Moody or more? Identifying a childhood behavior disorder

Moody or more? Identifying a childhood behavior disorderAs most parents can attest, it is not unusual for a child to occasionally be emotional or strong-willed. But frequent temper tantrums and consistent refusal to follow requests may be signs of a deeper problem. When a child is persistently defiant and aggressive, it could be a sign of disruptive behavior disorder (DBD).

“Children with DBD may react intensely whenever presented with a limit or given a directive,” explains Felipe Amunategui, PhD, a child and adolescent psychologist at University Hospitals Rainbow Babies & Children’s Hospital. Youths with DBD are likely to behave inappropriately and to vehemently deny responsibility for their actions. Commonly, adults familiar with the child will likely observe:

  • Frequent temper tantrums
  • Arguments with adults
  • Deliberately annoying others
  • Blaming others for mistakes or misbehavior
  • Being resentful, spiteful or vindictive
  • Being aggressive toward peers, with angry or disruptive behaviors toward adults

Signs of a problem

Dr. Amunategui explains that distinguishing DBD from normal behavior often involves assessing the nature and extent of the problem. “Children with DBD typically exhibit problematic behaviors on an almost daily basis – behavior that is clearly disruptive to the children’s family or classroom,” he says. According to the current Diagnostic and Statistical Manual of Psychiatric Disorders, DBD should be suspected whenever the problematic behaviors are disruptive in two settings and they are not appropriate for the child’s age.

Before puberty, DBD is more frequently diagnosed in boys. After puberty, it is diagnosed almost equally among boys and girls. There are different types of DBD, and the causes are poorly understood. The behaviors appear to arise from a combination of genetics and maladaptive parent-child interactions or environmental factors that begin in early childhood. Dr. Amunategui adds, “Children with DBD often have difficulty making friends because they underestimate the impact of their behavior while they also misinterpret peers’ behavior as hostile and respond aggressively.”

Treatment is key

The earlier a child is diagnosed with DBD, the better the outcome. “Treatment is important because a child’s development, relationships and education are at risk if the disorder is not treated,” says Dr. Amunategui. In addition, untreated DBD has shown evidence to facilitate the development of significant conduct problems and substance use disorders.

Parents who are concerned that their child may have DBD should seek help from a primary care doctor, pediatrician, child psychologist or child behavior expert. Diagnosing a DBD can be difficult and should be handled by a professional with a clinical background and experience with the disorder.

Advanced behavioral health services

UH Rainbow Babies & Children’s Hospital offers expert behavioral health care for children and teens with a variety of emotional and behavioral conditions, such as:

  • Aggression
  • Anxiety
  • Conduct disorders
  • Eating disorders
  • Mood disorders
  • Social problems

To schedule an appointment or learn more, call 216-UH4-KIDS (216-844-5437) or request an appointment online at

A closer look at conduct disorder

Conduct disorder is a behavior disorder, sometimes diagnosed in childhood, that is characterized by antisocial behaviors that violate the rights of others and age-appropriate social standards and rules. Children and adolescents with conduct disorders often have other psychiatric problems that may contribute to the development of the conduct disorder. The antisocial behaviors may include:

  • Aggressive conduct toward others, such as bullying or physical fights
  • Deceitfulness, such as lying or theft
  • Destructive conduct, such as vandalism or arson
  • Violation of rules, such as truancy, running away or very early sexual activity
Luis Amunategui

Child and Adolescent Psychologist, UH Rainbow Babies & Children’s Hospital
Assistant Professor, Case Western Reserve University School of Medicine

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