Disruptive Behavior Disorders

Nature of Disruptive Behaviors:

Disruptive behavior disorders (DBD) are a group of behavioral disorders defined by ongoing
patterns of hostile and defiant behaviors that children and adolescents direct towards any type of
authority figure. While all children go through periods of testing limits by acting out in negative
behaviors, youth with DBD participate in these behaviors to such an extreme that it affects their
everyday lives, as well as the lives of those around them (Valley Behavioral Health, 2017)

Occurrence:

Statistics

Disruptive behavior disorders, like ODD and conduct disorder, are said to be the most common
psychiatric conditions diagnosed in children worldwide. Studies have shown that conduct
disorder affects 1-4% of adolescents in the United States and oppositional defiant disorder is
estimated to develop in approximately 10.2% of children. The presence of DBD is also known to
be more prevalent in boys than it is in girls. (Valley Behavioral Health, 2107)

Behavioral & Biological Explanations

Causes and Risk Factors of Disruptive Behavior Disorders (Valley Behavioral Health, 2107)

Research has identified both biological and environmental causes for Disruptive Behavior
Disorders. Youngsters most at risk for Oppositional Defiant and Conduct Disorder are those who
have low birth weight, neurological damage or Attention Deficit Hyperactivity Disorder.
Youngsters may also be at risk if they were rejected by their mothers as babies, separated from
their parents and not given good foster care, physically or sexually abused, raised in homes with
mothers who were abused, or living in poverty.

The development of DBD is theorized to be the result of a variety of contributing factors,

including genetic, physical, and environmental components. The following are examples of what
these factors might include: (Valley Behavioral Health, 2107)

Genetic: Children with DBD typically have family members who also suffer from some form of
mental illness, including mood disorders, personality disorders, and anxiety disorders. This
indicates that there is most likely a genetic component that leads children to become more
susceptible to developing and portraying symptoms of DBD.

Physical: Imbalances in the brain’s frontal lobe have been hypothesized to affect the onset of
DBD. The frontal lobe is responsible for regulating people’s emotions and is said to be the
“home” of personality development. When neurotransmitters (chemicals in the brain responsible
for communication throughout the brain) are imbalanced, the result is an impairment in their
ability to communicate properly. This communication dysfunction can lead to the onset of DBD
symptoms.

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Environmental: The environment that children grow up in can have a big impact on whether or
not they develop the behavioral patterns that define DBD. If children are surrounded by a chaotic
home life, they may begin to act out simply because it allows them to have something that they
can control since they have no power over the chaos around them. Similarly, children who are
raised without any form of appropriate discipline or whose parents tend to be more absent than
not can experience major impacts on the ways in which they begin to behave. Atypical mother-
child interaction at the time of birth has also been theorized to have an effect on the onset of
DBD.

Risk Factors: VOLUME 16, NUMBER 4 | ASCA

Parent/Guardian mental health and parenting styles: research, including longitudinal studies
with large community samples, has suggested that students with a DBD diagnosis are more
likely to have a parent/guardian who experiences one or more mental health disorders, especially
depression, substance abuse, or antisocial personality disorder. Students with DBD also have a
higher possibility of experiencing one or more of the following: parental conflict and family
violence, parents/guardians using a disengaged parenting style—often with less monitoring of
the student’s behavior, parents/guardians believing that they cannot control their child’s
behavior, parents/guardians modeling poor problem solving skills, parents/guardians having
more negative interactions with the student and using harsher and/ or inconsistent discipline that
often features physical punishment (Duncombe, Havighurst, Holland, & Frankling, 2012;
Lochman et al., 2010; Webster-Stratton & Reid, 2010). These findings are relational, not causal.
Evidence from a large, longitudinal study with a diverse community sample points to a
bidirectional relation- ship between parenting practices and youth with conduct problems,
suggesting that parenting practices and DBDs each influence the other (Pardini, Fite, & Burke,
2008).
 These students are more likely
 to have been victimized via an assault, abuse, or theft at
a young age (Auger, 2011; Murray & Farrington, 2010).

