“You Can’t Make Me!” Disruptive Behavior Disorders
By Jackson Ranier, Ph.D.
The healthy passage of maturation is marked by an increased sense of individual autonomy and independence. To learn independence, children must push and test the limits of authority. Depending on their developmental level, children and adolescents will balance a sense of freedom of thought and action with protection from harm. Permeable boundaries that maintain a sense of belonging and connection to others while maintaining the wish to be separate build the capacity for strong, wholesome relationships. Developmentally, adults desire that children grow prosocially and become progressively more cooperative, positive and interested in satisfying social behavior.
However, all parents and teachers know children and adolescents will, at some point, refuse to see adult requests and directions as reasonable, which creates fertile ground for arguments. Children and teenagers will also make hollow promises from time to time, “forget” to complete tasks and become sullen and irritated when reminded. For most, these episodes of oppositional behavior are mild, brief and isolated incidents. Such scuffles are a part of growing up. Most children are shaped by the trial-and-error process of pushing against those in charge. There is a smaller group of children, though, with pervasively irritating and oppositional attitudes and behaviors that crystallize into habitual reactions against the desires of adults. The patterns of misbehavior undermine these kids’ satisfaction and effectiveness in daily living and cause the adults in their lives to tear their hair out in consternation and distress.
The extreme of misbehavior is called antisocial and is defined by recurrent violations of socially prescribed patterns of behavior. Such behavior is marked by hostility to others, aggression, a willingness to commit rule infractions, defiance of authority, lying, destruction of property and violations of the social folkways and customs of the community and larger society. When antisocial behavior reaches the point that it is identifiable as a typical, observable pattern in the child, it can be diagnosed as one of two types of a disruptive behavior disorder. A child with a conduct disorder is considered to be more serious than one having an oppositional-defiant disorder. Both types are characterized by varying degrees of delinquency, school failure, vocational maladjustment, difficulties in interpersonal relationships and distress that are predictable in the child’s developmental movement toward adulthood.
Regrettably, disruptive behavior disorders do not remit without active intervention. Without close attention and help, they are asocial patterns persisting into adulthood, when the individual may be diagnosed with an antisocial personality disorder. Excellent empirical evidence exists concerning the antisocial behavior patterns that emerge during childhood and adolescence:
• The majority of disruptive behavior disorders occur in boys, although girls are rapidly emerging with problems of interpersonal relational aggression.
• There are two types of antisocial behavior: overt, which involves acts against people, and covert, which involves acts against
property and/or self-abuse. By adolescence, many at-risk children display both forms, which escalates their risk status substantially.
• Three years after leaving school, 70% of antisocial youth have been arrested at least once.
• The more severe the antisocial behavior pattern, the more stable it is over the long term and across settings.
• Children who grow up with antisocial patterns are at severe risk for long-term negative developmental outcomes, including school dropout, substance abuse, vocational maladjustment and high mortality rates.
When to Be Concerned
• Brief intense depression, anxiety
• Unforgiving of others
• Recurring aggressive emotional eruptions
• Individual antisocial acts with little regret, guilt or remorse
• Isolation and withdrawal from normal activities
Disruptive children generally come from families where discipline is either extremely harsh, laissez faire and too permissive or a mixture of both. The key to poor discipline in these homes is based on inconsistency. Children with disruptive behavior disorders will spend much of their time outside the home, or, if they are restricted to the home, will elude parental observation, guidance and supervision.
Some children create a world of their own via the Internet and computer technology, effectively closing themselves off from family influence. Current research on teenagers with disruptive behavior disorders says that this age group “plays” to an imaginary audience, fed by fantasies that can be visually realized by accessing the resources of the computer. It is a truth that every human, adolescent or adult entertains fantasies of one kind or another. By definition, a fantasy is an imagined or conjured sequence of thoughts that fulfill a psychological need. As we age, the realization is learned and reinforced that the world does not always bend to individual wishes. The strength of fantasy decreases. However, as entertainment technology advances, it becomes easier to bypass this reality, so that virtual versions of the fantastic wishes of antisocial youth can be enacted. Such enactment blurs boundaries between what is real and what is imagined. As one young fellow said, “I like to play video games because I can ‘get even’.” For a teenager with poor boundaries and a malformed sense of himself, such virtual play reinforces isolation and fortifies anger.
