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Behavior or Conduct Problems in Children

Children sometimes argue, are aggressive, or act angry or defiant around adults. A behavior disorder may be diagnosed when these disruptive behaviors are uncommon for the child’s age at the time, persist over time, or are severe. Because disruptive behavior disorders involve acting out and showing unwanted behavior towards others they are often called externalizing disorders.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

  • Often being angry or losing one’s temper
  • Often arguing with adults or refusing to comply with adults’ rules or requests
  • Often resentful or spiteful
  • Deliberately annoying others or becoming annoyed with others
  • Often blaming other people for one’s own mistakes or misbehavior

Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Examples of CD behaviors include

  • Breaking serious rules, such as running away, staying out at night when told not to, or skipping school
  • Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals
  • Lying, stealing, or damaging other people’s property on purpose

Learn about the guidelines for diagnosing and treating ODD external icon and CD external icon

Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the specific child and family. The first step to treatment is to talk with a healthcare provider. A comprehensive evaluation by a mental health professional may be needed to get the right diagnosis. Some of the signs of behavior problems, such as not following rules in school, could be related to learning problems which may need additional intervention. For younger children, the treatment with the strongest evidence is behavior therapy training for parents, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child’s behavior. For school-age children and teens, an often-used effective treatment is a combination of training and therapy that includes the child, the family, and the school.

Get help finding treatment

Here are tools to find a healthcare provider familiar with treatment options:

  • Psychologist Locator external icon , a service of the American Psychological Association (APA) Practice Organization.
  • Child and Adolescent Psychiatrist Finder external icon , a research tool by the American Academy of Child and Adolescent Psychiatry (AACAP).
  • Find a Cognitive Behavioral Therapist external icon , a search tool by the Association for Behavioral and Cognitive Therapies.
  • If you need help finding treatment facilities, visit MentalHealth.gov external icon .

Managing Symptoms: Staying Healthy

Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

  • Engaging in regular physical activity, including aerobic and vigorous exercise
  • Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
  • Getting the recommended amount of sleep each night based on age
  • Strengthening relationships with family members

Prevention of disruptive behavior disorders

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders external icon , depression external icon , or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

Treatment of ADHD

My Child Has Been Diagnosed with ADHD – Now What?

When a child is diagnosed with attention-deficit/hyperactivity disorder (ADHD), parents often have concerns about which treatment is right for their child. ADHD can be managed with the right treatment. There are many treatment options, and what works best can depend on the individual child and family. To find the best options, it is recommended that parents work closely with others involved in their child’s life—healthcare providers, therapists, teachers, coaches, and other family members.

Types of treatment for ADHD include

  • Behavior therapy, including training for parents; and
  • Medications.
Treatment recommendations for ADHD

For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents. Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports. Learn more about how the school environment can be part of treatment.

Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way. To learn more about AAP recommendations for the treatment of children with ADHD, visit the Recommendations page.

Behavior Therapy, Including Training for Parents

ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children. Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include

These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the child.

Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying medication because:

  • Parent training in behavior management gives parents the skills and strategies to help their child.
  • Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
  • Young children have more side effects from ADHD medications than older children.
  • The long-term effects of ADHD medications on young children have not been well-studied.
School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:

  • Parent training in behavior management;
  • Behavioral interventions in the classroom;
  • Peer interventions that focus on behavior; and
  • Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Medications

Medication can help children manage their ADHD symptoms in their everyday life and can help them control the behaviors that cause difficulties with family, friends, and at school.

  • Stimulants are the best-known and most widely used ADHD medications. Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications.
  • Nonstimulants were approved for the treatment of ADHD in 2003. They do not work as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems. One child may respond well to one medication, but not to another.

Healthcare providers who prescribe medication may need to try different medications and doses. The AAP recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects. It is important for parents to work with their child’s healthcare providers to find the medication that works best for their child.

Parent Education and Support

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child. Learn more about the services of the NRC external icon .

