Diagnosing Behavioral Problems in Children

All children and adolescents act out from time to time—having tantrums, testing boundaries, or questioning rules—especially if they’re overly distressed or tired. In fact, such behavior is an expected part of development in toddlers and young teens. But when behavioral problems disrupt a child’s family, school, and social life, it may indicate a more serious condition.

Oppositional defiant disorder and conduct disorder are two types of behavioral disorders in children and teens. Other conditions may have similar symptoms or appear at the same time in a child with behavioral problems, including anxiety and other mood disorders, attention deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), and autism spectrum disorders.

Doctors at Hassenfeld Children’s Hospital at NYU Langone understand that it can be difficult for a parent to know when a child’s disobedience or rebelliousness signals a more troublesome pattern of behavioral problems. Our experts have the diagnostic expertise to distinguish among the different types of mood and behavioral disorders children may have.

Oppositional Defiant Disorder

Children and teens with oppositional defiant disorder (ODD) have a recurrent pattern of defiant and hostile behavior toward parents, teachers, or other authority figures that interferes with their day-to-day lives. Behaviors include frequent tantrums, excessive arguing with adults, and refusal to comply with an adult’s requests or rules. A child may try to annoy or upset people and may harbor anger or resentment. These symptoms may be more noticeable at home or at school, but they can be present in many places.

Signs of the disorder usually appear before age eight, but more serious symptoms may develop later. Symptoms tend to begin gradually, then worsen over months or years. The condition is common among children and teens with ADHD. Both disorders share common symptoms of disruptive behaviors. However, children and adolescents who have both ODD and ADHD tend to be more aggressive, have more negative behavioral symptoms of ODD, and perform worse in school than those who have ODD alone.

To receive a diagnosis of ODD, a child must engage in at least four of the following behaviors on a frequent basis: losing his or her temper, arguing with and defying adults, blaming others for his or her own errors or misconduct, being easily annoyed by others, or deliberately trying to annoy other people.

Conduct Disorder

Children with conduct disorder (CD) behave aggressively toward others or violate rules or laws—for example, by skipping school or shoplifting. There are four categories of conduct disorder behaviors: aggressive, destructive, deceitful, and violating rules.

Aggressive behavior includes threatening or harming people or animals, fighting with others, using weapons, and committing sexual assault. Destructive behavior involves damaging property. Deceitful behavior may include repeated lying, shoplifting, or stealing. A child who violates rules may engage in inappropriate behavior, such as running away from home, skipping school, or being sexually active at a very young age.

To receive a diagnosis of CD, a child must engage in at least three of the following behaviors for the prior 12 months, and at least one in the prior six months:

• bullying, threatening, or intimidating others
• initiating fights
• using a weapon that can harm others
• harming people or animals
• assaulting someone sexually
• setting fire in order to cause damage
• deliberately destroying property
• breaking into a house, building, or car
• lying to obtain goods or favors or to avoid obligations
• stealing
• staying out at night despite parental prohibitions, beginning before age 13
• running away from home overnight at least twice, or once without returning for a lengthy period
• being absent from school, beginning before age 13

Diagnostic Evaluation

To diagnose a behavioral problem in a child or adolescent, an expert trained in childhood development and behavior meets with you and your child to perform a comprehensive evaluation.

The first part of the evaluation involves interviews—both individually and together with parents—to assess your child’s background, medical history, and symptoms. When a clinician conducts the diagnostic interview with a child, he or she speaks with the child and observes the child's nonverbal communication, such as facial expressions and posture.

You also complete questionnaires to give the team a sense of your child’s behaviors and how they’re affecting daily life. Our clinicians also talk with your child’s teachers and caregivers.

After our child and adolescent psychologists, psychiatrists, or developmental–behavioral pediatricians have gathered the information about a child’s behavior, they meet with parents and the child to discuss the diagnosis and treatment options. Our specialists aim to help you understand your child’s behavior and provide you with a treatment plan to meet your child’s—and your family’s—needs.