Learn about the signs, risk factors, and treatment for disruptive behavior disorders, such as oppositional defiant or conduct disorders.
Learn more about disruptive behavior disorders:
- Signs and Symptoms
- Risk and Protective Factors
- Evidence-based Treatments
- Complementary Therapies and Activities
- Recovery and Social Support Services and Activities
- Future Directions in Research and Treatment
- Finding Treatment
It is common for children and adolescents to sometimes argue, be uncooperative, and defy parents or teachers. This is more likely when they are overwhelmed or stressed. When angry or hostile behavior persists and leads to problems at home, school, or with friends, there may be a more serious issue.
Disruptive behavior disorders involve an ongoing pattern of uncooperative or hostile actions, such as temper tantrums, fighting, cruelty, arguing, and defiance toward parents, teachers, or other authority figures. Young people with these disorders find it hard to control their emotions and actions. This leads to problems at school and in relationships with family or friends.
The two most common disruptive behavior disorders are oppositional defiant disorder and conduct disorder.
Oppositional Defiant Disorder
Children and adolescents with oppositional defiant disorder (ODD) show ongoing hostility. They are irritable. They argue with parents, teachers, and friends. They often rebel, defy rules, and hold grudges. They often have problems behaving at school. All young people behave this way at times. A young person with ODD shows these symptoms regularly.
In ODD, a young person’s actions are worse than in other children of the same age. The symptoms interfere with daily life. Young people with ODD may show symptoms only at home at first. Over time, they may show symptoms in other settings such as school, activities outside of school, and relating to authority figures. Young people with ODD are at higher risk for depression or anxiety as they get older.
The three main types of ODD symptoms are: angry and irritable mood, argumentative and defiant behavior, and vindictiveness.
The symptoms are different in children younger than age five than in older children and adolescents.
Angry and Irritable Mood
Examples of angry and irritable mood include:
- Losing one’s temper often
- Being easily annoyed by others
Showing outbursts of rage or resentment toward others
Argumentative and Defiant Behavior
Examples of argumentative and defiant behavior include:
- Arguing with adults or other authority figures
- Defying rules or refusing to do things that an adult authority figure requests
- Deliberately annoying or upsetting others
- Blaming others for their own mistakes or misbehaviors
Examples of vindictiveness include:
- Showing a spiteful, nasty, or cruel attitude toward others
- Being mean, vengeful, or punishing toward others
Conduct disorder (CD) involves ongoing disruptive and violent actions that violate the rights of others, hurt others, or are not age appropriate. For example, a school-aged child might bully and physically fight with classmates, or an adolescent might destroy someone’s property.
Children who develop CD at a young age tend to have long-term behavior problems that last into adulthood. Often, young people with CD had ODD at a younger age. The symptoms of CD cause problems in daily life, such as at school, in friendships, or at home. Young people with CD have problems considering others’ needs or feelings.
The four main types of CD symptoms are: aggression to people and animals, destruction of property, deceit or theft, and serious violation of rules.
Aggression to People and Animals
Examples of aggression to people and animals include:
- Bullying, threatening, or intimidating others
- Starting physical fights
- Using weapons that can harm others
- Being physically cruel to people or animals
- Stealing from others, such as mugging or purse snatching
- Forcing others into sexual activity
Destruction of Property
Examples of destruction of property include:
- Setting fires
- Destroying others’ property
Deceit or Theft
Examples of deceit or theft include:
- Lying to get things from others
- Stealing things without others knowing, such as shoplifting
- Breaking into someone’s home, car, or building
Serious Violation of Rules
Examples of serious rule violations include:
- Breaking family rules, such as when to be home at night
- Running away from home overnight at least twice, or once without returning for a long time
- Often skipping school
Oppositional Defiant Disorder
ODD usually starts in preschool or childhood, and sometimes in early adolescence. About 3% of children have ODD. In young children, ODD is more common in males than females. In school-age children and adolescents, ODD occurs about equally in males and females.
About 8% of children and adolescents have CD at some point. Symptoms may start in preschool, but they usually start in middle childhood or adolescence. CD becomes more common in adolescence. It is more common in males than females. Males with CD usually have problems such as fighting, stealing, vandalism, and school discipline. Females with CD tend to show symptoms such as lying, running away, truancy, spreading rumors, and misusing friendships.
