Adolescent Behavioral Problems

Adolescent Behavioral Problems:

Introduction This paper shall examine the field of child psychology in respect to the topic of conduct disorder (CD). In child psychology, conduct disorder is an extremely difficult subject to accurately address and clarify, due primarily to the need to distinguish between normal childhood behaviors and the onset or development of an actual disorder. Once a child matures to the stage where he or she is allowed into the school system, however, it becomes pressing to identify and clarify the presence of CD in order to better assess the behaviors of that child. This paper shall investigate the issues and the psychological development of conduct disorder in both the childhood and the adolescent years. The diagnosis of conduct disorder shall be compared and contrasted against oppositional defiant disorder (ODD) and the correlation that conduct disorder has with attention deficit hyperactivity disorder (ADHD). Standard medical definitions for these disorders, as well as the growing body of literature on this field, shall be included to better round out the discussion and to signify the impact of such disorders on children and adolescents.

Conduct Disorder Conduct disorder (CD) is defined by the American Association of Child and Adolescent Psychology (AACA) as: " 'Conduct disorder ' is a complicated group of behavioral and emotional problems in youngsters. Children and adolescents with this disorder have great difficulty following rules and behaving in a socially acceptable way. They are often viewed by other children, adults and social agencies as "bad" or delinquent, rather than mentally ill." (AACA: 2000) The AACA then classifies the disorder through providing a list of behaviors that children suffering from CD often manifest in their daily activities, which includes:

- Aggression to people and animals
- Destruction of Property
- Deceitfulness, lying, or stealing
- Serious violations of rules

The AACA defines and describes the extent and impact of such behaviors, but then continues in suggesting that the primary hazard found in CD is not primarily due to the CD itself, but rather due to the additional disorders that frequently accompany a manifestation of CD. The AACA states:

"Many children with a conduct disorder may have coexisting conditions such as mood disorders, anxiety, PTSD, substance abuse, ADHD, learning problems, or thought disorders which can also be treated. Research shows that youngsters with conduct disorder are likely to have ongoing problems if they and their families do not receive early and comprehensive treatment. Without treatment, many youngsters with conduct disorder are unable to adapt to the demands of adulthood and continue to have problems with relationships and holding a job. They often break laws or behave in an antisocial manner.
"Many factors may contribute to a child developing conduct disorder, including brain damage, child abuse, genetic vulnerability, school failure, and traumatic life experiences." (AACA: 2000)

The research on conduct disorder strongly cautions that the problems found within CD are not strictly manifested by the child, but rather can be triggered from external or internal causes and – more importantly – promoted through the presence of other diseases and the lack of sufficient or timely treatment to keep the disorder in check. This, researchers caution, is the primary reason why CD among adolescents can be seen as a much more problematic manifestation of the disease than among children, for the initial form of conduct disorder has been allowed to run unchecked and therefore has had the opportunity to take on more dangerous attributes. One source suggests that CD in children is less serious than in adolescents because of the lack of exposure to stimulus that can promote social development problems, like excessive contact with video games and television. There are many forms of psychological disorders that are found in conjunction with conduct disorder. Two of the most common types of these associated disorders are oppositional defiant disorder and attention deficit hyperactivity disorder. These disorders shall now be examined to clarify their impact on children and adolescents.

- Oppositional Defiant Disorder (ODD) Where conduct disorder is classified as behavioral and emotional problems in both children and adolescents, oppositional defiant disorder (ODD) is classified as a combination of aggression and a tendency to purposefully bother others. This combination is psychologically effective for the afflicted individual: A child suffering from ODD will be "rewarded" in terms of attention for his or her socially- negative behaviors, while an adolescent can use the motivation from ODD to act out against authority in a psychologically gratifying manner.
Statistically, it is believed that approximately 5 % of all children and adolescents in the United States manifest some form of ODD. Child psychologists find that ODD is almost always associated with CD, indicating that there is a strong correlation between CD and ODD. Research also indicates that adolescents are more likely to have manifested this disorder than children, which in turn suggests that CD is a precursor to ODD. However, there is mounting evidence that suggests that there are potential outside instigators for both CD and ODD, such as prenatal smoking. One source reports that: "Women who smoke more than half- a- pack of cigarettes a day during pregnancy are significantly more likely to have a son with conduct disorder than mothers who did not smoke during pregnancy." (CQS: 1999)
Similar to CD, those afflicted with ODD manifest the following symptoms, where there are two definite facets of the disorder:

- [First] A pattern of negativistic, hostile, and defiant behavior lasting at least six months during which four or more of the following are present:
1. Often loses temper
2. often argues with adults
3. often actively defies or refuses to comply with adults ' requests or rules
4. often deliberately annoys people
5. often blames others for his or her mistakes or misbehavior
6. is often touchy or easily annoyed by others
7. is often angry and resentful
8. is often spiteful and vindictive
- [Second] The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning. [Author 's note: The previous criteria are then clarified in terms of time and frequency between flare-ups.]

