Child and Adolescent Psychiatry

Disruptive Behaviour 71

Box 6.3The symptoms of ADHD and disruptive behavioural

disorders overlap

Disruptive

behavioural

disorder

defiance

antisocial behaviour

aggression

impulsiveness

restlessness

inattention

ADHD

5 Autistic spectrum disorders: these are often accompanied by marked
tantrums or destructiveness, and the disruptive behaviour is occasion-
ally the principal cause for referral. A number of children and ado-
lescents meet the criteria for a disruptive behavioural disorder while
also having some traits on the autistic spectrum (but not enough for a
diagnosis).

Epidemiology

A disruptive behavioural disorder was diagnosed in 4% of children in the
classic Isle of Wight study, and more recent Office of National Statistics sur-
veys of children and adolescents confirm an overall rate of 5%; many other
studies have reported even higher rates. The prevalence is particularly high
in deprived inner-city areas. Boys display disruptive behavioural disorders
around three times more commonly than girls. Disruptive behavioural
disorders are associated with lower socio-economic status (this covers a
multitude of variables), and large family size. The age of onset can vary
considerably. The Dunedin study found a clear distinction between early
and late onset conduct symptoms:

Early onset(typically around age 3–7 years) was found in 7% of the

population and led to a pattern of persistent antisocial and offending be-

haviour that in over half carried on into adulthood, so that there was no

diminution when the participants were last studied in their thirties. This

early onset, lifetime persistentpattern is characterised by increased levels

of many parenting risk factors (teenage parent, harsh and inconsistent

discipline, family conflict, maternal mental health problems, changes of

primary caregiver) and neurocognitive risk factors (hyperactivity, lower