Risk Factors Across Disruptive Behavior Disorders
There is no single cause for these disorders. It is unclear why some children develop them. Biological, environmental, and psychological factors may play a role
Young people are more likely to develop disruptive behavior disorders if they have:
- A parent who had ODD or CD
- A parent who had other behavioral disorders, such as schizophrenia, depression or bipolar disorder, attention deficit hyperactivity disorder (ADHD), or a severe alcohol use disorder
- Differences in parts of the brain involved in mood, judgment, problem solving, perceptions of threats, and impulse control
In some cases, the following may be risk factors for a disruptive behavior disorder:
- Abuse or neglect
- Being abandoned by parents or guardians
- Chaotic environments, including lack of structure or rules
- Exposure to violence
- Parental criminality
The following may be risk factors for a disruptive behavior disorder:
- High emotional reactivity
- Difficulties controlling emotions
- Problems dealing with frustration
Many children and adolescents with disruptive behavior disorders have other disorders such as ADHD, anxiety disorders, depression, bipolar disorder, substance use disorders, or learning problems. Disruptive behaviors can be hard to treat if other disorders are not treated.
ADHD is the most common disorder tied to disruptive behaviors. Young people with both ADHD and disruptive behaviors tend to have more severe symptoms. ADHD combined with ODD tends to lead to more problems with aggression, misbehavior, and school performance. Delinquency in adolescence, aggression in adolescence, and serious violent offenses in adulthood are more likely in people with both CD and ADHD than with CD alone.
Early treatment is best. A trained professional should do a full evaluation to make the diagnosis. No single treatment works best. Treatments must address each person’s needs and symptoms. Treatment must consider the child’s age and development, severity of symptoms, any co-occurring disorder, and the child’s ability to participate in treatment. The treatment plan should consider the goals and abilities of family members.
A young person or caregiver should consult a healthcare professional when choosing the right treatment and consider the patient’s own gender, race, ethnicity, language, and culture.
Parent training, behavioral family therapy, and skills-based interventions are common approaches.
Parent training programs teach skills that family members can use to manage a child’s behavior. Skills include rewarding positive actions, communicating well, giving clear instruction, using discipline and supervision, and managing outbursts and aggression.
Examples of effective parent training programs include:
- Helping the Noncompliant Child (for children ages three to eight)
- Parent-Child Interaction Therapy (for children ages two to eight)
- Incredible Years Program (for children up to age 12)
- Triple P-Positive Parenting Program (for children up to age 16)
- Parent Management Training—Oregon Model (for children ages 2–18)
- The Kadin Method for Parenting the Defiant Child
- Familia Adelante (for high-risk Latino/Latina youth and their families)
Behavioral Family Therapy
Behavioral family therapy programs involve working with the family and the child or adolescent. The family learns how to support wellness. The programs can include parent training and ways to deal with complex behavior problems.
Multisystemic therapy focuses on all areas of life that might affect a person’s actions. This includes home, family, teachers, neighborhoods, and friends. The idea is that each area plays a role in how the person acts and reacts. Focusing on these areas helps improve the person’s life.
Functional family therapy is a strength-based approach. It focuses on risk factors and protective factors within and outside of the family. The person learns to avoid risk factors and build protective factors.
Brief strategic family therapy is a problem-focused approach. It focuses on skill building. It helps families overcome individual and family-wide behavior patterns. It provides strategies for bringing families into therapy.
Multidimensional treatment foster dare gives young people a place to stay in the community instead of hospital care, group homes, juvenile justice centers, or residential care. Families learn to provide treatment and supervision at home, in school, and in the community. The program emphasizes clear rules with follow-through on consequences and rewards for good behavior. It also includes guidance from a mentoring adult, and avoiding friends who may influence bad behaviors.
Skills-based interventions teach young people to deal with problematic events and actions. This includes how to relate to others, interpret situations, and respond to upsetting events. The interventions may be combined with other treatments to address severe disruptive behaviors:
- Cognitive behavioral therapy teaches young people skills to reduce behavior problems.
- Social skills training helps young people learn how to interact with peers.
- Cognitive problem-solving training and coping skills training teaches young people positive ways to respond to stressful events, cope with difficulty, and change thought patterns that lead to bad behaviors.
- Anger management is individual therapy that helps young people learn how to manage anger and respond better to situations.
- Aggression Replacement Training is a structured program for aggressive youth that teaches social skills and anger control, and builds awareness of fairness, justice, and concern for the rights and needs of others.