Again, those in the field of research strongly caution that if a child or adolescent is successfully diagnosed with ODD than other psychological disturbances be examined and clarified. Again, the longer ODD has been left untreated in a child the more likely that other psychological disorders can manifest in turn, and the more likely it is for ODD to have developed into multiple behavioral disorders. One study suggests that as many as forty percent of all adolescents that have ODD have a serious form of behavioral problem called attention deficit hyperactivity disorder. (Kuhne et al.: 1997)

- Attention Deficit Hyperactivity Disorder (ADHD) The prominence that attention deficit hyperactivity disorder (ADHD) has received in the media in recent years has caused this disorder to overshadow the presence of both CD and ODD, which indicates that there might be a strong chance that therapists and parents alike are working to cure their child 's symptoms but not the cause. As noted, ADHD is frequently associated with both CD and ODD, and the longer CD or ODD are left untreated the more likely ADHD will be added to the child 's psychological profile. The DSM-IV Diagnostic Criteria for ADHD (2000) cautions that there are multiple forms of ADHD and all are characterized by specific behavioral markers. These markers can range from aggression to inattention to hyperactivity – The type of ADHD manifested in a given child depends primarily on their behavior and the limits placed on their actions. The DSM-IV finds that there are four subcategories of ADHD, and are:

"ADHD, predominantly inattentive type
Meets inattention criteria for the past 6 months
"ADHD, predominantly hyperactive-impulsive type
Meets hyperactive- impulsive criteria for the past 6 months
"ADHD, combined type
Meets criteria for [both prior types] for the past 6 months
"ADHD, not otherwise specified
Prominent symptoms of inattention or hyperactivity- impulsivity that do not meet the criteria for ADHD
In partial remission." (DSM- IV: 2000)

The manifestations of ADHD are also of interest to researchers: In the past, it could be generalized that those suffering from ADHD were adolescents. This suggested that ADHD was not a spontaneous behavioral problem but rather was developed through neglecting various forms of psychological problems such as CD and ODD. The issue addressed under these circumstances was that ADHD was the result of untreated behavioral problems due to its onset in the later years of a child 's development, through their adolescent period. However, the disease is apparently manifesting more and more frequently within younger individuals, suggesting that either ADHD was not accurately predicted in the afflicted individual or that the disorder is triggered through other causes. Many researchers theorize that the later is the case, and are working to attribute a correlation between ADHD and various social stimuli such as video games and television. (NIH: 1998)