Environmental factors also influence the course of the disorder. Poverty, exposure to
violence,
 and participation in deviant peer groups are all associated with greater incidence and
enhanced severity of DBDs (Nguyen, Huang, Arganza, & Liao, 2007; Webster- Stratton & Reid,
2010). Considering whether students from a country or area ravaged by war or violence might be
misdiagnosed is also important. Although their behaviors in school could be considered
violations of age appropriate norms, these same actions and attitudes could be contextually
appropriate protective behaviors in settings outside of school (APA, 2013; Davis, 2011).

Risk Factors: (Valley Behavioral Health, 2017), (Center for Mental Health of the U.S.
Department of Health and Human Services, US)

 Exposure to violence
 Family history of mental illness or substance abuse
 Familial discord
 Suffering from abuse and/or neglect
 Being male

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  Poor or inconsistent parenting / lack of parental involvement
 Dysfunctional home life
 Modeling of aggression
 Media violence

Other explanations:
In a recent study conducted by Dr. Amy Roy of Fordham University, more than 75
percent of children who presented with severe temper outbursts also fit the criteria for
ADHD. That doesn’t necessarily mean they’ve been diagnosed with ADHD — in fact the
disorder may be overlooked in kids who have a history of aggression.
“What people don’t understand is that a lack of focus, an inability to complete work and
tolerate boredom, among other symptoms, can contribute to the escalation toward the
explosive outbursts,” explains Dr. Vasco Lopes, a clinical psychologist. So you have to
get to the underlying cause.”
Learning disorders (https://childmind.org/article/disruptive-behavior-why-its-often-
misdiagnosed)
When a child acts out repeatedly in school, it’s possible that the behavior stems from an
undiagnosed learning disorder. Say he has extreme difficulty mastering math skills, and
laboring unsuccessfully over a set of problems makes him very frustrated and irritable. Or
he knows next period is math class.
“Kids with learning problems can be masters at being deceptive — they don’t want to
expose their vulnerability. They want to distract you from recognizing their struggle,”
explains Dr. Nancy Rappaport, a Harvard Medical School professor who specializes in
mental health care in school settings. “If a child has problems with writing or math or
reading, rather than ask for help or admit that he’s stuck, he may rip up an assignment, or
start something with another child to create a diversion.”
Paying attention to when the problematic behavior happens can lead to exposing a
learning issue, she adds. “When parents and teachers are looking for the causes of
dysregulation, it helps to note when it happens — to flag weaknesses and get kids
support.” https://childmind.org/article/disruptive-behavior-why-its-often-misdiagnosed
Sensory processing problems
Children who have trouble processing sensory information can have extreme and
sometimes disruptive behavior when their senses are feeling overwhelmed. They might
do things like scream if their faces get wet, throw violent tantrums whenever you try to
get them dressed, crash into walls and even people, and put inedible things, including
rocks and paint, into their mouths.
Besides tantrums and mood swings, kids with sensory processing issues are also at risk
for running away when an environment becomes too overwhelming for them. The “fight
or flight” response can kick in when kids are feeling overloaded with sensory input, and
their panicked reactions can put them in real danger.
https://childmind.org/article/disruptive-behavior-why-its-often-misdiagnosed

On the other side of the equation, there are also factors associated with productive
behavior (EPI)
“Protective Factors” (can reduce the risk of anti-social and disruptive behavior):

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 Individual Domain
High IQ
 Female gender

positive social orientation
Family domain
A warm supportive relationship with parents or older adults
Parental monitoring or supervision activities
School domain
Extracurricular activities

encouragement from teachers toward their future
Peer domain
Having friends who behave conventionally
Associating with peers who disapprove of violence

* So, while the school has little control over many of these variables, it can, in fact, adjust
practices to mediate the effect of risk factors and enhance the protective factors to have a
positive impact on student behavior in the school environment.

