Behavioral disorders in children

This section includes a group of behavioral disorders characterized by a persistent type of dissocial, aggressive or defiant behavior, reaching the point of a pronounced violation of age-appropriate social norms.

Examples of behavior on which the diagnosis is based include excessive fighting or disruptive behavior; cruelty to other people or animals; gross destruction of property; arson, stealing, lying, skipping school or running away from home, unusually frequent and severe temper tantrums; defiant, provocative behavior; persistent, overt disobedience. Any of these categories, if severe, is sufficient to warrant the diagnosis, but isolated acts do not warrant the diagnosis.

Given the heterogeneous nature and complex mechanism of formation included in the category of behavioral disorders, for their diagnosis it is necessary to conduct an individual examination aimed at establishing the causal factor with the determination of the specific weight of the biological and socio-psychological component. This is the prerogative of a psychiatrist. A pediatrician should have an idea of the main types of behavioral disorders, their clinical features, differentiating primarily socialized and non-socialized forms.

The classification of behavioral disorder syndromes that existed in domestic psychiatry before the transition to ICD-10 was carried out using the multi-axial classification proposed by V.V. Kovalev (1985). The classification included the following axes:

• socio-psychological;
• clinical and psychopathological;
• personal-dynamic.

The socio-psychological approach made it possible to classify various forms of behavior as deviant, deviating from the forms accepted in a given society for moral and ethical reasons.

The clinical-psychopathological approach provided for the division of deviant behavior into pathological (according to ICD-10, asocialized) and non-pathological (according to ICD-10, socialized) forms of behavior. The main criteria for classifying deviant behavior as manifestations of pathology (V.V. Kovalev, 1985):

• the presence of a pathocharacterological syndrome (the presence of pathological character traits in a subject);
• manifestation of deviant behavior outside the main microsocial groups;
• a combination of behavioral disorders with neurotic disorders (low mood, sleep and appetite disturbances, anxiety, etc.);
• dynamics of deviant behavior with a tendency toward pathological transformation of personality.

The personality-dynamic axis allows us to classify behavioral disorders into three main manifestations of personality dynamics - reactions (characterological, pathocharacterological), developments (social-psychological deformation of personality in the process of prolonged stay in an abnormal psychosocial situation or formations in the process of ontogenesis of constitutional nuclear psychopathies) and states (formed psychopathies and character accentuations).

Unsocialized behavior disorders

ICD-10 code

F91.1 Unsocialized conduct disorder.

A type of behavior characterized by a combination of persistent dissocial or aggressive behavior with significant general disruption of the child's relationships with other children and adults.

These behavioral disorders correspond to the existing concepts in Russian psychiatry about pathological forms of deviant behavior. Pathological forms of deviant behavior are most often manifested by typological variants.

• A typological variant with a predominance of increased affective excitability. The structure of the behavioral disorder is dominated by manifestations of emotional excitability, irritability, a tendency to affective discharges with aggressive actions (fights, insults) and subsequent somatopsychic asthenia. Expressed reactions of active protest, oppositional behavior associated with restrictions and prohibitions imposed by teachers or parents are characteristic. In this case, children either actively protest against the school regime or refuse to attend classes.
• The typological variant with a predominance of mental instability is characterized by increased suggestibility, dependence of behavior on external conditions with a predominance of motives for obtaining pleasure, a tendency to lie and steal, and easy initiation into drug use.
• The typological variant with a predominance of disturbances of drives most often includes escapes and vagrancy, aggressive-sadistic disorders. Dromomanic tendencies are often combined with disturbances of sexual drive, often taking the character of perversion. In girls, sexual disinhibition is the leading sign in the pathology of behavior of this variant.
• The impulsive-epileptoid variant is expressed in a tendency to long and intense affective outbursts that arise instantly, sometimes for an insignificant reason, accompanied by aggressive acts, a slow exit from the state of sullen-angry affect, vindictiveness, stubbornness, reactions of active protest. Against the background of mood swings with a dysphoric tint, brutal antisocial behavior is often observed as an expression of malicious-aggressive affect.

Treatment

Assistance is provided in inpatient and outpatient psychiatric care (hospitals, semi-hospitals, dispensaries), as well as in non-psychiatric institutions that have a license to provide medical services (medical and psychological offices of children's clinics, centers for psychological, medical and social support).

Socialized conduct disorder

ICD-10 code

F91.2 Socialized conduct disorder.

Includes group conduct disorder; group delinquency; gang membership offending; stealing in company with others.

This type of behavioral disorder is characterized by persistent dissocial and aggressive behavior that occurs in children who are usually well integrated into their peer group. The main feature that allows them to be differentiated from non-socialized behavioral disorders is the presence of adequate, long-term relationships with peers. They correspond to the existing concepts in Russian psychiatry about non-pathological forms of deviant behavior.

Treatment

Assistance is provided in open and closed non-medical institutions engaged in correctional and educational work with difficult children and adolescents (specialized schools, educational and educational complexes for socially maladjusted children and adolescents).

Oppositional defiant behavior disorder

ICD-10 code

F91.3 Oppositional defiant disorder.

This type of behavioral disorder is defined by the presence of negativistic, hostile, defiant, provocative behavior that is beyond the normal level of behavior of a child of the same age in similar socio-cultural conditions, and the absence of more severe antisocial or aggressive actions that violate the law or the rights of others.

This disorder is typical for children under 10 years of age. In older children, this type of disorder is usually accompanied by antisocial or aggressive behavior that goes beyond open disobedience, disobedience, or brutality.

Treatment

Assistance is provided in open institutions of a psychological and medical nature (centers of psychological, medical and social support, children's consultation centers of a medical psychologist, medical and psychological offices of children's clinics).