dissocial Disorder. These may show occasional lack of
typical individuals may exhibit occasional concern for others or struggle
prosocial limited concern, remorse, or emotional with expressing emotions, but
emotions expression, but these are not persistent these behaviors are not a
or pervasive features. consistent pattern.

Additional Clinical Features of Conduct-Dissocial Disorder (ICD-11)

Table 1: Delinquent Peer Groups

Feature Description Example

Individuals with Conduct- A teenager with Conduct-Dissocial

Association with Dissocial Disorder may be part Disorder joins a group of friends
delinquent peers of groups engaging in who steal from local stores and
delinquent activities. vandalize property.

Teenagers with Conduct-Dissocial

Particularly This association is more Disorder who did not exhibit
common in frequent when the disorder problems earlier in childhood are
adolescent onset starts in adolescence. more likely to be part of such
groups.

Table 2: Relationship with Oppositional Defiant Disorder (ODD)

Feature Description Example

A child with ODD who argues

ODD was previously excessively with parents and teachers
Historically viewed
considered a precursor may develop Conduct-Dissocial
as hierarchical and
to Conduct-Dissocial Disorder if their behavior escalates to
developmental
Disorder. more severe rule-breaking and
aggression.
 Both disorders can be
An adolescent diagnosed with Conduct-
diagnosed together,
Can co-occur with Dissocial Disorder may also meet criteria
especially with
ODD for ODD due to their ongoing defiance
persistent behavior
and disobedience.
problems.

Table 3: Risk Factors for Long-Term Antisocial Behavior

Feature Description Example

A child diagnosed with Conduct-

Childhood onset
Individuals with this Dissocial Disorder before adolescence
and limited
combination are at higher risk and exhibiting limited empathy and
prosocial
for persistent problems. remorse is at greater risk for future
emotions
antisocial behavior.

Distinction These are separate An individual with Conduct-Dissocial

between characteristics, and childhood Disorder starting in childhood may
subtypes and onset does not guarantee still display typical prosocial
specifiers limited prosocial emotions. emotions.

Table 4: Comorbidity with Other Disorders

Feature Description Example

An individual with Conduct-Dissocial

Conduct-Dissocial
Frequent co- Disorder may also struggle with ADHD,
Disorder often occurs
occurrence with learning difficulties, anxiety disorders,
alongside other mental
other disorders mood disorders, or substance use
health conditions.
disorders.

Table 5: Boundary with Normality

Feature Description Example

A teenager participating in a
Political protest not
Engaging in peaceful protests peaceful protest against
indicative of
should not be misconstrued as a environmental injustice does not
Conduct-Dissocial
symptom of the disorder. necessarily meet criteria for
Disorder
Conduct-Dissocial Disorder.
 The disorder involves behaviors An isolated act of theft due to
Criminal offenses that may have legal peer pressure or impulsive
and legal consequences, but not all decision-making wouldn't
repercussions criminal acts are indicative of necessarily qualify for the
Conduct-Dissocial Disorder. diagnosis.

Diagnosis should consider the A single criminal act should not

Focus on broader individual's overall behavior solely determine the diagnosis; a
pattern of behavior pattern, not just isolated persistent and pervasive pattern
incidents. of antisocial behavior is crucial.

Table 6: Course Features

Feature Description Example

A child who develops Conduct-

Individuals with earlier
Earlier onset Dissocial Disorder at a young age and
onset and more severe
and worse exhibits severe aggression may be at
symptoms tend to have
prognosis higher risk for future criminal behavior
poorer outcomes.
and co-occurring disorders in adulthood.

The disorder's course can

An individual diagnosed with Conduct-
Variable course vary significantly, with some
Dissocial Disorder in adolescence may
with potential individuals experiencing
show improvement and no longer meet
remission complete remission by
the criteria for the disorder in adulthood.
adulthood.

A child who initially exhibits occasional

Symptoms may start mild lying may escalate to more serious
Progression of
(e.g., lying) and worsen over behavior like stealing or physical
symptoms
time (e.g., assault). aggression if the underlying issues are
not addressed.

