Disruptive behavior disorders

Abstract

Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder are a heterogeneous group of childhood onset behavioral disorders that are traditionally lumped together as Disruptive Behavior Disorders (DBD) because they share behaviors that cause significant disturbance and distress within the child's environment, usually school and/or family, as well as causing severe developmental and psychosocial dysfunction for the individual. ADHD is characterized by symptoms of inattention, impulsivity, and hyperactivity; ODD by hostility, anger, argumentativeness, and defiance; and conduct disorder by aggression, deceitfulness and violation of the rights of others. The DBDs play an enormous social role because they represent a high risk for developmental trajectories that harbor psychosocial, economic, psychiatric, and criminal morbidity across the lifespan and have significant socioeconomic and health impact on a national level. The DBDs may share comorbidities and some etiologic and pathophysiologic characteristics, however, their clinical manifestations, developmental trajectories, and biologic substrates are distinct. The explosion of neurobiological literature regarding the DBDs, most specifically on ADHD, reflects the complex, fluid, and often contradictory manifestations of brain-behavior relationships. This complexity is enhanced further by the accumulating research demonstrating significant differences in manifestations according to age, cognitive status, sex, comorbidities, psychosocial context, and treatment response. There is an enormous degree of individual variation shaped by the transaction of biological and environmental factors, which again has major implications for prevention and diagnostic and therapeutic interventions. For practical purposes, the current discussion focuses on each condition separately. © 2008 Humana Press, a part of Springer Science+Business Media, LLC.