Symptoms

Signs and Symptoms of Disruptive Behavior Disorders (Valley Behavioral Health, 2107)

The symptoms of disruptive behavior disorders will vary based on the age of the child and the
type of behavioral disorder that he or she has. Children’s temperament, social skills, and coping
mechanisms will also affect the severity of the symptoms. The following are some common
examples of symptoms that people with DBD may exhibit:

Behavioral symptoms:

 Social isolation
 Bullying
 Revenge-seeking behaviors
 Lying
 Stealing
 Willful destruction of property
 Blaming others
 Actively defying or refusing to comply with rules
 Being cruel to animals
 Playing with fire

Cognitive symptoms:

 Difficulty concentrating
 Frequent frustration
 Memory impairment

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  Inability to “think before speaking”
 Lack of problem-solving skills

Psychosocial symptoms:

 Lack of empathy
 Lack of remorse
 False sense of grandiosity
 Persistent negativity
 Chronic annoyance and irritability
 Low self-esteem

Effects:

Effects of Disruptive Behavior Disorders (Valley Behavioral Health, 2107)

If children do not receive proper treatment interventions, the effects of DBD can be long-lasting
and can, in some cases, lead to the development of antisocial personality disorder. Some
examples of the long-term effects that untreated DBD can have on a person include:

 Criminal involvement
 Incarceration
 Substance abuse
 Risky sexual behaviors
 Inability to develop and maintain healthy, meaningful relationships
 Social isolation

The 2 most common forms of disruptive behavior disorders are oppositional defiant
disorder (ODD) and conduct disorder. Conduct disorder is characterized by persistent and
repetitive behaviors that involve violating the basic rights of other human beings and
severely breaking rules set to enforce age-appropriate societal norms. Oppositional
defiant disorder is similar to conduct disorder but usually presents itself earlier in a
child’s life. ODD is characterized by patterns of hostile, defiant, and disobedient
behaviors directed at parents, teachers, and any other type of authority figure. (Valley
Behavioral Health, 2107)

Classification

Four other types of disruptive behavior disorders that school counselors are likely to
encounter: conduct disorder (CD), oppositional defiant disorder (ODD), intermittent
explosive disorder (IED), and adjustment disorder with disturbance of conduct. (T
Grohaus) (ASCA | Professional School Counseling)

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association
actually distinguishes between two types of serious disruptive behavior:

Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). Both are made up of a

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 complex mix of psychological, environmental and, perhaps, even biological forces, so
understanding these disorders is an important first step in addressing them in schools.

The common diagnosis: ODD (https://childmind.org/article/disruptive-behavior-why-its-often-

misdiagnosed)

Often children who lash out or refuse to follow direction are thought to have oppositional
defiant disorder (ODD), which is characterized by a pattern of negative, hostile, or defiant
behavior. Symptoms of ODD include a child frequently losing his temper, arguing with adults,
becoming easily annoyed, or actively disobeying requests or rules. In order to be diagnosed with
ODD, the child’s disruptive behavior must be occurring for at least six months. But there are a
number of other issues that could lead to kids being oppositional or out of control in school or at
home.

Oppositional Defiant Disorder

While students with CD may intimidate or frighten peers and adults, students with ODD are
more likely to aggravate or anger others (Auger, 2011). This disorder features “a frequent and
persistent pattern of angry/irritable mood, argumentative/de ant behavior, or vindictiveness”
(APA, 2013, p. 463). Additional symptoms may include being stubborn, breaking rules,
inappropriately blaming others for their own behaviors, intentionally annoying others, and
throwing tantrums (Cooley, 2007; Kazdin, 2010). Often, students with ODD feel their behavior
is a justifiable response to unfair demands or conditions (APA, 2013).

Usually ODD symptoms present when the student is preschool age. The symptoms may appear
at home first and can be reserved for familiar adults but not for relative strangers, so educators
should be wary of first impressions (APA, 2013; Auger, 2011). Lifetime prevalence estimates for
oppositional de ant disorder range from 1-11% (APA, 2013;
 Nock et al., 2007) and it can grow
in intensity to meet criteria for CD, stay at the same level, or diminish over time (Kaffenberger,
2011). Accurately predicting which persons with ODD will increase their symptomology and
which will decrease over time is difficult, but approximately 70% of ODD abates by age 18
(Bernes et al., 2011).