Table 7: Developmental Presentations

Feature Description Example

Typical age While possible in early childhood, the typical onset Onset after the age of
of onset is during early to middle adolescence. 16 is uncommon.
 Individuals exhibiting Conduct-Dissocial Disorder
Rare onset
symptoms for the first time after 16 are unlikely to
after age 16
meet diagnostic criteria.

Table 8: Culture-Related Features

Feature Description Example

Assessment should consider cultural In some cultures,

Consideration of
norms and expectations to avoid children may be
cultural context
misdiagnosis. absent

Sex- and/or Gender-Related Features of Conduct-Dissocial Disorder (ICD-11)

Feature Description Example

Conduct-Dissocial Disorder Males are diagnosed with Conduct-

Prevalence is more common among Dissocial Disorder more frequently than
males. females.

Males are more likely to exhibit behaviors

like stealing, vandalism, fighting, and
Symptom Males and females exhibit school discipline problems, while females
presentation different symptom patterns. are more likely to exhibit lying, truancy,
substance abuse, absconding, and
prostitution.

Males tend to display both Males with Conduct-Dissocial Disorder

physical and relational may engage in physical violence like
Type of
aggression, while females hitting and pushing, while females may
aggression
are more likely to exhibit use social tactics like spreading rumors or
relational aggression only. excluding others.

Boundaries with Other Disorders and Conditions (ICD-11)

Table 1: Boundary with Oppositional Defiant Disorder (ODD)

Feature Description Example

 A child with ODD may argue with
Conduct-Dissocial Disorder
parents and refuse to follow rules, but
Severity and involves severe and dissocial
wouldn't violate major rules like
nature of behavior violating major rules
stealing or harming others, which are
behavior and rights, exceeding ODD's
characteristic of Conduct-Dissocial
noncompliance and defiance.
Disorder.

An adolescent with Conduct-Dissocial

Disorder engaging in aggressive
ODD and Conduct-Dissocial
behavior and property destruction
Comorbidity Disorder can co-occur and be
might also meet criteria for ODD if
and diagnosis diagnosed together if both
they exhibit persistent defiance and
criteria are met.
disobedience towards authority
figures.

Table 3: Boundary with Mood Disorders

Feature Description Example

When behavior problems A teenager experiencing a manic

occur solely within the episode may act impulsively and
Context of context of a mood episode aggressively, but if these behaviors
behavior (e.g., depression, mania), a resolve when the mood episode
problems separate diagnosis of subsides, a separate diagnosis of
Conduct-Dissocial Disorder Conduct-Dissocial Disorder wouldn't
is usually not needed. be warranted.

A teenager with depression might be

Mood disorders may present
irritable and argumentative, but
with irritability, but Conduct-
wouldn't necessarily exhibit persistent
Distinguishing Dissocial Disorder involves a
and intentional rule-breaking,
symptoms broader pattern of antisocial
aggression, or disregard for others'
behavior beyond mood-
rights, which are key features of
related irritability.
Conduct-Dissocial Disorder.

Table 4: Boundary with Intermittent Explosive Disorder (IED)

Feature Description Example

IED involves impulsive An individual with IED may experience

Nature of outbursts, not a broader sudden and intense anger episodes leading
aggression pattern of antisocial to aggressive outbursts, but these wouldn't
behavior. involve a consistent pattern of rule-
 breaking, lying, and violating others'
rights, as seen in Conduct-Dissocial
Disorder.

An individual with Conduct-Dissocial

Conduct-Dissocial
Disorder might plan and steal something
Disorder aggression is
Premeditation for personal gain, while an individual with
often premeditated and
and intent IED might have an impulsive outburst of
instrumental, while IED
anger leading to property damage without
aggression is impulsive.
a specific goal.