Medication alone is not used to treat disruptive behavior disorders. It may be useful as part of a treatment plan that includes treating ADHD, mood disorders, or anxiety disorders, or other physical or mental disorders. For example, when medication is used to treat ADHD, disruptive behaviors tend to decrease.
For basic information about medications, visit Mental Health Medications from the National Institute of Mental Health (NIMH). For up-to-date information on medications, side effects, and warnings, visit the Food and Drug Administration.
Complementary therapies and activities can help young people improve their well-being, and are meant to be used along with evidence-based treatments. For more information on natural products or mind-body practices, access the National Center for Complementary and Integrative Health.
Early Intervention and Prevention Programs
Dealing with early symptoms can help reduce or prevent problems tied to disruptive behavior disorders. Effective prevention programs, and early assessment and treatment, can help improve children’s actions and stop symptoms from getting worse.
Early identification screening for disruptive behaviors is sometimes done with preschool children who have behavior problems at school or at home. Identifying the child’s needs early and providing treatment and supports may improve outcomes for the child and family.
Parent training programs can prevent aggressive, disruptive, and antisocial actions by young people. Such programs teach parents how to:
- Develop warm, nurturing relationships with their children
- Replace harsh parenting with consistent discipline that sets boundaries for misbehavior
- Use positive parenting methods to reward good behavior
Schoolwide positive behavioral supports focus on improving classroom management and improving students’ relationships, self-awareness, decision-making, and social skills. The programs include consequences for misbehavior and rewards for good behavior. Students with severe behavioral needs may receive team-based services.
Stress management for families can help caregivers and families of young people with disruptive behaviors deal with frustration and respond calmly to misbehavior.
Mentoring programs for at-risk youth, community-based programs, and programs lasting a year or more can help young people with disruptive behaviors.
Solution-focused therapy helps young people with disruptive behaviors learn to achieve goals. This approach assumes that the person knows what would make life better. The sessions help the person take steps to improve their life.
Wraparound services can address the needs of young people with disruptive behaviors. This involves a team that plans community-based services. The team may include family members, service providers, teachers, and agency staff. They work together to create and use a personal care plan.
Substance use disorder treatment is often needed for children and especially adolescents with disruptive behaviors. Alcohol and drug use is common in this group and must be dealt with for other treatments to work.
Yoga, meditation, mindfulness activities, and participation in sports with an involved coach can help reduce disruptive behaviors.
Apps for health improvement and personal support are available for smartphones and tablets. The SAMHSA App Store and the federal National Center for Telehealth & Technology have free apps for download. For an up-to-date list of federal apps, access the Federal Government Mobile App Directory.
Self-help and support groups can provide youth and their families with knowledge and support to make treatment decisions that work for them. Organizations and websites provide self-help information and help youth and families find local support groups. They can help foster hope and promote outreach and engagement. This includes both youth peer-to-peer and family-to-family supports provided by a certified peer or family support specialist who can promote hope, foster recovery, and build resiliency skills. To learn more, visit the SAMHSA Recovery and Recovery Support topic.
Resources for young people with disruptive behavior disorders and their families include:
- Conduct Disorder Resource Center from the American Academy of Child and Adolescent Psychiatry (AACAP)
- Oppositional Defiant Disorder Resource Center from AACAP
- Family Run Executive Director Leadership Association (FREDLA)
- Conduct Disorder information from Mental Health America
- National Alliance on Mental Illness (NAMI)
- Effective Child Therapy from the Society of Clinical Child and Adolescent Psychology
- Youth MOVE National
Researchers are studying new medications and therapies for disruptive behavior disorders. Studies are looking at which psychotherapies work best for young people of different ages, cultures, genders, and symptoms. Some studies are looking at subtypes, or groups of symptoms in young people with disruptive behaviors. The goal is to learn how to better diagnose and treat them based on brain function, brain structures, and other factors.
Early intervention and prevention studies are trying to identify children who can benefit from treatment.
Studies also are looking at links between trauma and disruptive behaviors.
Consult a healthcare professional who has training and experience working with disruptive behavior disorders. For general information on mental illnesses and to locate treatment services in your area, contact SAMHSA’s National Helpline, 1-800-662-HELP (4357). SAMHSA’s Behavioral Health Treatment Locator and the National Institute of Mental Health Help for Mental Illnesses webpage have more information and resources.
If you are having suicidal thoughts or are worried that someone you know might be suicidal, contact the Suicide Prevention Lifeline, 1-800-273-TALK (8255).