ADHD Disruptive Behavior can be Treated, Implications for Prevention

The concept of prevention is defined in this way:  Reducing vulnerability and protecting against cumulative risk in the developmental period must take into account the particular factors that are most relevant for the outcomes of interest.  Let’s use this as a guiding principle. 

In my previous post I reported that mentalhelp.net reported that 60-80% of children with ADHD have co-morbid disorders.  That seems slightly high to me so I will review more research on that at a later date, but today we will work with this data.  According to this data, three of the top 4 most common and arguably the worst ADHD common Co-morbidities are Oppositional Defiant Disorder, Substance Abuse and conduct disorder.  (My last post:  ADHD Common Co-morbidities how bad?) These problems have a relationship to one another.

Some data suggests that oppositional defiant disorder tends to precede conduct disorder in time. 

Conduct disorder plays a role in predicting substance abuse and dependence.

If we can treat oppositional defiant disorder and conduct disorder we may also be preventing substance abuse and use.

In terms of prevention, if we can prevent oppositional disorder from developing or intervene to improve it you could be preventing conduct disorder and substance abuse and use. Or if conduct disorder is already an issue then treating it may prevent substance use and abuse.
So, intervening with oppositional defiant disorder and conduct disorder could also be framed as preventing substance abuse and use. In the prevention model we would be reducing vulnerability and protecting against cumulative risk in the developmental period by taking into account the particular factors that are most relevant for the outcomes of interest: disruptive behavior.
There are Other Substance Abuse Factors which would need to be addressed.

The process of abusing substances is complicated but most research has found that friends’ use and community norms are more important as predictors for starting drug use. Psychological variables (e.g., negative emotion, psychopathology) and biogenetic variables (e.g., neurochemical systems, family history of alcoholism) are more important in the transition to regular and frequent use. So, clearly these other factors that put a child at risk for developing substance abuse and later substance dependence must be addressed when one is attempting to prevent substance use and abuse.

Now let me get back to oppositional defiant disorder. How can we intervene with it or prevent it? As noted in my last post Oppositional defiant disorder is the most common co-morbid disorder with ADHD.

Oppositional defiant disorder includes arguing, refusing to comply, a person who is frequently angry, resentful, vindictiveness, deliberately annoys others, is easily annoyed and blames others for his mistakes.

Disruptive Behavior Treatment Studies Reviewed from 1985 to 2000 Shows Improvements Made and Kept.

An impressively thorough review of studies by Farmer, Compton, Burns & Robertson, 2002 found that disruptive behavior or aggressive behavior which included both conduct disorder and oppositional defiant disorder were improved and the progress was sustained for significant periods of time post intervention. A variety of approaches worked best but those which included both parents and children worked best. There was also positive support for multifaceted approaches to interventions presented in either a treatment or a prevention framework. The biggest limitation of this study was that it was limited to children between 6 to 12 years old. Also, the most conspicuous among the omissions (due to dates studied) are Patterson’s Living with Children curriculum (e.g., Patterson & Guillion, 1968; Wiltz & Patterson, 1974) and Barkley’s work on treatment for youths with ADHD (e.g., 1981, 1987, 1990; Barkely et al., 2000).

What this means is child counseling especially family counseling is a critical intervention if your child shows aggression and or oppositional defiant disorder behavior.

Oppositional defiant behavior includes arguing, refusing to comply, and a person who is frequently angry, resentful, shows vindictiveness, deliberately annoys others, is easily annoyed and blames others for his mistakes.  Conduct disorder includes aggression and various rule and law breaking behaviors. 

So, if we intervene between ages 6 to 12 we can possibly prevent the development of conduct disorder and substance use dependence. 

However, there is another very strong predictor of conduct disorder I will consider in my next post.

Dr. Charles Shinaver

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