Table 5: Boundary with Personality Disorder

Feature Description Example

Conduct-Dissocial Disorder An individual with Conduct-Dissocial

focuses on recurrent behavior Disorder may exhibit antisocial
patterns, while Personality behavior for several years, but it's not
Duration and
Disorder is characterized by necessarily a deeply ingrained part of
pervasiveness
enduring and pervasive their personality across different areas
disturbances in personality of life, as seen in a Personality
traits. Disorder diagnosis.

Treatment Approaches for Conduct-Dissocial Disorder (ICD-11)

Table 1: Evidence-Based Interventions

Intervention Description Target population Evidence

CBT helps individuals Strong evidence for

identify and modify Adolescents and effectiveness in
Individual
unhelpful thinking young adults reducing antisocial
Cognitive
patterns and behaviors with Conduct- behavior, improving
Behavioral
associated with their Dissocial social skills, and
Therapy (CBT)
Conduct-Dissocial Disorder. reducing emotional
Disorder. distress.

Parent PMT equips parents Parents of Moderate to strong

Management with skills to manage children and evidence for
Training (PMT) their child's behavior adolescents with effectiveness in
effectively and build Conduct- reducing behavioral
 positive parent-child Dissocial problems and
relationships. Disorder. improving parent-
child communication.

MST is an intensive
family and community- Moderate evidence
Youths with
based intervention that for effectiveness in
Conduct-
Multisystemic addresses the various reducing antisocial
Dissocial
Therapy (MST) factors contributing to behavior,
Disorder and
the child's behavior delinquency, and
their families.
problems in different substance use.
settings.

Social skills training

Adolescents and
helps individuals
young adults
develop skills for Moderate evidence
with Conduct-
building and for effectiveness in
Social Skills Dissocial
maintaining healthy improving social
Training Disorder who
relationships, resolving skills and reducing
struggle with
conflicts constructively, aggressive behavior.
social
and expressing
interactions.
emotions appropriately.

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Table 2: Additional Considerations

Feature Description Example

An adolescent with mild Conduct-

Treatment approaches are
Dissocial Disorder might benefit from
Severity and tailored to the individual's
individual CBT, while a youth with a
individual specific needs and the severity
more severe case might require a
needs of their Conduct-Dissocial
combination of interventions like MST
Disorder.
and social skills training.

An adolescent with Conduct-Dissocial

If the individual has co-
Disorder and ADHD might benefit
occurring mental health
from a combination of CBT for
Comorbidity conditions like ADHD or
Conduct-Dissocial Disorder and
depression, treatment should
medication or behavioral interventions
address both disorders.
for ADHD.
 Family involvement is crucial
Parental participation in therapy
for successful treatment.
Family sessions and implementation of learned
Interventions like PMT can
involvement strategies at home can significantly
equip parents with skills to
impact treatment outcomes.
support their child's progress.

Conduct-Dissocial Disorder
Regular check-ins with a therapist or
can be a chronic condition.
counselor can help the individual
Long-term Long-term follow-up and
identify potential triggers and develop
follow-up support are essential to
coping mechanisms to avoid future
maintain progress and prevent
behavioral problems.
relapse.

Utilizing community resources

Connecting with others who understand
like support groups, mentoring
Community- the challenges of Conduct-Dissocial
programs, and educational
based Disorder can provide a sense of
interventions can complement
resources community and belonging for both the
therapy and provide additional
individual and their family.
support.

Conduct-Dissocial Disorder Subtypes: Childhood Onset vs. Adolescent Onset (ICD-11)

Feature Childhood Onset (6C91.0) Adolescent Onset (6C91.1)

No symptoms present before

Symptoms appear before the age of 10
Age of Onset adolescence (typically after 10
years.
years of age).

Repetitive and persistent violation of

Same behavior pattern as
others' rights, societal norms, rules, and
childhood onset, but
Description laws, including aggression, property
symptoms first appear during
destruction, deceitfulness, theft, and
adolescence.
serious rule violations.