Tips for Parents

The following are suggestions that may help with your child’s behavior:

  • Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
  • Get organized external icon. Encourage your child to put schoolbags, clothing, and toys in the same place every day so that they will be less likely to lose them.
  • Manage distractions. Turn off the TV, limit noise, and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works.
  • Limit choices. To help your child not feel overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or that one.
  • Be clear and specific when you talk with your child. Let your child know you are listening by describing what you heard them say. Use clear, brief directions when they need to do something.
  • Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress.
  • Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic—small steps are important!
  • Discipline effectively. Instead of scolding, yelling, or spanking, use effective directions, time-outs or removal of privileges as consequences for inappropriate behavior.
  • Create positive opportunities. Children with ADHD may find certain situations stressful. Finding out and encouraging what your child does well—whether it’s school, sports, art, music, or play—can help create positive experiences.
  • Provide a healthy lifestyle.Nutritious food, lots of physical activity, and sufficient sleep are important; they can help keep ADHD symptoms from getting worse.

ADHD in Adults

ADHD lasts into adulthood for at least one-third of children with ADHD 1 . Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD external icon and the National Institutes of Mental Health external icon

More information

For more information on treatments, please click one of the following links:

Absence seizure

Medically reviewed by Drugs.com. Last updated on Jun 18, 2020.

Overview

Absence seizures involve brief, sudden lapses of consciousness. They’re more common in children than in adults.

Someone having an absence seizure may look like he or she is staring blankly into space for a few seconds. Then, there is a quick return to a normal level of alertness. This type of seizure usually doesn’t lead to physical injury.

Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens.

Symptoms

An indication of simple absence seizure is a vacant stare, which may be mistaken for a lapse in attention that lasts about 10 seconds, though it may last as long as 20 seconds, without any confusion, headache or drowsiness afterward. Signs and symptoms of absence seizures include:

  • Sudden stop in motion without falling
  • Lip smacking
  • Eyelid flutters
  • Chewing motions
  • Finger rubbing
  • Small movements of both hands

Afterward, there’s no memory of the incident. Some people have many episodes daily, which interfere with school or daily activities.

A child may have absence seizures for some time before an adult notices the seizures, because they’re so brief. A decline in a child’s learning ability may be the first sign of this disorder. Teachers may comment about a child’s inability to pay attention or that a child is often daydreaming.

When to see a doctor

Contact your doctor:

  • The first time you notice a seizure
  • If this is a new type of seizure
  • If the seizures continue to occur despite taking anti-seizure medication

Contact 911 or emergency services in your area:

  • If you observe prolonged automatic behaviors lasting minutes to hours — activities such as eating or moving without awareness — or prolonged confusion, possible symptoms of a condition called absence status epilepticus
  • After any seizure lasting more than five minutes

Causes

Many children appear to have a genetic predisposition to absence seizures.

In general, seizures are caused by abnormal electrical impulses from nerve cells (neurons) in the brain. The brain’s nerve cells normally send electrical and chemical signals across the synapses that connect them.

In people who have seizures, the brain’s usual electrical activity is altered. During an absence seizure, these electrical signals repeat themselves over and over in a three-second pattern.

People who have seizures may also have altered levels of the chemical messengers that help the nerve cells communicate with one another (neurotransmitters).

Risk factors

Certain factors are common to children who have absence seizures, including:

  • Age. Absence seizures are more common in children between the ages of 4 and 14.
  • Sex. Absence seizures are more common in girls.
  • Family members who have seizures. Nearly half of children with absence seizures have a close relative who has seizures.

Complications

While most children outgrow absence seizures, some:

  • Must take anti-seizure medications throughout life to prevent seizures
  • Eventually have full convulsions, such as generalized tonic-clonic seizures

Other complications can include:

  • Learning difficulties
  • Behavior problems
  • Social isolation

Diagnosis

Your doctor will ask for a detailed description of the seizures and conduct a physical exam. Tests may include:

Electroencephalography (EEG). This painless procedure measures waves of electrical activity in the brain. Brain waves are transmitted to the EEG machine via small electrodes attached to the scalp with paste or an elastic cap.

Rapid breathing (hyperventilation) during an EEG study can trigger an absence seizure. During a seizure, the pattern on the EEG differs from the normal pattern.

  • Brain scans. In absence seizures, brain-imaging studies, such as magnetic resonance imaging (MRI), will be normal. But tests such as MRI can produce detailed images of the brain, which can help rule out other problems, such as a stroke or a brain tumor. Because your child will need to hold still for long periods, talk with your doctor about the possible use of sedation.
  • An EEG records the electrical activity of your brain via electrodes affixed to your scalp. EEG results show changes in brain activity that may be useful in diagnosing brain conditions, especially epilepsy and other seizure disorders.

