Teens with Discipline Problems

frustrated teenagerAdolescence tends to be a difficult time for everyone. Many parents struggle to understand the impulsive and irrational way their teenagers behave, but adolescents and adults fundamentally differ in the way they solve problems, behave, and make decisions. It can be frustrating when your teen doesn’t listen to you, but it can be helpful to understand there is a biological reason teenagers act the way they do.1

Scientific research shows that brain development continues throughout adolescence well into early adulthood. The amygdala, the area of the brain responsible for immediate reactions (fear, aggression), develops early in the adolescent brain. However, the frontal cortex, the area of the brain responsible for reasoning and complex thought, does not fully mature until early adulthood.1

When dealing with your teenager’s behavioral health, then, it is helpful to remember that there are significant differences in the way you and your child think. Teenage behavior is guided more by the emotional amygdala than the logical frontal cortex, but that does not mean teens don’t know the difference between right and wrong. And it does not mean they shouldn’t be held accountable for their actions. But it is helpful to understand the limitations they have at this age.

Parenting a teenager is tough work in the best of circumstances. Parenting a teen with discipline problems can feel downright impossible. There are several behavioral disorders that appear to be more common in adolescents, so in some cases, it is possible that the root of your child’s disciplinary problem is a diagnosable mental health disorder.

Behavioral Health

happy teenager Behavioral health refers to a person’s state of being and how their behaviors and choices affect their overall health and wellness. Behavioral health disorders are illnesses that are precipitated or perpetuated by your conscious decisions and which you are unable to resist the urge to repeat, despite negative consequences. Read More

Common Behavioral Disorders in Teens

All teenagers display impulsive and oppositional behaviors from time to time as they test boundaries and push for more independence. However, sometimes these disruptive behaviors become chronic and severe, creating disciplinary problems. Oppositional behavior becomes a concern when it interferes with a teen’s normal home, social, or academic life. In such cases, there may be a behavioral health disorder present.2

The DSM-5 (the most recent edition of the diagnostic manual for the mental health community) includes a new chapter on disruptive, impulse control, and conduct disorders. These disorders, often first diagnosed in children and adolescents, are united by the presence of difficult, disruptive, antisocial, or aggressive behavior. These behaviors can occur in different forms at varying levels of severity and may be premeditated, defensive, or impulsive in nature.2

Oppositional Defiance Disorder

The mildest of these behavior disorders is Oppositional Defiance Disorder (ODD), which is present in 1-16% of school-age children and adolescents.3 It is characterized by consistent uncooperative, defiant, negative, and annoying behavior toward parents, teachers, peers, and other authority figures.3 Teens with ODD are consistently troubling to those around them, leading to regular disciplinary problems.

Symptoms of ODD may include:3,4If left untreated, ODD can lead to major discipline problems and potentially develop into a more severe disorder known as conduct disorder.

  • Frequent temper tantrums.
  • Excessive arguments with adults.
  • Deliberate attempts to annoy or distress people.
  • Refusal to comply with adult requests and rules.
  • Always questioning rules.
  • Blaming others for their own misbehaviors or mistakes.
  • Becoming easily annoyed by others.
  • Frequently having an angry attitude.
  • Speaking harsh, hateful words.
  • Seeking revenge.

ODD often coexists with other mental health disorders, which can make the symptoms difficult to differentiate. A teen showing symptoms of ODD should have a comprehensive behavioral health evaluation to look for coexisting conditions such as attention-deficit hyperactivity disorder (ADHD), mood disorders (e.g., depression, bipolar disorder), anxiety disorders, and personality disorders (e.g., borderline personality). If left untreated, ODD can lead to major discipline problems and potentially develop into a more severe disorder known as conduct disorder.2

Conduct Disorder

Conduct Disorder (CD) is characterized by a persistent pattern of behaviors that infringe on the rights and property of others.5 Teens with conduct disorder have an exceptionally hard time following rules and acting in socially acceptable ways. They often display aggression toward people and animals, destroy property, and act deceitfully. Teens who engage in these behaviors have significant disciplinary problems at home and school (and even in their communities) because they consistently break rules, regulations, and, in some cases, laws.5

Teens with CD are often written off by teachers and social agencies as bad kids instead of kids with mental health problems. This is, in part, because the CD diagnosis itself is so intertwined with major disciplinary issues. A conduct disorder diagnosis may be given if at least 3 of the following criteria have been present in the previous 12 months:5

Aggression to People and Animals

hooded teen brandishing knife

  • Often bullies, threatens, or intimidates others
  • Often initiates physical fights
  • Has used a weapon that can cause serious physical harm to others
  • Has been physically cruel to people
  • Has been physically cruel to animals
  • Has stolen while confronting a victim (mugging, robbery)
  • Has forced someone into sexual activity

Destruction of Property

  • Has deliberately engaged in fire-setting with the intention of causing serious damage
  • Has deliberately destroyed others’ property (other than by fire setting)

Deceitfulness or Theft

  • Has broken into someone else’s house, building, or car
  • Often lies to obtain goods or favors or to avoid obligations (“cons” others)
  • Has stolen items of nontrivial value without confronting a victim (shoplifting)

Serious Violations of Rules

  • Often stays out at night despite parental prohibitions, beginning before the age of 13
  • Has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period
  • Is often truant from school, beginning before the age of 13

Research suggests that teens with CD who do not receive comprehensive treatment will have ongoing problems throughout their lifetime. Without mental health treatment, teens with CD often have a difficult time adapting to adult life, and they frequently go on to have trouble holding a job, maintaining relationships, and avoiding the criminal justice system.5 Some may develop antisocial personality disorder, which is characterized by complete apathy to other people’s rights and needs.6

