Review of DSM5 Mental Disorders for NCMHCE Study

1. Oppositional defiant disorder2. Intermittent explosive disorder3. Conduct disorder4. Pyromania5. Kleptomania6. Other specified/unspecified disruptive, impulse control and conduct

disorder

AssessmentsAchenbach System of Empirically Based Assessment ASEBAConner's Revised 3 Rating Scale Brown Attention-Deficit ScaleWoodcock-Johnson III Wechsler Intelligence Scale for Children IV (WISC-IV)Level 1 Cross-Cutting-rated Symptom Measure 6-17

Treatment1. MedicationsLithium/antipsychotics

2. TherapyCBTParent trainingParent-child Interaction Therapy Behavior Modification TherapyEmotion Regulation & Social Skills TrainingGroup therapyFamily therapyEngagement of teachers and other involved adults

Risk factors for ODD, Conduct DisorderHaving a parent with a mood or substance abuse disorder Being abused or neglected Harsh or inconsistent discipline Lack of supervision Poor relationship with one or both parents Family instability such as multiple moves, changing schools frequently

Parents with a history of ADHD, or conduct problems

Financial problems in the family Peer rejection Exposure to violence Frequent changes in daycare

providers Parents who have a troubled

marriage or are divorced Poverty

Disruptive Mood Dysregulation 2-3 times weeklyFor 12 or more monthsAges 6-10, until age 18Persistently irritable or angryVerbal and/or physical rages

Oppositional DefiantDifficult behavior for 6 monthsVerbal ragesArgumentativeAggressiveMore severe

Intermittent Explosive 3 times yearlyVerbal aggressionAssaultsOutbursts causing damageAges 6-adultRemorseful

DiagnosisRecurrent behavioral outbursts showing a failure to control aggressive impulses Not premeditatedAge 6 or older1. Verbal aggression2 times weekly for 3 months2. Behavioral outbursts causing damage and/or physical assault against animals or people 3 times within 1 year

S4. Treatment1. Medications2. TherapyCBTGroup therapy

DiagnosisDifficult behavior for 6 monthsNegativity Defiance Disobedience Hostility directed toward authority figures

Leads to:Frequent temper tantrums Argumentativeness with adults Refusal to comply with adult requests or rules Deliberate annoyance of other people Blaming others for misbehavior Being touchy and easily annoyed Anger and resentment Spiteful or vindictive behavior Aggressiveness toward peers

ComorbidADHD 50% of time

S1. Find Out MoreDetailed history of presenting problem, symptomsDetailed developmental history Medical history Affective functioning Cognitive functioningTrauma historyDestructiveness and self destructivenessFamily and social history Abuse of substances Exposure to pornographyAcademic performance on tests Psychological testing

S2. Assess & ReferConsult with both parents and other involved adultsPsychological testing TestsAchenbach System of Empirically Based Assessment ASEBAConner's Revised 3 Rating Scale Brown Attention-Deficit ScaleWoodcock-Johnson III Wechsler Intelligence Scale for Children IV (WISC-IV)Level 1 Cross-Cutting-rated Symptom Measure 6-17

S4. TreatmentLong-term, multi-modalFamily therapyEngagement of teachers and other involved adultsParent trainingParent-child Interaction Therapy Supportive therapyTraining in problem solvingCBTBehavior Modification TherapyEmotion Regulation & Social Skills Training

S5.MonitoringChange in behavioral functioning at home and school

S6. TerminationFollow-up family visit

DiagnosisRepetitive and persistent pattern of behavior1. Requires 3 of the following in the past 12 months, with at least 1 in the past 6 monthsAggression to people and animals Intimidates others oftenInitiates physical fights oftenUsed a dangerous weaponPhysically cruel to people or animals Stolen while confronting a victim

Forced sex on someone Destruction of property Arson Deceitfulness or theft Broken into someone’s place Deceives and manipulates others Serious violations of rules Run away from home 2 times Beginning before age 13 years2. Onset before age 13

Diagnosis IIComorbidityADHD Generalized Anxiety DisorderMajor Depressive Disorder

Rule OutAntisocial Personality Disorder: Over age 18, and more severe

S1. Find Out MoreDetailed history of presenting problem, symptomsDetailed developmental history Medical history Affective functioning Cognitive functioningTrauma historyDestructiveness and self destructivenessFamily and social history Abuse of substances Exposure to pornographyAcademic performance on tests Psychological testing

S2. Assess & ReferConsult with both parents and other involved adultsPsychological testing TestsAchenbach System of Empirically Based Assessment ASEBAConner's Revised 3 Rating Scale Brown Attention-Deficit ScaleWoodcock-Johnson III Wechsler Intelligence Scale for Children IV (WISC-IV)Level 1 Cross-Cutting-rated Symptom Measure 6-17

S4. TreatmentTherapySchool-based therapies Behavioral therapy Parental skills trainingMedicationsLithium/antipsychotics

DiagnosisRecurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary valueIncreasing sense of tension immediately before committing the theftPleasure, gratification or relief at the time of committing the theftStealing is not committed to express anger and is not in response to delusion/hallucinationNot explained better by CD, manic episode, or Antisocial Personality Disorder

S4. TreatmentCBTBehavior therapy

Diagnosis1. Deliberate and purposeful fire setting on more than one occasionTension or affective arousal before the actFascination with, interest in, curiosity about or attraction to fire 2. Motive does not include:Monetary gainTo conceal a crimeIdeologyExpress angerResponse to delusion/hallucinationImpaired judgement

Rule OutConduct DisorderManic EpisodeAntisocial Personality Disorder