Evidence-Based Psychosocial
Treatment of Disruptive Behavior
Disorder - Overview
Developed by the Center for School Mental Health with support provided
in part from grant 1R01MH71015-01A1 from the National Institute of
Mental Health and Project # U45 MC00174 from the Office of Adolescent
Health, Maternal, and Child Health Bureau, Health Resources and Services
Administration, Department of Health and Human Services
Defining Disruptive Behaviors
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Two main types of Disruptive Behavior
Disorders (DBD):
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Oppositional Defiant Disorder (ODD) – loses
temper, argues with adults, easily annoyed,
actively defies or refuses to comply with adults.
Conduct Disorder (CD) – aggression toward
peers, destruction of property, deceitfulness or
theft, and serious violation of rules.
Oppositional Defiant Disorder
A pattern of negativistic, hostile and defiant
behavior lasting greater than 6 months of which
you have 4 or more of the following:
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Loses temper
Argues with adults
Actively defies or refuses to comply with rules
Often deliberately annoys people
Blames others for his/her mistakes
Often touchy or easily annoyed with others
Often angry and resentful
Often spiteful or vindictive
Oppositional Defiant Disorder
(ODD)
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Prevalence-3-10%
Male to female -2-3:1
Outcome-in one study,
44% of 7-12 year old
boys with ODD
developed into CD
Evaluation-Look for
comorbid ADHD,
depression, anxiety
&LD/MR
Conduct Disorder
(CD)
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Aggression toward
people or animals
Destruction of
property
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Deceitfulness or
Theft
Serious violation
of rules
Conduct Disorder
(CD)
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Prevalence-1.5-3.4%
Boys greatly
outnumber girls (3-5:1)
Co-morbid ADHD in
50%, common to have
LD
Course-remits by
adulthood in 2/3.
Others become
Antisocial Personality
Disorder
Conduct Disorder
“You left your D_MN car in the driveway again!”
Disruptive Behavior Disorder NOS
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Disorders characterized by conduct or
oppositional defiant behaviors that do not
meet criteria for ODD or CD
Still must have impairment in functioning
MH interventions shown to be
EFFECTIVE for Disruptive behavior
and Willful misconduct problems
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“Parent Training in behavior management
has the clearest support for its efficacy,
having been evaluated in 24 controlled
tests…”
What is Parent Training?
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Why children misbehave – correcting
misperceptions
Identifying and removing barriers to effective
child management
Paying attention to and reinforcing child’s
good behavior (improving emotional
relationship)
Issuing effective commands (compliance
training)
Use of time-out
Reinforcement and response cost system
(tokens or points) for
appropriate/inappropriate behaviors
Extension to school and public settings behavior report card
ODD/CD: Practice Components
89
Tangible Rewards
Commands/Limit
Setting
73
70
Time Out
% of EBP w/
Practice
Component
68
Parent Priase
54
Problem Solving
0
20
40
60
80
100
What works for DBD?
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Most of the evidence-based practice elements
used for Disruptive Behavior Disorders have
their basis in Clinical Behavior Therapy.
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We covered the basic premises behind behavior
therapy in the first unit.
We will cover the specifics of effective interventions
for DBD in this unit.
Problem-solving is also effective for treating
students with Disruptive Behavior Disorders.
What doesn’t work for DBD?
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Treatments with little or no evidence of
effectiveness include
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Special elimination diets
Vitamins or other health food remedies
Psychotherapy or psychoanalysis
Biofeedback
Play therapy
Chiropractic treatment
Sensory integration training
Social skills training
Self-control training
Clinical Behavior Therapy:
Theory
Proposed Mechanism: Individuals with
ODD/CD have difficulty understanding the
consequences of their actions.
Approach: Application of the principles of
social learning theory to modify children’s
behavior by training parents and teachers
to manipulate environmental antecedents,
consequences and contingencies.
The ABC Model
Antecedents
Behavior
Contingencies
Consequences
An example: The ABC Model
Antecedent
9:30 bell signals
beginning
of math period
Behavior
Student ignores
bell while rest of
class takes out math
books
Consequences
Teacher yells at
student
The ABC Model
Antecedent
9:30 bell signals
beginning
of math period
Behavior
Student takes out
math book
Contingencies
Teacher makes
eye contact
with student,
says, “Take
out your math
books.”
Consequence
Teacher smiles
at student
Specific interventions to help the
ODD/CD student
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Parent praise
Commands/limit setting
Tangible rewards
Response cost
Parent monitoring
Time out
Psycho-education with parent
Problem solving
Resources
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Several empirically-supported protocols
exist:
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Defiant Children/Defiant Teens (Russell
Barkley)
Helping the Noncompliant Child (Rex
Forehand)
Videotape Parent Modeling (Carolyn
Webster-Stratton)
Resources
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Parent/Teacher DBD Rating Scale
http://ctadd.net/ctadd/PDFs_CTADD/DBD.pdf
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Vanderbilt Assessment Scales
http://www.nichq.org/nichq
Resources
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The University of Buffalo Center for
Children and Families
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http://wings.buffalo.edu/adhd/
Free resources on disruptive behavior
disorders:
Parent handouts
 Teacher handouts
 Assessment tools
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