In the last post, we saw how:
- There are biological, psychological and social factors that can lead to disruptive behavioural disorders.
- In the study, boys appeared to have all the study findings that were associated with disruptive behaviour.
- Pharmacotherapy and psychotherapy are very helpful in treating those who have Intermittent explosive disorder.
Welcome to Medic Vibes, where we discuss mental health disorders and make sense of them. Dr Ebingo Kigigha is a medical doctor (aspiring psychiatrist) and creative person (illustration and music). This has been our routine for four consecutive months. This month will be dedicated to Eating Disorders. In the first month, we discussed Depression, and in the subsequent month, anxiety. We just finished with Schizophrenia.
In this post, we are looking at A study done in Nigeria. To learn more just keep scrolling down. You can also skip to the key point of the post if you which or go to the conclusion to get the summary.
The features of Disruptive disorder is very similar to the features of bipolar disorder in a broad sense. The difference is that the features do not have an episodic nature to them. Some clinicians consider chronic mood disturbances and irritant behaviour in young patients to be early signs that they may suffer from bipolar disorder. Disruptive behavioural disorder simply does not fit into the typical features of the mania of bipolar disorder are episodic and the irritant features of the condition are longer lasting and do not come in episodes.
The disruptive disorder also looks like oppositional defiant disorder because they both have features of irritability and anger and temper outbursts and some of the patients with disruptive behaviour meet the criteria for oppositional defiant disorder. But the case is not the same when the conditions are reversed so those who have oppositional defiant disorder usually do not meet the criteria for disruptive disorder.
The features seen in oppositional defiant disorder are annoyance and defiance which are not seen in disruptive behaviour. Also while disruptive behaviour requires that the patient have an outburst in one setting, oppositional defiant behaviour requires just one setting for its diagnosis.
Disruptive behaviour is a chronic disorder and studies done over long periods show that those with this disorder in childhood usually suffer from depression, dysthymic and anxiety.
Conduct disorders in Nigeria (Research Method)
People illustrations by Storyset
The study was designed as a survey where the correspondents respond to some questions. This method investigates socio-psychological states through questionnaires.
This is done to reach the reason behind the ideas, thoughts and features of the person in question.
This study was done in Nsukka’s Urban settlement in Enugu Nigeria.
Enugu is in the southeastern part of Nigeria. This area has 17 Local Government Areas.
214 were the students chosen for the study, 109 were kindergartners and 105 were primary school students.
164 children met the criteria for the study 88 were in kindergarten and 76 were in primary school. The age groups were between 3 to 5 years and 8 to 10 years. The reason children in this age group were selected is that their behaviour is typically not affected by adults.
Children usually do not change their behaviour because of an adult observer and children when they realize they are being observed, they do not alter the study with confounders like anxiety.
The sample was selected through adopted sampling techniques because it would otherwise reduce the chance of having reasonable findings. The study used the National Educational Association Technique used to equate sample size in a population.
The population was between 280 and 290 meaning that the sample is supposed to be around 162 using the National Educational Association Technique.
The total population of the two classes was 289 meaning the sample size is supposed to be around 164 in both kindergarten and primary school.
The children were observed with the questionnaire and rated based on a scale that had 4 points. The rating scale was for disruptive behaviour and had features like the child's behaviour in a rowdy class if the child does not have writing materials if the child does not communicate properly if the child is faced with a bully and when the child is stressed.
The way the rating was formatted was that any behaviour that does not happen while the children are being observed was noted as “does not occur” and was rated as score 1. If the disruptive behaviour happens between 1 and 3 times during the period of observation it is noted to “occur slightly” and this was given a score of 2.
The behaviour is noted to happen 4 to 6 times in the week this was noted to “occur frequently” and was given a score of 3. If the behaviour happened more times than that then it was said to “occur most frequently” and was given a score of 4.
The student was studied individually and their behaviour was noted as they interacted in groups and the differences in the individual's behaviour were noted.
When observing each child was observed for 20 minutes it was to assess the factors that bring about the disruptive behaviour.
The observation was done in the classroom and when children were playing on the playground. There were 2 observers and they rated the children based on the 4 points of the survey.
The information was analyzed using the Cronbach Alpha reliability technique to see the validity of the survey method. The validity value was 0.89 for the devices. The rating scale was assessed by 3 experts, 2 of which were in Educational Psychology, 2 were in the department of psychology and 1 was from the science education department at the University of Nigeria.
After validation and the survey devices were modified, the average of the 3 points was used as 2.5 and those who fell below were noted to occur slightly and those above were noted to occur frequently.
Treatment
Parent behavioural therapy
Some studies have used some techniques by therapists who had training in behavioural therapy to teach the parent how to deal with disruptive behaviour. The parent during this time learns how to structure for the child, have positive reinforcement techniques, and have continuous discipline while building a sustainable relationship. Relationship building is done through proper communication
Group therapy
Formal research found that sometimes high-risk youth do not show progress in some of the treatment techniques available and sometimes may worsen the problem.
There is however evidence from studies that group therapy can be effective. Studies have also been done to understand the factors in a patient that makes them respond to group therapy.
In children in grades 4 and 5 who have 32 sessions of group therapy in s study on Coping Power.
They found from a study that observed 938 groups that a cool and non-restrictive therapy style showed better results than the behaviour of the subjects in the study. It also showed that the leadership in these groups had a part to play in dealing with aggressive behaviour in these children below the age of adolescence.
Questions
- What did you learn about Eating Disorders?
Conclusion
- Children with disruptive behavioural disorders tend to suffer from depression, dysthymia or anxiety.
- The scoring system used in this study included 4 points used by the 2 observers to assess the children.
- Parental therapy and group therapy showed good results on some patients even some who were high risk.
References
- Kaplan-Sadocks-Comprehensive-Textbook-Psychiatry
- Page demarcations made with Inkscape.org
- Healthline
- NCBI 1
- NCBI 2
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You are really doing a good job, I won't be surprised if most of these parents did not even realize that their kids have the disorder, great and needed awareness.
Thank you very much. From what I have read so far its something that bothers parents so much.
I have seen a mother bring her child to the clinic for something similar, turns out that was a mild case of ADHD but parents (especially experienced ones) are very concerned about such behaviour
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