Regretfully, those children with disruptive behavior diagnoses are most often destructive and difficult to manage. Given the stability of the syndrome and the relatively strong association to antisocial behavior into adulthood, most people agree that the earliest possible interventions will target three primary settings: the home and parents, the school and teachers and the social life with peers.
In the family, order and consistency have been noted as benchmarks for stability. Lowering the emotional temperature of family members is critical if responsibility is to be accurately attributed to standards of behavior. It is not unusual to find that parents will display the same behaviors they find so offensive in their oppositional child. A father’s 13-year-old son was mandated to a prescribed school alcohol and drug program when marijuana was found in his school bag. The father admitted “smoking dope” on a daily basis, but said, “It’s an adult privilege and he’s not an adult.”
Students with disruptive behavior disorders are at high risk for failures in adjustment with teachers and peers. Because of their high rates of aggressive behavior, antisocial students are especially vulnerable to social rejection by their non-antisocial peers. If they are also noncompliant with teacher directives or engage in oppositional behavior, then rejection by teachers is also a real possibility. In combination, these behaviors nearly ensure a negative outcome, marked by low grades, low classroom motivation, poor study skills and a negative attitude toward learning.
The social impact of aggressive youth registers strongly within their peer group. They display poor judgment in daily situations. They do not pick up on social cues and will interpret events according to their own negative belief systems. Although many oppositional children and adolescents know the difference between right and wrong, they choose not to apply their knowledge. One teenager said, as he was being dressed down by a teacher, “I just don’t think about that stuff when I get into trouble.” The inability to connect behavior with consequences is common.
Treatment for children and adolescents with disruptive behavior disorders requires understanding how misunderstood the youth feels. Such a paradox allows adults a window into the child’s inner world. While antisocial behavior “requires” contempt for any help from others, understanding a young person’s worldview can encourage strong connections. Most disruptive behavior disordered kids will deny having problems. As one young girl said, “It ain’t my problem. It’s everybody else’s.” When challenged that many adults were worried about her, she said, “That’s not my problem, either. I don’t need help.” Change comes through an alliance with a goal of helping the young person view him or herself through others’ eyes. Most diagnosed children and adolescents will have difficulty seeing how they come across to others; many have distorted self-perceptions. It is useful and healing for them to have the benefit of objective feedback from an adult in whom they trust. If the child cannot form such alliances with those adults in the community, then professional intervention from a mental health clinician is required.
Multisystemic intervention with the individual, his or her family and school and community resources increases the likelihood of success. Healing proceeds more effectively when there are stable, broad-reaching resources, and it is more difficult when the youngster is deeply entrenched in a pattern of severe disruptive behavior with fewer resources available.
When to Worry
• Absence of morality
• Refusal to take any responsibility for actions
• Intimidation of parents into defensive behaviors
• Chronic, repetitive destructive acts
• School failure or legal problems.
Rainer, J.P. & Brown, F.F. (2007). Crisis counseling and therapy. Binghamton, NY: Haworth Press.
Rainer, J.P. (2001). Reaching at-risk and unmanageable adolescents: strategies for practitioners. In Vandecreek, Leon (Ed.), Innovations in Clinical Practice, 19, p. 35 - 49. Sarasota, FL; Scholastic Research Press.
Jackson Rainer, Ph.D., is Dean of the Graduate School and a Professor of Psychology at Gardner-Webb University in Boiling Springs, North Carolina. He has been a practicing psychologist with adolescents and families for more than twenty years.