Disruptive Behavior Disorder - Not Otherwise

Disruptive Behavior Disorder Not-Otherwise-Specified
The material on this page was original an e-mail sent to members of
the BehaviorAdvisor.com B-list. To sign up, go to: http://behavioradvisor.com/12001.html
Hello fellow B-Lister! As we continue with our every-weekend discussion of "The kids in our classroom",
this week we look again at one of our greatest concerns: Disruptive Behavior. Today, we look at it
through a medium-strength lens.
We’ve talked previously about Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant
Disorder (ODD) and Conduct Disorder (CD). All three conditions are found in a section of the DSM-IVtr
mental health manual titled “Attention-Deficit and Disruptive Behavior Disorders”. But there is one
more condition in that section that we haven’t yet talked about: Disruptive Behavior Disorder Not
Otherwise Specified (NOS) (or the ICD-9 equivalent, “Conduct Disorder
In order to warrant a diagnosis of Disruptive Behavior Disorder – NOS, a youngster must be ruled out of
ADHD as the primary issue (although it can co-exist with DBD-NOS... referred to as being "co-morbid"),
and display some of the criteria of ODD (often a precursor to CD) and/or CD, but not enough to fully
enter those domains. The Not Otherwise Specified diagnosis indicates that there is a real and significant
behavioural maladjustment, but more time and information is necessary to determine if it enters the
realms of ODD and CD. Strong evidence of impaired social abilities, problematic interactions at home,
and/or disruptive actions in school and at home has been documented, but it is, at present, not far
enough along the continuum to justify the ODD or CD diagnosis. Does the NOS label sound a bit
tentative or even timidly avoidant? Does it strike you as a catch-all garbage can diagnosis into which any
vague and nebulous behavior pattern can be thrown?
claims, but there are also valid reasons for the identifier:
Some professionals make those
The circumstances of the youngster’s behavior are unique
The behavior is perplexing and oddly structured
Continued observation is necessary to rule out other possibilities
More information needs to be gathered before a specific and more intensive diagnosis can be
One of the wonderful graduate students in my teacher training program in behavior disorders created a
great Powerpoint slide show on the topic. Using the case history of a hypothetical, but realistic student
(“C”), the behavior is aligned with the DSM criteria before approaches and interventions are
identified. You can find the script for each slide in the notes section under it.
Here are a few more suggested approaches and strategies:
1. Rob Plevin’s 3 free videos on working effectively with disruptive classes is still available.
2. Develop a removed, but caring approach when dealing with disruptive actions. One of the best pieces
of advice I ever received was from a mentor assigned to help me back when I was having problems in
the classroom. I was taking things personally and reacting in a negative, hostile manner because these
kids were keeping me from teaching. My mentor told me about how the emotions that we feel are
dependent on the way in which we interpret situations. When a kid would act out, instead of thinking
"Dammitt. This kid is getting in the way of my teaching and the learning of others. I'm letting this kid
know who is boss", I learned to think "Kid in crisis who needs competent assistance right now. How can
I help him/her?" Instead of resentment leading to anger (anger is a secondary emotion that follows a
primary one), I felt compassion. Helpful, supportive interventions came to mind. Sizing up a situation
differently brings out the master teacher mindset.
3. Teach the behaviors we wish to see via modeling.
4. Directly teach appropriate actions, social skills, anger management strategies, problem solving, and
5. Get the counselor involved in teaching cognitive behavioral strategies (How to size up situations
differently, thus influencing feelings and actions).
6. Provide more supervision than is necessary with other students.7. Build positive relationships to
enhance chances of cooperation and compliance.
8. Make use of strong, research-supported, positive interventions
8a. Differential reinforcement: It's a twenty Peso/Yen/Deutchmark term for a one monetary unit idea,
but the different variations of the DR procedure are highly effective with intervention resistant kids.
8b. Self monitoring: Promote self-regulation of behaviour by having the student keep track of his/her
9. Pick up additional defiance-defusing tips.
10. Teach problem solving skills to devise alternative solutions to anger and rebellion.
Modify the character of the youngster using the Circle of Courage model of
intervention. This model and materials can "turn around" an errant kid. It's a powerful and positive
The Behavior Transformation Guide allows you to determine a youngster's present level of
readiness to change his/her behaviour. Based on the oucome of the assessment, strategies are provided
to move the youngster toward greater levels of willingness to change his/her behavior for the better.
Use "The Behavior Survival Guide for Kids: How to make good choices and stay out of
trouble”. The self-help book for kids with behavior disorders continues to receive RAVE reviews. Put in
on the book shelf or use it as the social skills curriculum.
14. Implement the FREE 100+ lesson plans that accompany The Behavior Survival Guide (or use them in
15. Engage the youngster in Multi-Systematic Training(MST: http://mstservices.com/index.php/what-ismst)
16. For girls who tend to me more responsive to peer-influence and empathy-based interventions than
boys, provide this intervention focus.
1. Develop a home-school behavior change program based on the monetary system.
Learn the principles of changing behaviour for the better, and effective strategies
for helping your child make better behavior choices.
Leave “The Behavior Survival Guide for Kids: How to make good choices and stay out of
trouble” out on the coffee table for your child to pick up.
4. Seek out family counseling.
5. If your child is engaging in drug abuse, seek out drug-exit programs. One research study showed that
1/2 of drug users with conduct disorder no longer exhibited the disorder when free of illicit substances.
6. For girls who tend to me more responsive to peer-influence and empathy-based interventions than
boys, seek out this intervention focus.
7. Acquire the comprehensive program designed specifically to help parents of children with Conduct
Disorder/highly disobedient behavior change their child's behavior for the better. (Click on the Total
Transformation box below)
NEXT WEEK: Anxiety.
Best regards,
Dr. Mac
Author: Tom McIntyre, Ph.D. [email protected]
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