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Disruptive Behaviours - Coggle Diagram
Disruptive Behaviours
ADHD
DSM 5 Diagnostic Criteria
Inattentive symptoms >6/9, hyperactive impulsive symptoms >6/9 (for greater than 17, 5 symptoms are required)
Inattention
Fails to give close attention to details, 2. difficulty sustaining attention, 3. does not seem to listen, 4, Does not follow through on instructions and fails to finish schoolwork, 5. Difficulty organizing, 6. Avoids/dislikes and reluctant to engage in tasks requiring sustained mental effort 7. Loses objects 8. Easily distracted 9. Forgetful in daily activities
Hyperactive Symptoms
Fidgets or taps hands, 2. Leaves seat in situations where sitting is expected, 3. Runs about or climbs, 4. Unabel to play or engage in leisure activities quietly, 5. Often on the go/driven by motor. 6. Talks excessively
Impulsive Symptoms
Blurts out answer before question is completed, 2. difficulty waiting his/her turn 3. Interrupts or intrudes on others
Several Symptoms must have been present
Several symptoms must be present >2 settings
Clear interference in functioning
Symptoms Not better explaiend by a medical condition
DDx
Learning problems, conduct disorder, mood, anxiety, reactive attachment, autism spectrum, sleep problems, substance related disorder, emdication, impaired hearing/vision, personality change
Assessment
Parent interview for developmental history, child/adolescent interview, information from teachers and other sources, rating scales, medical evaluation
Neurobiology
Genetics accounts, non genetic facotrs, parenting is not a cause of ADHD, polygenic disorder, dysfunction in cortico-striatal-thalamic, catecholamine dysfucntion
Parents with ADHD have 50% chance of passing onto child
Pharmacodynamics
Methylphenidate
Blcoks DA/NE transporters in the presynaptic neuron, thus inhibiting reuptake and resulting in increase synaptic concentrations of these neurotransmitters
Amphetamines
Stimualte release of DA and to a lesser extent, NE from presynaptic sites
Secondary effects involving inhibition of DA reuptake
Course of Disorder
Hyperactive symptoms more lilely to improve, and inattentive symptoms more likely to persist
Adults
Diagnostic Chalenges
More difficult to diagnose, requires presence of ADHD symptoms in childhood
Screning
Ask if ever diagnosed as a child, family member with ADHD, lifelong history of distractibility/inattention/disorganization
Diagnosis
1st step: Focused biopsychoscial history
2nd Step: brief childhood history/childhood ADHD Sx
3rd step: Assess lifelong and current ADHD symptoms
Treatment
Non Medication INtervention
Children
Psychoeducation, Behavioral parent management training, behavioral school and academic intervention
Adults
Psychoeducation, behavioural intervention and goal setting, assistive and organizational technologies, work place or academic accommodations
Stimulants
Methylphenidate (Ritalin, Biphentin, concerta), Amphetamines (Dexedrine, Adderall, Vyvanse)
Disruptive Behaviour Disroders
Oppositional Defiant Disorder
DSM5
Pattern of angry irritable mood, vindictiveness lasting at least 6 months by at least 4 symptoms from any of the following categories
Angry/Irritable Mood
Often loses temper, often touchy or easaily annoyed, often angry or resentful
Argumentative/Defiant Behavior
Often argus with authority figures, often desies or refuses to comply with requests from authority figuires, deliberately annoys others, blames others for his/her mistakes/misbehavior
Vindictiveness
Spiteful or vindictive at least twice in past 6 months
Disturbances in behavior assocaited with distress in indiviudal or others in his/her immediate social context
Behaviors do not occur exclusively during course of a psychotic substance use, depressive or bipolar disorder
Defining Features
Appears by age 8, age innapropritate, Severe age innapropriate ODD behaviors are not common in young children
Risk and Prognostic Features
Temperamental (facotrs related to problems in emotional regulation), enviornmental (harsh, inconsistent, or neglectful child rearing practices are common in families of children and adolescents)
Diagnosis
Course, developmental assessment, comorbidity, language and cognitive developmental abilities, trauma attachment and goodness of fit, screening questions sesnitive to ODD
DDx
ADHD, Depressive/Bipolar disoders, DMDD, intellectual disability, language disorder, social anxiety disroder
Conduct Disorder
DSM5
Repetitive and persistent pattern of behjavior in which the basic rights of others or major age appropriate nromals or rules are violated of at least 3/15 of the following criteria
Aggression to people and animals
often bullies/threatens/intimidates others, intiates physical fights, used weapn to cause serious harm, physically cruel to people, physcally cruel to animals, stolen confronting a victim, forced someone into sexual activity
Destruction of properly
Engaged in fire setting with intention of causing serious damage, deliberately destroyed other's properly
Deceitfulness or theft
Borken into someone's house, lies to obtain goods/favors, stolen items of nontrivial value withut confronting vic
Serious violations of Rules
Stays out at night, run away from home, truant from home
Disturbances causes clinically signfiicant impairment in social, academic, or occupation
If individual is 18 uears or older
Specifiers
Childhood onset (beofre 10), adolescent onset (after 10), unspecified onset
Specify with limited prosciocial emotions, lack of remorse or guilt
Diagnosis
Callous-lack of empathy, unconcerned about performance, shallow or defieint affect
DDx
Oppositional defiant disroder, depressive and bipolar disorder, ADHD, adjustment disorder
Treatment
Evidence based
Prent management training, problem solving skills training, stop now and plan, multisystemic therapy, multidimensional treatment foster care
Core elements
Behavior, parent child relationship building, problem solving skills, anger management, affect education, psychoeducation, homework, role-play