Intermittent Explosive Disorder

Intermittent Explosive Disorder (IED) is another disruptive disorder that can contribute to discipline problems in teenagers. IED is characterized by recurring outbursts of aggression, often involving violence or destruction of property, that are disproportionate to the precipitating stressors or preceding events.2 Research suggests that IED is common—a national study of adolescents found that 7.8% of participants met the criteria for IED at least once in their lifetime.7

In teens with IED, explosive episodes can occur suddenly and without warning. The aggressive outbursts usually last 30 minutes or less and can occur several times a week, but may also be separated by weeks or months of nonaggression. Less-severe verbal outbursts can occur in between episodes of physical aggression. Teens with IED may be irritable, aggressive, and angry much of the time.8

The explosive episodes of physical and verbal aggression can happen at any time, which means teens are likely to face disciplinary problems at home and at school. Because teens with IED react completely out of proportion to situations, they will have difficulty maintaining friendships and relationships. If left untreated, IED can continue for years, although the level of aggression may begin to decrease with age.8

Kleptomania

Kleptomania is an impulse control disorder that often leads to disciplinary and legal problems because it is characterized by the recurrent failure to resist the urge to steal items that are not needed for personal use. Kleptomania often first manifests itself in adolescence.

Unlike typical teenage shoplifters, kleptomaniacs don’t steal for personal gain, on a dare, or in collaboration with others. Teens with kleptomania steal because they cannot resist the impulse to do so.9

Although it is not a behavioral disorder, Adolescent Substance Use Disorder is another factor that can contribute to discipline problems. Substance use disorder is not always addiction, but can include everything from experimental use of alcohol and drugs, to dependence and addiction. It is common for teens struggling with mental health disorders to have coexisting substance use disorders, and it is critical to intervene early, treating both disorders at the same time.10

Behavioral Therapy

doctor talking with teenager Dialectical behavioral therapy focuses on developing emotional and social skills. Emotional regulation skills give you the ability to cope with sudden changes in mood and to control impulses that could otherwise be dangerous. Similarly, mindfulness is the ability to be self-aware of a situation as it is, not how you think it should be. Read More

What Parents Can Do to Address Teen Discipline Problems

A comprehensive psychological exam can help assess what mental health issues your teen may be experiencing, if any. Many parents have trouble seeing defiant behavior as a mental health problem, so they wait to see if stricter disciplinary efforts will work or if their teen grows out of it. Sometimes they wait to see if school disciplinarians or the juvenile justice system scares them straight. But waiting too long is risky.

There is evidence to suggest that early intervention and treatment can help children overcome disruptive disorders, such as oppositional defiant disorder. Treatment may also prevent a disorder like ODD from developing into a more serious condition like conduct disorder or antisocial personality disorder.

Treatment usually consists of a combination of therapies, including family therapy, behavioral therapy, and parent training. Some teens may benefit from medication as well. In treatment, teens learn healthy techniques to manage their anger and modify their disruptive behaviors. Parents learn better ways to discipline, as well as strategies for positive reinforcement.11

If you are concerned that your teen is acting abnormally aggressive, disruptive, or impulsive, it may be time to seek treatment. Start by educating yourself about the different behavioral disorders that are common in teens. Learn some of the jargon. Set a time to talk to your teen about your concerns about their mental health. Plan what you want to say and try to include specific examples of behavior that worry you.

A comprehensive psychological exam can help assess what mental health issues your teen may be experiencing, if any. You may want to start with your teen’s primary care giver to ask for a referral to an adolescent psychiatrist in your area. Comprehensive psychiatric evaluations usually require several hours that include 1 or more office visits for the child and parents. With permission from the parents, the psychiatrist might contact other significant people, including teachers, relatives, or the child’s primary care doctor.12

If a psychiatrist thinks a diagnosis is warranted, take the recommended treatment steps as soon as possible.

Resources

The following is a list of resources you might find helpful when seeking treatment for discipline problems.

Sources

  1. American Academy of Child and Adolescent Psychiatry. (2016). Teen brain: behavior, problem solving, and decision making.
  2. Grant, J. E. & Leppink, E. W. (2015). Choosing a treatment for disruptive, impulse-control, and conduct disorders: limited evidence, no approved drugs to guide treatment. Current Psychiatry, 14(1), 28.
  3. Johns Hopkins. Oppositional defiant disorder.
  4. American Academy of Child and Adolescent Psychiatry. (2013). Oppositional defiant disorder.
  5. American Academy of Child and Adolescent Psychiatry. (2013). Conduct disorder.
  6. American Academy of Pediatrics. (2015). Antisocial personality disorder.
  7. McLaughlin, K. A., Green, J. G., Hwang, I., Sampson, N. A., Zaslavsky, A. M. & Kessler, R. C. (2012). Intermittent explosive disorder in the national comorbidity survey replication adolescent supplement. Archives of General Psychiatry, 69(11), 1131–1139.
  8. Mayo Clinic. (2015). Intermittent explosive disorder.
  9. Mayo Clinic. (2014). Kleptomania.
  10. National Institute on Drug Abuse. (2014). Principles of adolescent substance use disorder treatment: a research-based guide.
  11. American Academy of Child and Adolescent Psychiatry. (2009). Oppositional defiant disorder: a guide for families.
  12. American Academy of Child and Adolescent Psychiatry. (2012). Comprehensive psychiatric evaluation.
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