Oppositional Defiant Disorder (ODD):

A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during
which four (or more) of the following are present:

1. Often loses temper

2. Often argues with adults
3. Often actively defies or refuses to comply with adults’ requests or rules
4. Often deliberately annoys people

5. Often blames others for his or her mistakes or misbehaviors

6. Is often touchy or easily annoyed by others

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 7. Is often angry and resentful

8. Is often spiteful or vindictive

Note: Consider a criterion met only if the behavior occurs more frequently than is
typically observed in individuals of comparable age and developmental level. The
disturbance in behavior causes significant clinical impairment in social, academic, or
occupational functioning.

Conduct Disorder (CD):

Conduct Disorder (ASCA | Professional School Counseling)

In the DBD family of syndromes, the most severe behaviors and concerns accompany a
CD diagnosis. As the Diagnostic and Statistical Manual (DSM) notes, “the essential
feature of conduct disorder is a repetitive and persistent pattern of behavior in which the
basic rights of others or major age- appropriate societal norms or rules are violated”
(APA, 2013, p. 472). Students with this disorder often either proactively initiate
aggression or react aggressively to a perceived provocation or threat (Auger, 2011). They
may engage in frequent fights or assaults, exhibit bullying and intimidating behavior,
display cruelty to animals and people, participate in deliberate destruction of property,
lie, steal, and break rules or laws. Although a majority of the time the disorder remits as
the student grows into adulthood, a substantial number of students with this disorder will
meet the criteria for antisocial personality disorder as adults (APA, 2013; Cooley, 2007;
Kazdin, 2010).
Symptoms may appear in the preschool years and rarely begin after age 16. If the student
displays at least one characteristic associated with CD before age 10 and fully meets the
criteria prior to puberty, he or she will likely be classified as having the childhood-onset
type (vs. adolescent-onset type). An earlier arrival of symptomatic behaviors
 is
associated with a greater likelihood of physical aggression towards others and an
increased risk of persistence into adulthood (Kaffenberger, 2011; Webster-Stratton &
Reid, 2010).
Other risks for students with CD include truancy, lower academic achievement and
graduation, higher rates of unemployment, lower long- term SES, and greater possibility
of engaging in criminal behavior and substance abuse (Auger, 2011; Bernes et al., 2011;
Webster-Stratton & Reid, 2010). Students with CD may have low self-esteem, lack
empathy or remorse, inaccurately attribute hostile intent to others’ actions and attitudes,
and blame others for their behavior (APA, 2013; Auger, 2011). This disorder is difficult
to treat, even with evidence-based practice (Kaffenberger, 2011).

* A repetitive and persistent pattern of behavior in which the basic rights of others or
major age- appropriate societal norms or rules are violated, as manifested by the presence
of three (or more) of the following criteria in the past 12 months, with at least one
criterion present in the past 6 months.

Aggression to people and animals

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 1. Often bullies, threatens, or intimidates others

2. Often initiates physical fights

3. Has used a weapon that can cause serious physical harm to others (for example, a bat,
brick, broken bottle, knife, gun)
4. Has been physically cruel to people

5. Has been physically cruel to animals

6. Has stolen while confronting a victim (for example, mugging, purse snatching,
extortion, armed robbery)

7. Has forced someone into sexual activity

Destruction of property
1. Has deliberately engaged in fire setting with the intention of causing serious damage
2. Has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or theft
1. Has broken into someone else’s house, building, or car

2. Often lies to obtain goods or favors or avoid obligations (that is, “cons” others)

3. Has stolen items of nontrivial value without confronting a victim (for example, shoplifting, but
without breaking and entering; forgery)

Serious violations of rules

1. Often stays out at night despite parental prohibitions, beginning before age 13 years

2. Has run away from home overnight at least twice while living in parental or parental surrogate
home (or once without returning for a lengthy period)

3. Often truant from school, beginning before age 13 years

4. Disturbance in behavior causes clinically significant impairment in social, academic, or
occupational functioning

Co-Occurring Disorders (Valley Behavioral Health, 2107)

Disruptive behavior disorders can co-exist with other mental illnesses. The most common
illnesses known to co-exist with DBD include:

 Attention-deficit hyperactivity disorder (ADHD)

 Anxiety disorders
 Depressive disorders
 Substance abuse disorders

The first challenge in helping a child manage his behavior better is to understand why he’s doing
what he’s doing. In the same way that a headache or a fever can be caused by many things,

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frequent outbursts — which clinicians call “emotional dysregulation”— can reflect a number of
different underlying issues. (081417)

In many cases disruptive, even explosive behavior stems from anxiety or frustration.

