IN COMMENTARY
Disruptive behaviours: The numbers, the causes
and the costs of not intervening
Also in this issue
- IN COMMENTARY
Disruptive behaviours: The numbers, the causes and the costs of not intervening - IN REVIEW
Addressing disruptive behaviours - IN FOCUS
The latest evidence on Multi-Systemic Therapy (MST) - IN PRACTICE
Applying the research evidence
Mental health –– or social and emotional wellbeing –– is central for healthy development in all children, and vital for all children to thrive and become healthy adults. Behaviour is an important part of social and emotional wellbeing, although behaviour challenges occur with most children from time to time. Disruptive behaviours can vary dramatically in severity. Some challenging behaviour may be typical to a developmental stage, such as when a three-year-old experiences a temper tantrum in a grocery store. However, when behaviours become particularly serious and persistent and cause significant impairment in children’s functioning, there may be a clinically significant mental health problem such as conduct disorder (CD).
A child may be diagnosed with CD if he or she engages in repetitive and persistent violation of social rules including: aggression causing harm to people, animals or property; significant theft; or serious rule violations such as truancy or running away. Such serious and persistent disruptive behaviour problems usually suggest there are underlying causal factors that need to be addressed to help children to experience less distress and to function better at home, at school and in the community.
We have received many questions from policy-makers, practitioners and parents about disruptive behaviours in children. Here we respond to some of these questions.
How common are clinically significant disruptive behaviours?
Disruptive behaviours are common. Among children aged 4 to 17 years, an estimated 4.2% (or approximately 4 in 100 children) have severe behaviour concerns warranting a clinical diagnosis of CD.1 This means that at any given time an estimated 29,000 children in BC are affected, making CD the third most common mental disorder among children. If milder behaviour problems are considered, many more than 29,000 children are likely affected. Conduct-related problems are the most common reason for children to be referred to mental health services in school and community settings.2 Also, many other mental health problems (including anxiety, learning disorders, depression and psychosis) often first present as disruptive behaviour.3
Most important risk factors involve variables beyond the level of the individual child
Given the large numbers of children experiencing clinically significant behaviour problems, it is not surprising that parents, foster parents, teachers and practitioners frequently identify a need for intervention. Perhaps most importantly, children with severe behaviour problems need to receive early interventions because without these their problems frequently persist, leading to distress and impairment throughout adulthood.4
What causes disruptive behaviours?
Disruptive behaviours are likely caused by a web of interacting factors affecting children, families and the broader community environment.5 Known determinants are highlighted in the table below. These factors are interrelated and the relative importance of each can vary during different developmental periods. Notably, most important risk factors involve variables beyond the level of the individual child. For example, when children experience inconsistent nurturing or are exposed to harsh discipline, they are much more likely to exhibit their distress through behaviour problems.
Determinants of Disruptive Behaviours
| Protective Factors6, 7 | |||
|
Long-term support from at least one consistent care-giving adult Good learning abilities Good social skills |
Easy temperament Few siblings Sense of skill or competency Positive beliefs about the larger world |
||
| Risk Factors5 | |||
Child Factors Irritable or difficult temperament Impulsivity and attention problem Early physical fighting Learning difficulties |
Family Factors Low parental engagement and monitoring Parental hostility Harsh discipline Young maternal age Maternal smoking |
Social Factors Peer rejection Negative experiences leading to negative thought patterns Isolation with deviant peers Absence of healthy school and community programs Absence of healthy and consistent long-term adult support |
|
To be most effective, interventions need to reduce risk factors and enhance protective factors –– in other words, to address the underlying causes of children’s behaviour problems and create environments that enable more children to thrive.
Preventing just one case of CD can save an estimated $1.7 million in cumulative lifetime costs
What are the costs associated with disruptive behaviours?
Severe problems like CD are associated with distress for children and with significant costs for society. When children’s behaviour problems are not addressed early, there are significant costs associated with then providing many necessary services including: mental health; child protection; special education; and youth justice. Because of the multiple sectors involved, preventing just one case of CD has been estimated save an estimated $1.7 million in cumulative lifetime costs.8 Most importantly, children cannot go on to meet their full potential when behaviour problems interfere with their development and functioning. In addition to helping more children thrive, public investments are likely enhanced if resources are deployed “upstream” by addressing the underlying causes and preventing problems before they arise, rather than waiting until problems are entrenched.2 Fortunately, many of the situations leading to children developing serious behaviour problems are preventable, as we outline in the next article.
References:
1. Waddell et al. 2005. A public health strategy to improve the mental health of Canadian children. Canadian Journal of Psychiatry, 50(4), 226-233.
2. Foster et al. 2005. The high costs of aggression: Public expenditures resulting from conduct disorder. American Journal of Public Health, 95(10), 1767-1771.
3. Kim-Cohen et al. 2003. Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60(7), 709-717.
4. Kessler et al. 2005. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602.
5. National Institute of Mental Health. 2001. Taking stock of risk factors for child/youth externalizing behavior problems. Bethesda, MD: National Institute of Mental Health.
6. Werner & Smith (1992). Overcoming the odds: High risk children from birth to adulthood. Ithaca, NY: Cornell University Press.
7. Luthar, S. S. (Ed.). (2003). Resilience and vulnerability: Adaptation in the context of childhood adversities. Cambridge: Cambridge University Press.
8. Cohen. 1998. The monetary value of saving a high-risk youth. Journal of Quantitative Criminology, 14(1), 5-33.