Disruptive behavior disorder not otherwise specified (DBD NOS) is a term for disruptive disorders in children which, if left untreated, often lead to antisocial personality disorders; however, the symptoms of these disruptive disorders do not fall into other disruptive behavior diagnoses.
The two major forms of disruptive behavior disorders are oppositional defiant disorder (ODD) and conduct disorder (CD). Symptoms of ODD include recurrent or persistent negativity, defiance or noncompliance, disobedience, resentful attitude, consistent loss of temper, intentional annoyance of others, and hostility in the child toward authority figures like parents and teachers for at least six months. Symptoms of CD, on the other hand, involve consistent or repetitive violation of the rights or autonomy of others, or constant violation of age-appropriate social rules or norms. These violations can include physical cruelty to animals and other people, as well as criminal activity.
In contrast to these two diagnoses, DBD NOS can have some of these symptoms, or share symptoms of both disorders, but the disorder does not neatly fit into either category. The diagnosis describes the child’s disruptive behavior at school or toward authority figures, and it allows the therapist or clinician to begin documenting the behavioral issue, but still have room to update the diagnosis later, as more information on the child becomes available.
Research shows that both biological and environmental factors contribute to children’s development of disruptive behavior disorder NOS. Biological factors can include:
- Low birth weight
- Neurological damage at an early age
- Comorbid disorders like attention disorders (ADD or ADHD)
- Mother smoking during pregnancy
- A sibling with a disruptive behavior disorder
Environmental factors can include:
- Parental rejection, especially in cases where a reliable replacement caregiver cannot be found (children in foster care often face this problem)
- Physical violence, sexual abuse, or emotional abuse, toward the child or another family member
- Exposure to other types of violence
- Neglect or lack of supervision
- Parental criminality or mental health disorder
- Parental/caregiver drug abuse
Children with at least one parent who suffers alcoholism have a strongly increased risk of developing a disruptive behavior disorder, including DBD NOS. Adults who abuse alcohol are more likely to live in poverty, abuse or neglect their families, or have an underlying mental health disorder causing the addiction. Mothers who drink during pregnancy are more likely to have small or premature babies with neurological damage, which could also cause DBD NOS to appear in either the affected child or the child’s siblings. In addition, children whose parents struggle with alcohol addiction or abuse are more likely to have environmental causes of disruptive behavior disorders.
When one member of a family suffers from alcoholism, each person in the family reacts differently. However, according to the National Association of Children of Alcoholics (NACoA), alcohol is a contributing factor in over half of most types of violence, including domestic abuse. Substance abuse, including alcoholism, contributes to 81 percent of reports to child welfare agencies. Alcohol abuse has a huge impact on families, and it contributes to increased risk of psychological disorders, including disruptive behavior disorder NOS.
Factors that lead to a child’s development of disruptive behavior disorder NOS occur very early in life, so it is important to know the early warnings signs. For very young children, these early signs include:
- Failing grades or school performance
- Persistent poor grades in spite of effort
- Worry or anxiety about going to school
- Refusal to go to sleep or anxiety about sleeping
- Lack of friends and refusal to participate socially
- Fidgeting or nervous movement
- Difficulty paying attention
- Frequent temper tantrums
- Threats of self-harm or suicide
When parents, other family members, legal guardians, teachers, school administrators, and caregivers know these signs, the child and the rest of the family can get help sooner. Research shows that when caregivers and support agencies coordinate to help the child, then the child’s outcomes later in life dramatically improve.
So far, no medications have been found to treat disruptive behavior disorders specifically, including DBD NOS. Medications in children and young adults tend to have serious side effects, so if medications are used when coupled with therapy, caregivers should monitor children for signs of these side effects.
The number one recommended treatment for children with disruptive behavior disorders is therapy for the parents, which helps them modify parenting strategies. By helping the parents, other factors in the child’s DBD NOS can be discovered, and this includes parental alcoholism.
The best approach to helping children with disruptive behavior disorder, when the problem stems from parental alcoholism, is to bring the entire family into treatment. For the person struggling with alcoholism, the ultimate goal is abstinence from alcohol. Generally, over half of people struggling with alcoholism successfully abstain as long as they have good social support and motivation to stay sober. Those with little or no social support and a lack of motivation to stay sober are far more likely to relapse. Support should include help from a therapist, support group, or rehabilitation facility.
Families can help this individual to stay sober, but often, close family members like children are too traumatized themselves to offer emotional support. This is why it is important for the whole family to seek help from counselors or support groups. Children of alcoholic parents can benefit from help from other adults, including teachers, other family members, and therapists. These interactions not only help them develop better coping mechanisms for stress, but can also help them develop trust in other adults, as well as their own sense of independence.
Other treatments that help children with DBD NOS include skills training for the child and possibly for other members of the family. These skills include communication, conflict resolution, and anger management. If the whole family seeks help for problems related to alcohol abuse together, then they can overcome resentment and learn new ways to cope with stress.
Break the Cycle of Addiction to Help Struggling Children
Children are affected by parental behavior, and abusive, neglectful, or disruptive behaviors in parents lead to similar problems in children. Too often, children of alcoholics grow up to become alcoholics themselves, and when they have children, the entire cycle begins again.
Even if the parent struggling with alcoholism does not seek treatment, others involved in the family’s life can help. Teachers, school administrators, other family members, or friends of the family can help children via support groups offered through national or local organizations. If a child begins to show signs of a disruptive behavior disorder, parents can be advised by school counselors or others to seek help at a local hospital or with a behavioral therapist. This can lead to help for the entire family, as the therapist finds root causes of the child’s DBD NOS.