It’s easy to jump to the conclusion that a child who’s pushing or hitting or throwing tantrums is
angry, defiant or hostile. But in many cases disruptive, even explosive behavior stems from
anxiety or frustration that may not be apparent to parents or teachers.

Anxiety disorders (081417)

Children with anxiety disorders have significant difficulty coping with situations that cause them
distress. When a child with an untreated anxiety disorder is put into an anxiety-inducing
situation, he may become oppositional in an effort to escape that situation or avoid the source of
his acute fear.

For example, a child with acute social anxiety may lash out at another child if he finds himself in
a difficult situation. A child with OCD may become extremely upset and scream at his parents
when they do not provide him with the constant repetitive reassurance that he uses to manage his
obsessive fears.

We tend to associate anxiety with kids freezing, avoiding things they’re afraid of, or clinging to
parents, notes says Dr. Rachel Busman, a clinical psychologist at the Child Mind Institute. “But
you can also see tantrums and complete meltdowns.”

“Anxiety is one of those diagnoses that is a great masquerader,” explains Dr. Laura Prager,
director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can
look like a lot of things. Particularly with kids who may not have words to express their feelings,
or because no one is listening to them, they might manifest their anxiety with behavioral
dysregulation.”

ADHD https://childmind.org/article/disruptive-behavior-why-its-often-misdiagnosed

Many children with ADHD, especially those who experience impulsivity and hyperactivity, may
appear to be intentionally oppositional. These children may have difficulty sitting still, they grab
things from other kids, blurt out inappropriate remarks, have difficulty waiting their turn,
interrupt others, and act without thinking through the consequences.

These symptoms are more a result of their impaired executive functioning skills—their ability to
think ahead and assess the impact of their behavior—than purposeful oppositional behavior.

Intermittent Explosive Disorder

Unlike students with ODD who may display symptoms selectively with familiar adults and
peers, students with IED will usually appear to be ne prior to having a rapidly emerging
exhibition of impulsive and intense verbal aggression and/or aggressive behavior. These episodes

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are often in disproportionate response to a seemingly small provocation, usually last less than 30
minutes, and may involve verbal and physical assaults and/or to focus on perceived injustices
(Coccaro & McCloskey, 2010). All of these symptoms can lead to interpersonal and school
difficulties.

The disorder can begin in childhood but the mean age of onset is in the early teen years (Kessler,
Coccaro, Fava, & Jaeger, 2006). Those with
 IED have a higher likelihood of having
experienced traumatic events (APA, 2013; Coccaro & McCloskey, 2010). One year prevalence
rate is approximately 2.7% in the U.S. Some regions of the world (e.g., Asia and the Middle
East) experience lower incidence and research is mixed regarding the possibility of IED
occurring with greater frequency in males (APA, 2013). In addition, IED has a heightened level
of comorbidity with mood, anxiety, and substance abuse disorders. Students with IED also tend
to have more mental health concerns and greater impairment of overall functioning than non-IED
peers (Coccaro & McClos- key, 2010; Kessler, Coccaro, Fava, & Jaeger, 2006; McCloskey, Lee,
Berman, Noblett, & Coccaro, 2008).

Adjustment Disorder with Disturbance of Conduct


Although adjustment disorder with disturbance of conduct is not classified as a DBD in the DSM
(APA, 2013), this article includes it due to the primary manifestations of the disorder, which
include truancy, aggressive behavior, and violation of rules and laws (Auger, 2011). Unlike the
other disorders provided here, which may include environmental influences, adjustment disorder
with disturbance of conduct is seen as a response to a stressor: “by definition, the disturbance in
adjustment disorders begins within 3 months of onset of a stressor and lasts no longer than 6
months after the stressor or its consequences have ceased” (APA, 2013, p. 287). As is evident,
the behaviors associated with this disorder can cause problems in the school and/or social arenas
(Auger, 2011). Although this disorder can lead to distress for the student and others, it is usually
the most benign of the DBDs. The student is likely to need support and counseling with the aim
of enhancing his or her ability to cope with and respond to the stressor, as opposed to focusing
only on the student’s behavior (Auger, 2011).