Features must be present for at

Features must be present for at least 12
Diagnostic least 12 months. Isolated
months. Isolated dissocial acts don't
Criteria dissocial acts don't warrant
warrant diagnosis.
diagnosis.
 A teenager begins engaging in
A child exhibits aggressive behavior,
fights, vandalizes property,
Example destroys others' property, and frequently
and steals money in their mid-
lies from a young age (before 10).
teens (after 10).

Adolescent onset may be

Early onset may indicate a greater risk for
influenced by various factors
Explanation long-term problems with antisocial
like peer pressure or
behavior.
environmental changes.

3. Mixed disorders of conduct and emotions

Mixed Disorders of Conduct and Emotions (ICD-10): A Breakdown

Subcategory Additional
Description Emotional Disturbance Examples
(ICD-10 Code) Information

- Symptoms
last for at least
a year and
Requires both conduct cause
disorder (F91.-) - Depression: Sadness or significant
and persistent, irritability, loss of interest or distress or
F92.0 -
marked pleasure in activities, feelings impairment in
Depressive
depression (F32.-). of worthlessness or guilt, daily life. -
Conduct
Individuals experience hopelessness or thoughts of Individuals
Disorder
significant depressive death, sleep or appetite may also
symptoms alongside disturbances exhibit other
conduct problems. symptoms of
depression
not listed
here.

Requires conduct - Anxiety - Examples

F92.8 - disorder (F91.-) Disorders: Generalized listed are not
Other with other significant anxiety, panic disorder, social exhaustive.
Mixed emotional anxiety disorder, etc. Other
Disorders disturbances not - Obsessive-compulsive emotional
of Conduct meeting criteria for disorder disturbances
depressive conduct (OCD) - Phobias: Specific may also co-
 and disorder. This category phobias, social phobia, etc. occur with
Emotions covers a wider range of - Dissociative conduct
emotional problems disorders: Depersonalization, disorder in
co-occurring with derealization this category.
conduct disorder. - Hypochondriasis: Excessive - Symptoms
health concerns last for at least
a year and
cause
significant
distress or
impairment in
daily life.

- This
category is
used when the
Used when conduct
emotional
problems co-occur
disturbance
with unspecified
doesn't
F92.9 - emotional
- Combination of emotional clearly fall
Mixed disturbances not
symptoms not fitting a under any of
Disorder of meeting criteria for
specific diagnosis, such as the other
Conduct other subcategories.
anger outbursts, mood swings, subcategories.
and This category
irritability, or emotional - Symptoms
Emotions, acknowledges the
dysregulation. last for at least
Unspecified complexity of co-
a year and
occurring problems
cause
without a specific
significant
emotional diagnosis.
distress or
impairment in
daily life.

Important Points:
• Both conduct problems and emotional symptoms must be persistent and
significant (lasting for at least a year) for a diagnosis.
• The severity and specific types of conduct problems and emotional disturbances can
vary greatly between individuals.
• This classification system is not used in the newer ICD-11 (released in 2019).
Additional Notes:
• This table provides a general overview. Professional diagnosis requires a
comprehensive evaluation by a mental health professional.
 • If you suspect yourself or someone you know might be struggling with mixed disorders
of conduct and emotions, seeking professional help is crucial.

