This chapter deals with problems of conduct, commonly considered as externalising disorders, which involve self-control of emotions and behaviours. “Problem behaviour,” “challenging behaviour,” “severely challenging behaviour,” and “emotional disorders” or “behavioural disorders” are all terms that describe behaviours that create problems at home, at school, and in the community.
Mental health problems presenting in young people have been broadly categorised into externalising and internalising problems and behaviours (Wilmshurst, 2005). Internalising behaviour difficulties are defined as those “problems that negatively impact the child's internal psychological world rather than the external environment” (Fite et al., 2008, p. 64). Externalising problems include impulsive and antisocial behaviours, such as distracting others, disobeying teachers, and aggression towards others, along with behaviours associated with inattention, and hyperactivity (Achenbach & Rescoria, 2001). Externalising behaviour has also been related to other mental health issues (Sawyer et al., 2000).
Teachers are often less accepting of students with social, emotional, and behavioural difficulties, so they are strongly associated with negativity in the student–teacher relationship (Baker, Grant, & Morlock, 2008). Furthermore, the association between disruptive behaviour and low achievement is well established, particularly with males (Hinshaw, 1992; Prior et al., 1999). As externalising behaviours have been associated with subsequent development of antisocial behaviours, difficulty in negotiating social relationships, substance abuse, and early school leaving, they are of considerable concern to educators and health professionals (Baker et al., 2008; Hunter, 2003).
Disruptive behaviour disorders are evident in behaviours that violate the rights of others or bring the individual into conflict with social norms or authorities (Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; DMS-5; American Psychiatric Association, 2013). The disorders include oppositional defiant disorder, (ODD), conduct disorder (CD), and intermittent explosive disorder. They can be considered on a spectrum according to the emphasis on emotion or behaviour, as seen in Table 19.1.
Many of the symptoms that are used to identify behavioural disorders occur in typical development; however, the frequency, persistence, intensity, and impact on functioning are key factors in diagnosing significant variation from the norm. Age and stage of development are important factors to consider.