delineate disruptive behavior occur among typically developing persons H e a l t h M e d i c a l

delineate disruptive behavior occur among typically developing persons H e a l t h M e d i c a l

Respond to at least two of your colleagues by providing one alternative therapeutic approach. Explain why you suggest this alternative and support your suggestion with evidence-based literature and/or your own experiences with clients.

2 paragraphs

5-6 sentences each paragraph

2 references

Student #1

Managing Patients with Oppositional Defiant Disorder

Initial Post

Children with disruptive behavior show some patterns of uncooperative and defiant behavior, such as oppositional defiant disorder and conduct disorder, putting children at risk for long-term problems like mental disorders, delinquency and violence. One of the most common types of disruptive behavior disorders include disruptive behavior disorder not otherwise specified (DBD NOS), oppositional defiant disorder (ODD) and conduct disorder (CD). These type of disorder makes children stubborn, difficult, disobedient, and irritable. It’s imperative to get the right treatment early because that is key to treatment for health professionals caring for children with a disruptive behavior problem. Psychiatric mental health nurse practitioner can use the information on what therapy works best in order to help parents of children with disruptive behavior problems find the right treatment (CDC, 2020).

Managing Patients with Oppositional Defiant Disorder

The client selected for this discussion is an angry teenager who is overly upset about her life or family issues. She expresses her anger towards seeing and meeting her therapist. She also displays her preset intentions of not talking to her therapist and deems the meeting as worthless. Nelson et al., (2013) argue that 90% of the brain develops during the first three years of life when the brain has maximum plasticity. The flexibility of neural pathways is structured in response to environmental stimuli. During this period, a child’s social, biological, and emotional experiences play a crucial role in the development of brain architecture (Nelson et al., 2013). If at this point, the child is not supported and nurtured through a secure attachment, it has implications on later life learning, emotions, behavior, and health. Prout et al., (2018) cite that children and adolescents who display disruptive behaviors lack the capacity to express their emotions justifiably (Prout, Chacko, Spigelman, Aizin, Burger, Chowdhury, … & Hoffman, 2018).

The diagnosis of the client is vital to guide her management. According to DSM-V, behavioral symptoms such as aggression result from deregulated emotions, including anger (APA, 2013). However, many of the symptoms that delineate disruptive behavior occur among typically developing persons, but the duration and frequency guide the diagnosis of disruptive, impulse-control, and conduct disorders (APA, 2013). DSM-V also stated that disruptive behavior should be present for at least six months, with the client presenting with at least four symptoms related to an irritable mood, argumentative behavior, and vindictiveness (APA, 2013). These symptoms should also be demonstrated in the client’s interaction with at least one person who is not their sibling. Disruptive, impulse-control, and conduct disorders encompass three disorders, including oppositional defiant disorder, antisocial disorder, and conduct disorder (APA, 2013). The angry adolescent presents with most characteristics of oppositional defiant behavior, as delineated by DSM-V. For example, the client is angry, lost her temper and began shouting at the therapist, is spiteful, disrespectful, and even blames the therapist by saying the session is worthless and that the therapist knows nothing about her.

The management of disruptive behavior is primarily by psychotherapy. Gershy & Gray (2018) define psychotherapy as an approach in which the therapist and client work collaboratively to solve their concerns (Gershy, & Gray, 2018). It requires that the therapist provide an environment built on trust and allow the client to express their concerns without experiencing judgment. Psychotherapy aims to change disruptive thoughts and behaviors and help the client healthily relate to others (Gershy, & Gray, 2018).

For the angry adolescent, we will use parent-management training as our psychotherapeutic approach. Hood et al., (2015) cite that parent-management training is an evidence-based psychotherapeutic approach that teaches parents whose children have oppositional defiant behaviors about enhancing positive parenting practices, including supporting their children and decreasing harmful parenting practices such as focusing on inappropriate behaviors and harsh punishment (Hood, Elrod, & DeWine, 2015). Besides, this approach teaches parents and caregivers to provide an immediate and predictable parental response. We would not want to initiate medications on this client because the recommended psychotherapeutic medications in managing oppositional defiant disorder are atypical antipsychotics such as risperidone, which are associated with extrapyramidal side effects (Loy et al., 2017). Unless our client has severe behavioral symptoms or psychotherapy fails, then medications will be prescribed. Our goal of parent-management training is to enable the adolescent to cope with stressful situations and have a healthy relationship with peers and other people.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental

disorders (5th ed.). Washington, DC: Author.

Center for Disease Control and Prevention. (2020). Children’s Mental Health. Retrieved October 27, 2020 from

Hood, B. S., Elrod, M. G., & DeWine, D. B. (2015). Treatment of childhood oppositional defiant disorder. Current Treatment Options in Pediatrics, 1(2), 155-167.

Loy, J. H., Merry, S. N., Hetrick, S. E., & Stasiak, K. (2017). Atypical antipsychotics for disruptive behavior disorders in children and youths. Cochrane Database of Systematic Reviews, (8). From…

McLaughlin, K. A. (2016). Future directions in childhood adversity and youth psychopathology. Journal of Clinical Child & Adolescent Psychology, 45(3), 361-382. Retrieved October 27, 2020 from

Prout, T. A., Chacko, A., Spigelman, A., Aizin, S., Burger, M., Chowdhury, T., … & Hoffman, L. (2018). Bridging the divide between psychodynamic and behavioral approaches for children with the oppositional defiant disorder. Journal of Infant, Child, and Adolescent Psychotherapy, 17(4), 364-377. Retrieve October 27, 2020 from