4. Emotional disorders with onset specific to childhood

Separation Anxiety Disorder of Childhood
Description: Separation anxiety disorder (SAD) is characterized by excessive fear or anxiety
concerning separation from attachment figures, leading to significant distress and functional
impairment. It typically manifests in children when they are separated from their primary
caregivers or familiar environments.
Symptoms:
• Excessive distress, worry, or fear when separation is anticipated or occurs
• Persistent reluctance or refusal to go to school or other places away from home
• Fear of harm befalling loved ones when separated
• Physical symptoms such as headaches, stomachaches, or nausea when separation is
imminent
• Nightmares about separation or being alone
• Clinging behavior or excessive need for reassurance
Causes:
• Genetic predisposition, with family history of anxiety disorders
• Environmental factors such as stressful life events or family disruptions
• Overprotective parenting styles or early traumatic experiences related to separation
Impact:
• Impairment in social relationships, academic performance, and overall quality of life
• Interference with normal developmental tasks, such as gaining independence and
autonomy
• Increased risk of developing other anxiety disorders later in life
Prevalence:
• Estimated prevalence of 4-5% in children aged 7-11 years
Tips for Parents:
• Establish predictable routines and rituals to provide a sense of security
• Encourage gradual exposure to separation situations, starting with short separations and
gradually increasing duration
 • Teach coping strategies such as deep breathing, positive self-talk, or visualization
techniques
• Seek professional help if symptoms persist or significantly interfere with daily
functioning
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on gradual exposure, cognitive
restructuring, and relaxation techniques
• Parent-child interaction therapy to improve attachment relationships and
communication skills
• Medications such as selective serotonin reuptake inhibitors (SSRIs) in severe cases,
under the guidance of a qualified healthcare provider
Parental Care:
• Offer reassurance and support during separation situations, while also encouraging
independence and self-reliance
• Communicate openly with the child about their fears and concerns, validating their
feelings without reinforcing excessive dependence
• Collaborate with teachers and other caregivers to create a supportive environment for
the child's transition and adjustment
Phobic Anxiety Disorder of Childhood
Description: Phobic anxiety disorder involves irrational fears or anxieties about specific
objects or situations that are common in childhood but are experienced with an intensity or
persistence that is statistically unusual. These fears typically lead to avoidance behavior and
significant distress.
Symptoms:
• Persistent and excessive fear or anxiety about a specific object or situation, such as
animals, storms, or medical procedures
• Avoidance of the phobic stimulus or enduring it with intense distress
• Physical symptoms such as rapid heartbeat, sweating, trembling, or nausea when
exposed to the phobia
• Recognition that the fear is excessive or unreasonable but feeling unable to control it
Causes:
• Genetic predisposition, with family history of anxiety disorders
• Traumatic experiences or conditioning related to the phobic stimulus
• Learned behavior through observation or modeling, such as witnessing a parent's fear
reaction
Impact:
• Disruption of daily activities, social relationships, and academic performance
• Avoidance behavior may lead to missed opportunities for learning and growth
• Increased risk of developing other anxiety disorders or depression later in life
Prevalence:
• Prevalence rates vary depending on the specific phobia but may range from 3% to 8%
in children and adolescents
Tips for Parents:
• Provide a supportive and non-judgmental environment for the child to express their
fears and concerns
• Gradually expose the child to the phobic stimulus in a controlled and supportive
manner, starting with less intense exposures
• Model calm and confident behavior when dealing with anxiety-provoking situations,
while also acknowledging the child's bravery
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive
restructuring, and relaxation techniques
• Systematic desensitization to gradually confront the phobic stimulus in a hierarchical
manner
• Medications such as beta-blockers or benzodiazepines in severe cases, under the
guidance of a qualified healthcare provider
Parental Care:
• Validate the child's feelings and provide encouragement during exposure exercises,
while avoiding excessive reassurance or accommodation of avoidance behavior
• Reinforce brave behavior and efforts to confront fears, while also acknowledging and
praising small steps of progress
• Collaborate with mental health professionals to develop a comprehensive treatment
plan tailored to the child's needs and preferences
Social Anxiety Disorder of Childhood
Description: Social anxiety disorder involves an intense fear or anxiety about social situations,
including interacting with unfamiliar people, being observed, or performing in front of others.
These fears significantly interfere with social functioning and may lead to avoidance behavior.
Symptoms:
• Fear of embarrassment, humiliation, or rejection in social situations
 • Avoidance of social interactions, particularly with unfamiliar people or in performance
situations
• Physical symptoms such as blushing, sweating, trembling, or gastrointestinal distress
• Excessive self-consciousness or worry about being judged negatively by others
• Difficulty initiating or maintaining conversations, making eye contact, or speaking in
public
Causes:
• Genetic predisposition, with family history of anxiety disorders
• Negative experiences or traumas related to social interactions, such as bullying or
rejection
• Overprotective parenting styles or high levels of criticism and scrutiny
Impact:
• Impairment in social relationships, academic performance, and overall quality of life
• Increased risk of depression, substance abuse, or academic underachievement in
adolescence and adulthood
• Interference with developmental tasks such as forming friendships, dating, or pursuing
educational and career goals
Prevalence:
• Estimated prevalence of 2-4% in children and adolescents
Tips for Parents:
• Encourage participation in social activities that match the child's interests and abilities,
while respecting their comfort level
• Role-play social situations at home to practice social skills and build confidence
• Provide positive reinforcement for brave behavior and efforts to overcome anxiety,
while also acknowledging the challenges and providing support
Treatment:
• Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive
restructuring, and social skills training