    Treatment

    Your doctor likely will start at the lowest dose of anti-seizure medication possible and increase the dosage as needed to control the seizures. Children may be able to taper off anti-seizure medications, under a doctor’s supervision, after they’ve been seizure-free for two years.

    Drugs prescribed for absence seizure include:

      Ethosuximide (Zarontin). This is the drug most doctors start with for absence seizures. In most cases, seizures respond well to this drug. Possible side effects include nausea, vomiting, sleepiness, trouble sleeping, hyperactivity.

    Valproic acid (Depakene). Girls who continue to need medication into adulthood should discuss potential risks of valproic acid with their doctors. Valproic acid has been associated with higher risk of birth defects in babies, and doctors advise women against using it during pregnancy or while trying to conceive.

    Doctors may recommend the use of valproic acid in children who have both absence and grand mal (tonic-clonic) seizures.

  • Lamotrigine (Lamictal). Some studies show this drug to be less effective than ethosuximide or valproic acid, but it has fewer side effects. Side effects may include rash and nausea.
  • Lifestyle and home remedies

    Dietary therapy

    Following a diet that’s high in fat and low in carbohydrates, known as a ketogenic diet, can improve seizure control. This is used only if traditional medications fail to control the seizures.

    This diet isn’t easy to maintain, but is successful at reducing seizures for some people. Variations on a high-fat, low-carbohydrate diet, such as the glycemic index and modified Atkins diets, though less effective, aren’t as restrictive as the ketogenic diet and may also provide benefit.

    Additional options

    Here are other steps you might take to help with seizure control:

    • Take medication correctly. Don’t adjust the dosage before talking to your doctor. If you feel your medication should be changed, discuss it with your doctor.
    • Get enough sleep. Lack of sleep can trigger seizures. Be sure to get adequate rest every night.
    • Wear a medical alert bracelet. This will help emergency personnel know how to treat you correctly if you have another seizure.
    • Ask your doctor about driving or recreation restrictions. Someone with a seizure disorder will have to be seizure-free for reasonable lengths of time (intervals vary from state to state) before being able to drive. Don’t bathe or swim unless someone else is nearby to help if needed.

    Coping and support

    If you’re living with a seizure disorder, you may feel anxious or stressed about what your future holds. Stress can affect your mental health, so it’s important to talk with your doctor about your feelings and seek resources for help.

    At home

    Your family members can provide much-needed support. Tell them what you know about the seizure disorder. Let them know they can ask you questions, and be open to conversations about their worries. Help them understand the condition by sharing any educational materials or other resources that your doctor has given you.

    At school

    Talk with your child’s teachers and coaches about your child’s seizure disorder and how it affects your child at school. Discuss what your child might need from them if a seizure happens at school.

    You’re not alone

    Remember, you don’t have to go it alone. Reach out to family and friends. Ask your doctor about local support groups or join an online support community. Don’t be afraid to ask for help. Having a strong support system is important to living with any medical condition.

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    Preparing for an appointment

    You’re likely to start by seeing your family doctor or a general practitioner. However, you’ll probably be referred to a doctor who specializes in nervous system disorders (neurologist).

    Here’s some information to help you get ready for the appointment.

    What you can do

    • Write down any symptoms you notice, including any that may seem unrelated to seizures.
    • Make a list of all medications, vitamins and supplements you or your child takes.
    • Write down questions to ask the doctor.

    Preparing a list of questions will help you make the most of your time with your doctor. For absence seizure, some basic questions to ask your doctor include:

    • What’s the most likely cause of these symptoms?
    • What tests are needed? Do these tests require special preparation?
    • Is this condition temporary or long lasting?
    • What treatments are available, and which do you recommend?
    • What are the side effects of the treatment?
    • Is there a generic alternative to the medicine you’re prescribing?
    • Can my child also develop the grand mal type of seizure?
    • Are activity restrictions necessary? Are physical activities, such as soccer, football and swimming OK?
    • Do you have brochures or other printed material I can take? What websites do you recommend?

    Don’t hesitate to ask any other questions you have.

    What to expect from your doctor

    Examples of questions your doctor may ask, include:

    • When did the symptoms begin?
    • How often have the symptoms occurred?
    • Can you describe a typical seizure?
    • How long do the seizures last?
    • Is there awareness of what happened after the seizure?

    © 1998-2020 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. Terms of use.

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