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Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2011, Number 5

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Salud Mental 2011; 34 (5)

Trastornos de la conducta disruptiva en la infancia y la adolescencia: diagnóstico y tratamiento

Peña-Olvera F, Palacios-Cruz L

Language: Spanish
References: 34
Page: 421-427
PDF size: 87.05 Kb.


ABSTRACT

Disruptive behavior disorders (DBD) in childhood and adolescence are among the most frequent reasons for consultation and counseling.
In Oppositional Defiant Disorder (ODD), psychosocial management is the therapeutic intervention of choice. Training parents and caregivers in the behavioral management of the child or early adolescent (12 to 15 years) is the best interventions. Behavioral perspective needs to cover all contexts: family, school, and the child. The clinician must make an individualized treatment plan. The parents suggested interventions should be based on those with the greatest empirical evidence. The use of drugs may be useful as an addition to psychosocial interventions for symptomatic treatment and comorbid conditions. Severe and persistent ODD may require prolonged and intensive treatment. Brief interventions are usually ineffective.
Conduct disorder (CD) is a mixed manifestation that needs biological, psychological and social therapeutic intervention. Psychopharmacological treatment alone is never enough. Studies with drugs for the treatment of CD may be grouped by type of drug used: mood stabilizers, antipsychotics and stimulants. The overall effect size of psychotropic agents in the treatment of aggression is 0.56. Currently only three psychosocial treatments have been adequately evaluated: A) Training for parents, B) Cognitive training in problemsolving skills and C) Multisystemic therapy.
Conclusions: ODD and CD are among the most frequent and severe mental disorders in childhood and adolescence. The treatment of these conditions must be multimodal or multisystemic, including pharmacological, psychoeducational and psychotherapy.


REFERENCES

  1. Palacios L, Ulloa RE, De la Peña F. Trastornos externalizados concomitantes. En: Trastorno por déficit de atención diagnóstico y tratamiento, por Ruiz M. México, D. F: Capítulo 5; primera edición; Editores de Textos Mexicanos; 2003; pp. 57-80.

  2. Slade T, Watson D. The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychol Med 2006;36:1593-1600.

  3. Kendler KS, Aggen SH, Knudsen GP, Neale MC et al. The structure of genetic and environmental risk factors for syndromal and subsyndromal DSM-IV axis I and axis II disorders. Am J Psychiatry 2010;168:29-39.

  4. Asociación Psiquiátrica Americana. Manual Diagnóstico y Estadístico para los Trastornos Mentales (DSM). Cuarta edición, Washington D.C.: 2004.

  5. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneve, HC,: 1992.

  6. American Academy of Child and Adolescent Psychiatry. Practice parameter for the assessment and treatment of children and adolescents with oppositiona defiant disorder, J Am Acad Child Adolesc Psychiatry 2007;46:126-141.

  7. Martínez AL, Fernández CE, Lemus R, Mendoza MA et al. Diagnóstico y manejo de los trastornos de conducta en «Guías Clínicas». Hospital Psiquiátrico Infantil JNN, México, DF: Edit. Impresos Santiago S.A. de C.V.; 2010; Consultado en: http://www.sap.salud.gob.mx/downloads/pdf/nav_guias2.pdf Revisado por ´ltima vez el 15 de agosto de 2011.

  8. Vázquez J, Feria M, Palacios L, De la Peña F. Guía clínica para el trastorno negativista y desafiante. En: Berenzon Sh, Del Bosque J, Alfaro J, Medina-Mora ME (eds.) México: Instituto Nacional de Psiquiatría Ramón de la Fente Muñiz. (Serie: Guías clínicas para la atención en trastornos mentales) 2010. Consultado en: http://www.inprf.gob.mx/opencms/export/sites/INPRFM/psicosociales/archivos/guias/trastorno_negativista.pdf el 15 de agosto de 2011.

  9. Vázquez J, Feria M, Palacios L, De la Peña F. Guía clínica para el trastorno disocial. En: Berenzon Sh, Del Bosque J, Alfaro J, Medina-Mora ME (eds.). México: Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (Serie: Guías clínicas para la atención en trastornos mentales) 2010. Consultado en:http://www.inprf.gob.mx/opencms/export/sites/INPRFM/psicosociales/archivos/guias/trastorno_disocial.pdf el 15 de agosto de 2011.

  10. Burke JD, Loeber R, Birmaher B. Oppositional defiant and conduct disorder. A review of the past 10 years, part II. J Am Acad Child Adolesc Psychiatry 2002;41:1275-1293.