• Group therapy to provide opportunities for social interaction and peer support
• Medications such as selective serotonin reuptake inhibitors (SSRIs) or selective
serotonin-norepinephrine reuptake inhibitors (SNRIs) in severe cases, under the
guidance of a qualified healthcare provider
Parental Care:
 • Foster a supportive and accepting home environment where the child feels valued and
understood, while also setting appropriate boundaries and expectations
• Avoid pushing the child into social situations before they are ready, but gently
encourage gradual exposure and participation
• Model confident and assertive behavior in social interactions to serve as a positive role
model, while also acknowledging and validating the child's feelings
Sibling Rivalry Disorder
Description: Sibling rivalry disorder refers to emotional disturbances following the birth of a
younger sibling, characterized by jealousy, attention-seeking behavior, or aggression. While
some degree of rivalry is common among siblings, sibling rivalry disorder is diagnosed when
the degree or persistence of the disturbance is statistically unusual and associated with
abnormal social interaction.
Symptoms:
• Jealousy or resentment toward the younger sibling, expressed through verbal or
physical aggression
• Attention-seeking behavior to regain parental attention or affection, such as acting out
or exaggerated emotions
• Competitiveness or comparison with the sibling in various domains, such as
achievements, talents, or parental favoritism
• Disruption of family harmony or cohesion, leading to tension, conflict, or emotional
distress among family members
Causes:
• Competition for parental attention, resources, or affection
• Changes in family dynamics and routines due to the new sibling, including changes in
parental availability or attention
• Individual temperament and coping styles, such as sensitivity to perceived injustice or
unfairness
Impact:
• Disruption of sibling relationships and family dynamics, leading to long-term effects
on social development and emotional well-being
• Increased risk of behavioral problems, emotional difficulties, or adjustment difficulties
in childhood and adolescence
• Interference with parental bonding and attachment relationships, affecting parental
mental health and family functioning
Prevalence:
 • Sibling rivalry is common in families with multiple children, with varying degrees of
severity depending on factors such as age spacing, temperament, and parental
responsiveness
Tips for Parents:
• Acknowledge and validate each child's feelings and needs, while also setting clear
expectations for behavior and conflict resolution
• Provide opportunities for individual attention and bonding with each child, reinforcing
their unique strengths and qualities
• Foster cooperative rather than competitive interactions between siblings, emphasizing
teamwork, collaboration, and mutual respect
Treatment:
• Family therapy to address underlying family dynamics, communication patterns, and
conflict resolution strategies
• Parent-child interaction therapy to improve parent-child relationships and enhance
parental sensitivity and responsiveness
• Individual therapy for children to express and process their feelings in a safe and
supportive environment, learning coping skills and emotion regulation strategies
Parental Care:
• Spend quality one-on-one time with each child to reinforce their sense of importance
and value, promoting positive sibling relationships and emotional security
• Establish and enforce clear boundaries and consequences for aggressive or
inappropriate behavior, while also teaching conflict resolution and problem-solving
skills
• Model healthy communication, empathy, and cooperation in family interactions,
demonstrating positive ways of resolving disputes and managing emotions
Other Childhood Emotional Disorders
Description: This category includes various emotional disorders not fitting into specific
subtypes, such as identity disorder or overanxious disorder. Each disorder may have unique
presentations requiring individualized assessment and treatment.
Symptoms:
• Symptoms vary depending on the specific disorder but may include disturbances in
mood, behavior, or self-perception
• Impairment in social, academic, or familial functioning
• Examples include identity disorder characterized by confusion or instability in one's
sense of self, or overanxious disorder marked by excessive worry and anxiety about
everyday events or activities
Causes:
• Causes vary depending on the specific disorder but may involve genetic, environmental,
or psychosocial factors
• Examples include genetic predisposition, early trauma or adversity, or maladaptive
coping strategies
Impact:
• Impairment in multiple domains of functioning, including emotional regulation,
interpersonal relationships, and academic achievement
• Increased risk of comorbid psychiatric disorders or psychosocial difficulties, affecting
long-term outcomes and quality of life
• Examples include disruption of identity formation, interpersonal conflicts, or academic
underachievement
Prevalence:
• Prevalence rates vary depending on the specific disorder and population studied, with
some disorders being relatively rare or understudied
• Examples include identity disorder, which may be less common but can have significant
impact on individual well-being and functioning
Tips for Parents:
• Seek professional evaluation and assessment to determine the specific nature and
treatment needs of the child's emotional disorder, collaborating closely with mental
health professionals to develop a comprehensive treatment plan
• Provide unconditional love and support while setting appropriate boundaries and
expectations, promoting resilience and adaptive coping skills
• Educate yourself about the child's disorder and available resources for support and
treatment, advocating for the child's needs within educational and community settings
Treatment:
• Individualized treatment plans tailored to the specific needs and symptoms of the child,
incorporating evidence-based interventions and therapeutic modalities
• Examples include cognitive-behavioral therapy (CBT), dialectical behavior therapy
(DBT), play therapy, or family therapy, depending on the nature and severity of the
disorder
• Medications may be considered for certain disorders or symptoms, under the guidance
of a qualified healthcare provider, with careful monitoring of benefits and side effects
Parental Care:
• Collaborate closely with mental health professionals to implement treatment strategies
and monitor progress, actively participating in therapy sessions and treatment planning
 • Create a supportive and nurturing home environment that promotes emotional
expression and growth, fostering open communication and validation of feelings
• Advocate for the child's needs within educational and community settings, seeking
accommodations and support services as needed to optimize functioning and well-being

