CHAPTER 6
Disruptive Behaviour
According to most epidemiological studies, the commonest sort of child
and adolescent psychiatric disorder involvespersistent failure to control be-
haviour appropriately within socially defined rules. It is often persistent, costly
for society, and not treated successfully. There are three overlapping do-
mains of disruptive behaviour:defianceof the will of someone in authority,
aggressivenessandantisocial behaviourthat violates other people’s rights,
property, or person. None of these is in itself abnormal or pathological
and indeed there are occasions when one tries to promote some of these
behaviours in over-dependent children. Some disobedient and destructive
behaviour is a part of normal development that usually diminishes with
maturity, and a diagnosis should only be made when the behaviours are
both extreme and persistent.
The naming of disruptive behavioural disorders involves a mixture of
straightforward and confusing elements. Let’s start with the straightfor-
ward bits. Both ICD-10 and DSM-IV recognise a category ofoppositional-
defiant disorder(ODD) where, as the name suggests, defiance is a major
ingredient. The other major behavioural disorder in DSM-IV is calledcon-
duct disorder(CD) and has aggression and antisocial behaviour as its major
ingredients. In DSM-IV, ODD and conduct disorder are alternatives – you
either have one or the other, but you are not officially allowed to have
both. So far, so good. Now for the confusing bit. In ICD-10, the term
‘conduct disorder’ refers to any sort of disruptive behavioural disorder –
including ODD and what DSM calls conduct disorder. You can imagine
how this muddles clear communication. For the ICD-orientated clinician,
ODD is a sub-type of (broadly defined) conduct disorder; for the DSM-
orientated clinician, ODD is different from a (narrowly defined) conduct
disorder. Beware! Whenever you see the term ‘conduct disorder’, make
sure you know if this is the narrowly defined DSM term or the broadly
defined ICD term. In this book, we use the termdisruptive behavioural
disorderto denote the broader term.
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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