In addition to the four diagnoses discussed above, other related diagnoses school counselors
might encounter are other specified disruptive, impulse- control, and conduct disorder or
unspecified disruptive, impulse-control, and conduct disorder. These might be used for students
who display significant oppositional, destructive, and/
 or aggressive behavior which does not
fully meet the criteria necessary for a diagnosis of CD, IED, or ODD (APA, 2013).

“One of the most powerful principles used to explain how behavior is learned is known as the
Matching Law (Herrnstein, 1974). In his original formulation, Herrnstein stated, for example, if
aggressive behavior is reinforced once every three times it occurs (e.g., by a parent giving in to a
temper tantrum) and prosocial behavior is reinforced once every 15 times it occurs (e.g., by a
parent praising a polite request), then the Matching Law would predict that, on average,
aggressive behavior will be chosen five times more frequently than prosocial behavior. Research

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has consistently shown that behavior does, in fact, closely follow the Matching Law. Therefore,
how parents (and later, teachers) react to aggressive, defiant, and other bad behavior is extremely
important. The Matching Law applies to all children; it indicates that antisocial behavior is
learned— and, at least at a young enough age, can be unlearned.” (EPI)

In schools, this Matching Law can be put into practice as well – helping to assure that an over-
emphasis on punishing undesirable behavior does not overwhelm any other efforts to promote
prosocial behavior. (EPI)

What Can Schools Do? (EPI)

Walker and his colleagues continue, “schools are not the source of children's antisocial behavior,
and they cannot completely eliminate it. But schools do have substantial power to prevent it in
some children and greatly reduce it in others.

First, and in some ways most importantly, schools can help by being academically effective. The
fact is, academic achievement and good behavior reinforce each other: Experiencing some
success academically is related to decreases in acting out; conversely, learning positive behaviors
is related to doing better academically.

Second, schools can, to a large and surprising extent, affect the level of aggression in boys just
by the orderliness of their classrooms.” Most disruptive behavior in classrooms occurs during
transitions from one activity to another – “breaks in the conceptual action” of the class. By
managing classes more efficiently and effectively, teachers can help reduce the opportunity for
disruption substantially.

Assessment and Identification ASCA | Professional School Counseling

As a broad scale data-gathering strategy, Cooley (2007) recommends mapping—identifying the

who, when, and where factors of behavioral incidents—along with adult and peer responses. This
and other data can be disaggregated (e.g., sorting the locale of incident, which adults are
involved most frequently, grade level of students, gender, race/ethnicity, and other cultural
factors) and then used to set up action plans detailing the people, places, and times to monitor
more closely. Once identified, monitoring progress or problems over time can provide valuable
information (ASCA, 2012; Cowan & Sheridan, 2009; Grothaus & Johnson, 2012). The use of
observations (especially in areas that receive less supervision), student self- reports, and
interviews with teachers and family members also can generate helpful data (Bernes et al., 2011).
These efforts will ideally focus on
 both the students and the school and community
environments. As Jenkins (2007) noted, it is essential to “ensure that the environment,
curriculum, and the instruction are appropriate for the learner to learn before you can assume that
the root of the problem lies within the learner” (p. 52).

To target the planned interventions more precisely, determining the antecedents for the
disruptive behaviors can be helpful. Once a trigger
 is known, the school counselor can

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implement efforts to minimize encounters with this situation and train the student to enact
alternative, effective, and acceptable responses. For example, if a student’s disruptive behaviors
appear to be triggered by perceived threats in social situations, interventions might include
guiding the student to check on the intended meaning of the words or gestures before erupting.