Separation Anxiety Disorder of Childhood

Aspect Description

- Excessive distress, worry, or fear when separation is anticipated or occurs -

Persistent reluctance or refusal to go to school or other places away from home
- Fear of harm befalling loved ones when separated - Physical symptoms such
as headaches, stomachaches, or nausea when separation is imminent -
Nightmares about separation or being alone - Clinging behavior or excessive
Symptoms need for reassurance

- Genetic predisposition, with family history of anxiety disorders -

Environmental factors such as stressful life events or family disruptions -
Overprotective parenting styles or early traumatic experiences related to
Causes separation

- Impairment in social relationships, academic performance, and overall quality

of life - Interference with normal developmental tasks, such as gaining
independence and autonomy - Increased risk of developing other anxiety
Impact disorders later in life

Prevalence - Estimated prevalence of 4-5% in children aged 7-11 years

- Establish predictable routines and rituals to provide a sense of security -

Encourage gradual exposure to separation situations, starting with short
separations and gradually increasing duration - Teach coping strategies such as
deep breathing, positive self-talk, or visualization techniques - Seek
Tips for professional help if symptoms persist or significantly interfere with daily
Parents functioning

- Cognitive-behavioral therapy (CBT) focusing on gradual exposure, cognitive

restructuring, and relaxation techniques - Parent-child interaction therapy to
improve attachment relationships and communication skills - Medications such
as selective serotonin reuptake inhibitors (SSRIs) in severe cases, under the
Treatment guidance of a qualified healthcare provider