The Implications of Conduct Disorder on Children, Adolescents, and Education In both children and adolescents, the development of psychological disorders such as conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder indicate a flaw in the educational and the parenting strategies used to address those students. While the research is still inconclusive on the subject, there is a strong potential that the development of the initial conduct disorder will promote other behavioral disorders if left unchecked. As one of the most telling signs of these behavioral disorders is their impact on school performance and social behaviors, resources state that an aware and active parent should simply not be placed in a position where one of the many forms of conduct disorders was allowed to progress unnoticed. The earliest form of such behavioral problems is CD, and this type of disorder should generally be caught by the child 's parents. In worst- case scenarios, the educator could bring this disorder to the parent 's attention. Yet in more cases than believed possible, CD and ODD are allowed to progress within a child through adolescence. (NIH: 1998)
In terms of developmental problems for CD, ODD, and AHHD among adolescents, the educational system is often called upon to analyze the behavior of the student and assess whether or not they have a clinical behavioral problem. The concept of the school therapist catching behavioral issues is not a new one: Often, the educational system is believed responsible for instances in which a child or adolescent is living in an environment where they are exposed to some form of abuse. In many ways, this indicates that the school therapist is called upon to redress matters of parenting in the student: This is also blatantly evident in behavioral issues like CD, where an attentive parent should have had the ability and – more importantly – the knowledge of their own child – to catch serious behavioral problems. Indeed, many critics of the school system suggest that its biggest failing is the commonly- held belief that the school system should be responsible for catching such slips in basic modern parenting issues. However, in the modern execution of the education system it can be concluded that this argument is moot, and that the school therapist is expected – regardless of whether or not they should be in a position to do so – to assess the performance of a child or an adolescent.
School psychologists are not in a position of control over the treatment of a student that they believe might be afflicted with a serious behavioral disorder. The school psychologist needs to create a report and then suggest to the school board and to the parents of the child or adolescent that additional treatment options should be sought out and applied. The report, which should address the guidelines put forth by the DSM-IV and should contain the school psychologist 's personal opinions on the student and his or her behavior, should then be sent to a professional psychologist or psychiatrist. The student and parents should thereafter work with both the school psychologist, the professional independent therapist, and the student 's educators in order to accurately promote the desired behaviors in that student and eliminate those that are unwanted. (NIH: 1998)
In terms of treatment options that have proven effective in addressing behavioral issues, there are a wide and varied range of methods that can be used to address a student 's specific behavioral problems. Again, the actual type of treatment that will be recommended to the student 's parents shall be based on the age of the student and the severity of his or her behavioral problems. The goal of treatment is generally designed to help reduce the student 's resistance to authority and to help promote a more accepting view of social norms. The use of pharmaceuticals for ADHD has also become an increasingly popular treatment option. (DeGrandpre: 1999) Finally, while there are many different treatment options available, the parents should always be made aware of the fact that there are no easy solutions to behavioral problems and that constant vigilance is needed to help gradually eliminate these problems from the student 's behavioral vocabulary. The older the child, the more ingrained these behaviors and the more necessary it is to effectively target and eliminate them before they manifest into adult psychosis.

Bibliography

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: Author.

CQS. (1999) "Prenatal Smoking Linked to Conduct Disorder in Boys." Available online at: http://www.cqs.com/smokaspd.htm

DeGrandpre, Richard. Ritalin Nation. New York: W. W. Norton & Company, 1999.

Hoza, B. et al. (2001). "Academic Task Persistence of Normally Achieving ADHS and Control Boys; Performance, Self Evaluations, and Attributions." J. of Consulting and Clinical Psychology. Vol.69 (2)

Kuhne M, et. al (1997) "Impact of Co- morbid Oppositional or Conduct Problems on Attention-Deficit Hyperactivity Disorder." J Am Acad Child Adolesc Psychiatry. Vol.36 (12).

LeFever, Gretchen B. et al. (1999) "The Extent of Drug Therapy for Attention Deficit-Hyperactivity Disorder Among Children in Public Schools". Am J. of Public Health Vol.89.

National Institutes of Health (NIH). (1998) Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). Bethesda, MD: Author.

Renauld J, Birmaher B, et al. (1999) "Suicide in Adolescents With Disruptive Disorders." J. Am. Child Adolesc. Psychiatry. Vol 38. (7).

Short, R. J., & Shapiro, S. K. (1993) "Conduct Disorder: A Framework for Understanding and Intervention in Schools and Communities." School Psychology Review. Vol 22 (3).

Bibliography: American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: Author. CQS. (1999) "Prenatal Smoking Linked to Conduct Disorder in Boys." Available online at: http://www.cqs.com/smokaspd.htm DeGrandpre, Richard. Ritalin Nation. New York: W. W. Norton & Company, 1999. Hoza, B. et al. (2001). "Academic Task Persistence of Normally Achieving ADHS and Control Boys; Performance, Self Evaluations, and Attributions." J. of Consulting and Clinical Psychology. Vol.69 (2) Kuhne M, et. al (1997) "Impact of Co- morbid Oppositional or Conduct Problems on Attention-Deficit Hyperactivity Disorder." J Am Acad Child Adolesc Psychiatry. Vol.36 (12). LeFever, Gretchen B. et al. (1999) "The Extent of Drug Therapy for Attention Deficit-Hyperactivity Disorder Among Children in Public Schools". Am J. of Public Health Vol.89. National Institutes of Health (NIH). (1998) Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). Bethesda, MD: Author. Renauld J, Birmaher B, et al. (1999) "Suicide in Adolescents With Disruptive Disorders." J. Am. Child Adolesc. Psychiatry. Vol 38. (7). Short, R. J., & Shapiro, S. K. (1993) "Conduct Disorder: A Framework for Understanding and Intervention in Schools and Communities." School Psychology Review. Vol 22 (3).