Ascertaining what sustains or rewards the behavior (i.e., maintaining variables), such as gaining
attention, approval, or what is perceived as respect, can also produce valuable data to inform
intervention plans. Another viable option is collaborating with school personnel (e.g., teachers,
school psychologist) to decipher the purpose of the problematic behavior via use of formal or
informal functional behavior assessments (Auger, 2011; Cowan & Sheridan, 2009). School
counselors can then work with the student to develop alternate, less costly behaviors and
cognitions that will achieve the desired outcomes. Along with the efforts to build capacity in
individual students, promoting positive changes in the school environment is important, such as
training adults to effectively engage students with DBDs (Jenkins, 2007).

Other factors to note include determining whether the behavior(s) are usually proactive and goal
directed or reactive. This can assist in deciding
 on types of interventions used (e.g., dealing
with proactive aggression by minimizing or eliminating student gain from the behavior, versus
minimizing triggers and negative thoughts or attributions when dealing with reactive behavior).
Verifying whether students use the behaviors because they are overstimulated (to calm
themselves) or under stimulated (i.e., bored) also can assist in designing more appropriate
interventions (Auger, 2011). In addition to assessing problematic behaviors, accessing and
harnessing student and family strengths and resources is vital to promoting student success
(Galassi & Akos, 2007; Grothaus, McAuliffe, & Craigen, 2012). Another important step is the
assessment of the school for strengths and concerns (e.g., school climate, classroom management
choices, discipline policies and procedures, and school personnel perspectives such as the
aforementioned cultural biases).

References:

Adelman, H. S., &Taylor, L. (2010). Mental health in schools: Engaging learners, preventing
problems, and improving schools.Thousand Oaks, CA: Corwin.

American Psychiatric Association. (2013).

Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

American School Counselor Association. (2009). The professional school counselor and student
mental health. Retrieved from http://www. schoolcounselor.org/ les/PS_
StudentMentalHealth.pdf

American School Counselor Association. (2010). The professional school counselor and school-
family- community partnerships. Retrieved from http://www.schoolcounselor.org/
les/Partnerships.pdf

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American School Counselor Association. (2012). The ASCA National Model: A framework for
school counseling programs (3rd ed.). Alexandria, VA: Author.

Coccaro, E. F., & McCloskey, M. S. (2010). Intermittent explosive disorder: Clinical aspects. In
E. Aboujaoude & L. M. Koran (Eds.), Impulse control disorders (pp. 221-232). NewYork, NY:
Cambridge University Press.

Conner, B.T., & Lochman, J. E. (2010). Comorbid conduct disorder and substance use disorders.
Clinical Psychology: Science & Practice, 17, 337-349. doi:10.1111/j.1468-2850.2010.01225.x

Cooley, M. L. (2007). Teaching kids with mental health & learning disorders in the regular
classroom. Minneapolis, MN: Free Spirit.

Corcoran, J., Broce, R. & Shadik, J. (2011). Oppositional de ant disorder and conduct disorder in
children. In J. Corcoran, Mental health treatment for children and adolescents (pp. 36-65). New
York, NY: Oxford University Press.

Valley Behavioral Health, 2017

Grothaus,T., & Johnson, K. F. (2012). Making diversity work: Creating culturally competent
school counseling programs. Alexandria, VA: American School Counselor Association.

Grothaus,T., McAuliffe, G., & Craigen, L. (2012). Infusing cultural competence and advocacy in
strength-based counseling. Journal of Humanistic Counseling, 51, 51-65.

Grothaus,T., McAuliffe, G. J., Danner, M. J. E., & Doyle, L. (2013). Equity, advocacy, and
social justice. In G. J. McAuliffe (Ed.), Culturally alert counseling: A comprehensive
introduction (2nd ed., pp. 45-73). Thousand Oaks, CA: Sage.

Kaffenberger, C. J. (2011). Helping students with mental and emotional disorders. In B.T. Erford
(Ed.), Transforming the school counseling profession (3rd ed., pp. 342-370). Upper Saddle
River, NJ: Pearson Education, Inc.

https://childmind.org/article/disruptive-behavior-why-its-often-misdiagnosed

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