Disruptive Behaviour 67social and relationship skills), gives information regarding prognosis, and
carries information about which treatments are likely to be effective.
Disadvantages of a category
There is the risk that an all-or-nothing classification that divides individ-
uals into those with and without a disruptive behavioural disorder might
create an us-and-them attitude that adds to the marginalisation of troubled
families. A diagnosis can also lead to the belief that the individual has an
immutable, biologically determined entity, for which little can be done. A
further disadvantage is that many professionals (for example, teachers and
social workers) and lay people outside medicine are not familiar with the
terms ‘conduct disorder’ or ‘oppositional-defiant disorder’ so that often it
does not help their understanding or management of children with the
problem.
In summary, both approaches have their advantages, and the wise
practitioner will try to bring the best of both to bear.
Is disruptive behaviour a psychiatric problem?
Whether disruptive behaviour should be assessed or treated by child and
adolescent mental health professionals is debatable. Certainly, the diffi-
culty is one of behaviour that is beyond the normal range and is causing
impairment or burden to others. However, so is smoking 40 cigarettes a
day as a teenager or driving motorcycles at 100 mph, yet these are more
likely to be seen as social or moral problems than health problems.
Perhaps those cases of disruptive behaviour that are clearly socially
determined and where management is solely a matter of discipline or
behaviour management could be seen as the province of social services,
education, or voluntary agencies. To be maximally effective, these other
agencies would need to acquire a wide range of assessment and man-
agement skills, many of which were originally developed within mental
health disciplines. They would need to be able to recognise the minority of
individuals with problems such as ADHD or depression who could benefit
from referral to mental health professionals, and to recognise learning
problems that could benefit from referral to specialist educational services.
They would also need to be able to offer, or refer families to, evidence-
based parenting groups, which are becoming more available. Given the
high prevalence of disruptive behaviour, and the relatively small number
of child and adolescent mental health professionals, the practicalities of
effective service provision demand some such spread of expertise and
responsibility, as discussed in Chapter 43 on the organisation of services.
The long-term financial cost to the public of disruptive behaviour in
children and adolescents is great, at least ten times that of controls, and
falls on many agencies, so there is a justification on economic grounds for
several government departments to become involved in contributing to
treatment and prevention.