Phobic Anxiety Disorder of Childhood

Aspect Description

- Persistent and excessive fear or anxiety about a specific object or situation,

Symptoms
such as animals, storms, or medical procedures - Avoidance of the phobic
Aspect Description

stimulus or enduring it with intense distress - Physical symptoms such as rapid

heartbeat, sweating, trembling, or nausea when exposed to the phobia -
Recognition that the fear is excessive or unreasonable but feeling unable to
control it

- Genetic predisposition, with family history of anxiety disorders - Traumatic

experiences or conditioning related to the phobic stimulus - Learned behavior
Causes through observation or modeling, such as witnessing a parent's fear reaction

- Disruption of daily activities, social relationships, and academic

performance - Avoidance behavior may lead to missed opportunities for
learning and growth - Increased risk of developing other anxiety disorders or
Impact depression later in life

- Prevalence rates vary depending on the specific phobia but may range from
Prevalence 3% to 8% in children and adolescents

- Provide a supportive and non-judgmental environment for the child to

express their fears and concerns - Gradually expose the child to the phobic
stimulus in a controlled and supportive manner, starting with less intense
exposures - Model calm and confident behavior when dealing with anxiety-
provoking situations, while also acknowledging the child's bravery - Seek
Tips for professional help if symptoms persist or significantly interfere with daily
Parents functioning

- Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive

restructuring, and relaxation techniques - Systematic desensitization to
gradually confront the phobic stimulus in a hierarchical manner - Medications
such as beta-blockers or benzodiazepines in severe cases, under the guidance
Treatment of a qualified healthcare provider

Social Anxiety Disorder of Childhood

Aspect Description

- Fear of embarrassment, humiliation, or rejection in social situations - Avoidance

of social interactions, particularly with unfamiliar people or in performance
situations - Physical symptoms such as blushing, sweating, trembling, or
gastrointestinal distress - Excessive self-consciousness or worry about being judged
negatively by others - Difficulty initiating or maintaining conversations, making eye
Symptoms contact, or speaking in public

- Genetic predisposition, with family history of anxiety disorders - Negative

experiences or traumas related to social interactions, such as bullying or rejection -
Causes Overprotective parenting styles or high levels of criticism and scrutiny
Aspect Description

- Impairment in social relationships, academic performance, and overall quality of

life - Increased risk of depression, substance abuse, or academic underachievement
in adolescence and adulthood - Interference with developmental tasks such as
Impact forming friendships, dating, or pursuing educational and career goals

Prevalence - Estimated prevalence of 2-4% in children and adolescents

- Encourage participation in social activities that match the child's interests and
abilities, while respecting their comfort level - Role-play social situations at home
to practice social skills and build confidence - Provide positive reinforcement for
brave behavior and efforts to overcome anxiety, while also acknowledging the
Tips for challenges and providing support - Seek professional help if symptoms persist or
Parents significantly interfere with daily functioning

- Cognitive-behavioral therapy (CBT) focusing on exposure therapy, cognitive

restructuring, and social skills training - Group therapy to provide opportunities for
social interaction and peer support - Medications such as selective serotonin
reuptake inhibitors (SSRIs) or selective serotonin-norepinephrine reuptake
inhibitors (SNRIs) in severe cases, under the guidance of a qualified healthcare
Treatment provider

Sibling Rivalry Disorder

Aspect Description

- Jealousy or resentment toward the younger sibling - Attention-seeking behavior to regain

Symptoms parental attention - Aggression toward the sibling, such as hitting or teasing

- Competition for parental attention or resources - Changes in family dynamics and

Causes routines due to the new sibling - Individual temperament and coping styles

- Disruption of family harmony and cohesion - Long-term effects on sibling relationships

Impact and self-esteem

- Sibling rivalry is common in families with multiple children, with varying degrees of
Prevalence severity

- Acknowledge and validate each child's feelings and needs - Encourage positive sibling
Tips for interactions through shared activities and cooperative play - Set clear boundaries and
Parents consequences for aggressive or inappropriate behavior

- Family therapy to address underlying family dynamics and improve communication -

Treatment Individual therapy for children to express and process their feelings in a safe environment