74 Chapter 6
Wider environment
1 School factorshave been shown to affect the rate of disruptive behavioural
disorders independently of home background: poorly organised, un-
friendly schools with low staff morale, high staff turnover and poor
contact with parents have higher rates of disruptive behavioural dis-
orders even when catchment area characteristics have been allowed for.
2 Wider social influences. Though disruptive behaviour is associated with
overcrowding, poor housing, and poor neighbourhoods, it is still unclear
if these factors are causal or simply markers for other family or socio-
economic variables. A prevailing set of values in a neighbourhood that
gives youths kudos for stealing, carrying knives, truanting and gaining
‘respect’ from others through frightening violence and joining a gang is
associated with more conduct disordered behaviour by residents.
Assessment
The severity and frequency of defiant, aggressive and antisocial acts in
the last month or so should be established in detail. Some parents are
prone to catalogue all ‘bad’ things done over the last year or even since
birth. Attention and activity should be enquired about in the same detailed
way (see Chapter 5) since ADHD is a common and easily overlooked
accompaniment (or differential diagnosis) of disruptive behavioural dis-
orders. Though it is worth enquiring about impulsiveness, this could be
part of either ADHD or a disruptive behavioural disorder. Do not forget to
enquire about emotional symptoms, particularly unhappiness and misery.
Part of the problem may derive from things that are upsetting the child
or adolescent, for example, a father who often fails to turn up for his
access visits, or a mother who never seems to appreciate her child’s efforts,
however hard he or she tries. The strength of these concerns may only
come out in an individual interview, and could easily be missed if the
family is only ever seen together. Remember to ask about autistic traits
(see Chapter 4) and also callous-unemotional characteristics.
Parenting practices should be enquired about in detail, with a blow-by-
blow account of what happens before, during and after a recent episode of
troublesome behaviour. Who ‘won’ the encounter? What was said? What
punishments or consequences were used and did they work? How long did
it take for relations to return to normal? More generally, ask how much
praise and encouragement is given for constructive behaviour, and how
much time is spent in joint activities. Get detailed recent examples. Try
to gauge the parents’ sensitivity to their child’s moods and needs, and
how much they take these into account when negotiating how to settle
disagreements and planning their child’s life.
Consider the parents’ emotional tone and attitude towards their child.
Asking about the child’s good qualities can be helpful. Is there some
warmth and approval despite the child’s difficulties, or is the tone entirely
negative? Powerful beliefs may be discovered, which will need to be