Overview of disruptive behaviour disorders in children

Disruptive behaviour disorders are conditions involving problems in the self-control of emotions and behaviours, and includes:

• oppositional defiant disorder—characterised by patterns of argumentative behaviour, angry mood and revengeful actions
• conduct disorder—characterised by aggression and breaking the law deliberately by engaging in activities such as lighting fires, shoplifting and vandalism.

Disruptive behaviour disorders are relatively common in the community, occurring in about 10% of children and are often comorbid with other conditions (eg major depression, anxiety disorders, attention deficit hyperactivity disorder, autism spectrum disorder, intellectual disability). If a disruptive behaviour disorder is suspected, refer to a psychiatrist or age-appropriate mental health service for confirmation of the diagnosis. Disruptive behaviour disorders commonly have a chronic course and a significant adverse impact on children and their families.

For the management of disruptive behaviour disorders in people with an intellectual disability, see Challenging behaviour.

Psychosocial treatment is first line for managing disruptive behaviour disorders. Provide psychoeducation, and refer to a psychologist, psychiatrist or age-appropriate mental health facility to address issues in the parent-child relationship—behavioural management and parenting programs are used.

Pharmacological treatment has a limited role in managing disruptive behaviour disorders, but may be considered if psychosocial treatment is not effective or if the patient is extremely aggressive. If pharmacotherapy is considered necessary, refer the patient to a psychiatrist or an age-appropriate mental health service.

Assess and treat comorbid conditions with psychosocial interventions and, if required, pharmacotherapy.