  11. Moffit TE. Adolescence limited and life course persistent antisocial behavior: a developmental taxonomy. Psychol Rev 1993;100:674-701.

  12. Shaw DS, Owens EB, Biovannelly J, Winslow EB. Infant and toddler pathways leading to early externalizing disorders. J Am Acad Child Adolesc Psychiatry 2001;40:36-43.

  13. Dodge K. The structure and function of reactive and proactive aggression. En: The developmental and treatment of childhood aggression. Pepler DJ, Rubin KH (eds.). Hillsdalle, NJ: Lawrence Erbaum Associates; 1991; pp 201-218.

  14. Connor DF. Agression & antisocial behavior in children and adolescents. Research and treatment. Nueva York: Guilford Press; 2002.

  15. Rutter M, Giller H, Hagell A. Antisocial behavior by young people. J Am Acad Child Adolesc Psychiatry 1999;38:1320-1321.

  16. Loeber R, Burke JD. Laheh BB, Winters A et al. Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry 2000;39:1468-1484.

  17. Costin J, Chambers SM. Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clin Child Psychol Psychiatry 2007;12:511-524.

  18. Barkley RA, Edwards G, Laneri M, Fletcher K et al. The efficacy of problem- solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD. J Consult Clin Psychol 2001;69:926-941.

  19. Lavigne JV, Lebailly SA, Gouze KR, Cicchetti C et al. Treating oppositional defiant disorder in primary care: a comparison of three models. J Pediatr Psychol 2008;33:449-461.

  20. Oliver BR, Barrer ED, Mandy WPL, Skuse DH et al. Social cognition and conduct problems: a developmental approach. J Am Acad Child Adolesc Psychiatry 2011;50:385-394.

  21. Díaz J, De la Peña F, Suárez J, Palacios L. Perspectiva actual de la violencia juvenil. Med UNAB 2004;6:115-124.

  22. Moffit TE, Jaffee SR, Kim-Cohen J, Koenen KC et al. Research review: DSM-V conduct disorder: research needs for an evidence base. J Child Psychol Psychiatry 2008;49:3-33.

  23. De la Peña F. Tratamiento multisistémico para adolescentes disociales. Salud Pública 2003;45(Supl 1):s124-s130.

  24. Gerardin P, Cohen D, Mazet P, Flament MF. Drug treatment of conduct disorders in young people. Europ Psychopharmacology 2002;12:361-370.

  25. Ercan ES, Basay BK, Basay O, Durak S et al. Risperidone in the treatment of conduct disorder in preschool children without intellectual disability. Child Adolesc Psychiatry Ment Health 2011;5:10-22.

  26. American Academy for Child and Adolescent Psychiatry. Practice parameter on the use of psychotropic medication in children and adolescents. J Am Acad Child Adolesc Psychiatry 2009;48:961-973.

  27. Pappadopulus E, Woolston S, Chait A, Perkins M et al. Pharmacotherapy of aggression in children and adolescents: efficacy and effect size. J Can Acad Child Adolesc Psychiatry 2006;15:1-14.

  28. Letourneau EJ, Henggeler SW, Borduin CM, Schewe PA et al. Multisystemic therapy for juvenile sexual offenders: 1-year results from a randomized effectiveness trial. J Fam Psychol 2009;23:89-102.

  29. Klietz SJ, Bourduin CM, Schaeffer CM. Cost-benefit analysis of multisystemic therapy with serious and violent juvenile offenders. J Fam Psychol 2010;24:657-666.

  30. Frick PJ et al. Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. J Abnormal Child Psychology 2005;33:471-487.

  31. Frick PJ, White SF. Research review: The importance of callous-unemotional traits for developmental models for aggressive and antisocial behavior. J Child Psychol Psychiatry 2008;49:359-375.

  32. Viding E, Frick PJ, Plomin R. Aetiology of the relationship between callous-unemotional traits and conduct problems in childhood. British J Psychiatry 2007;190(supl.49):s33-s38.

  33. Rowe R, Maughan B, Moran P, Ford T et al. The role of callous and unemotional traits in the diagnosis of conduct disorder. J Child Psychol Psychiatry 2010;51:688-695.

  34. Frick PJ, Body SD, Barry CT. Psychopathic traits and conduct problems in community and clinic-referred samples of children: further development of the psychopaty screening device. 2000;12:382-393.




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