All kids misbehave some times. And some may have temporary behavior problems due to stress. For example, the birth of a sibling, a divorce, or a death in the family may cause a child to act out. Behavior disorders are more serious. They involve a pattern of hostile, aggressive, or disruptive behaviors for more than 6 months. The behavior is also not appropriate for the child's age.

Warning signs can include

• Harming or threatening themselves, other people or pets
• Damaging or destroying property
• Lying or stealing
• Not doing well in school, skipping school
• Early smoking, drinking or drug use
• Early sexual activity
• Frequent tantrums and arguments
• Consistent hostility toward authority figures

If you see signs of a problem, ask for help. Poor choices can become habits. Kids who have behavior problems are at higher risk for school failure, mental health problems, and even suicide. Classes or family therapy may help parents learn to set and enforce limits. Talk therapy and behavior therapy for your child can also help.

What is attention deficit hyperactivity disorder (ADHD)?

ADHD is a neurodevelopmental disorder. It is usually first diagnosed in childhood and often lasts into adulthood. But some people don't get diagnosed with ADHD until they are adults. ADHD involves:

• Having trouble paying attention (inattention)
• Having trouble controlling impulsive behaviors (impulsivity)
• Being overly active (hyperactivity)

What are the types of attention deficit hyperactivity disorder (ADHD)?

There are three types of ADHD:

• Mostly Inattentive ADHD. People with this type of ADHD have trouble paying attention and are easily distracted. It's hard for them to organize or finish tasks. They may have trouble following instructions or conversations.
• Mostly Hyperactive-Impulsive ADHD. People with this type of ADHD have symptoms of both hyperactivity and impulsivity:
  • With hyperactivity, people feel a need to always be moving. They have trouble sitting still and may fidget and/or talk too much.
  • With impulsivity, people have trouble controlling their actions and words. They tend to act on sudden ideas or feelings without thinking about the possible results. They may interrupt others a lot or have trouble waiting their turn.
• Combined ADHD. People with this type of ADHD have a mix of inattentive and hyperactive-impulsive symptoms. Combined ADHD is the most common type.

It's normal to sometimes have trouble paying attention or sitting still, especially for children. But people with ADHD have more severe symptoms that can sometimes cause serious problems, for example, failing grades for a child or a job loss for an adult. The symptoms are ongoing and may affect family and social life, too.

What causes attention deficit hyperactivity disorder (ADHD)?

The exact cause of ADHD is unknown. ADHD probably results from a combination of factors, such as genetics and your environment. Researchers are looking at possible environmental factors that might raise the risk of developing ADHD. These factors include brain injuries, nutrition, and social environments.

What are the symptoms of attention deficit hyperactivity disorder (ADHD)?

The symptoms of ADHD depend on the type of ADHD a person has:

People with symptoms of attention problems may often:

• Miss details or make careless mistakes in schoolwork, at work, or in other activities
• Have trouble staying focused on play activities or work tasks
• Not seem to listen when spoken to directly
• Find it hard to follow instructions or finish tasks, or may start but get easily sidetracked
• Have trouble being organized, keeping belongings in order, and managing time
• Avoid doing tasks that require long periods of mental effort
• Lose important items, such as books, wallets, keys, eyeglasses, and cellphones
• Forget about doing daily activities

People with symptoms of hyperactivity-impulsivity may often:

• Fidget and squirm while seated
• Get up when staying seated is expected, such as at school or work
• Run around or climb when it's not appropriate (children) or feel restless (teens and adults)
• Have trouble doing quiet activities
• Be constantly moving or "on the go"
• Talk much more than is normal
• Blurt out answers before questions are completed
• Have trouble waiting for their turn
• Interrupt others for example during conversations or games

People with combined ADHD show a mix of inattention and hyperactivity-impulsivity symptoms

How is attention deficit hyperactivity disorder (ADHD) diagnosed?

There is no single test to diagnose ADHD. One step of the process for diagnosing ADHD involves having a physical exam, including vision tests, hearing tests (for children and adults), and other tests to rule out other problems with symptoms like ADHD. Other problems with similar symptoms include anxiety, depression, sleep problems, and certain types of learning disabilities.

The process also involves a thorough medical history and family history. And it usually includes using standardized ADHD symptom checklists, questionnaires, and/or interview questions. These tools have rating scales (scoring systems) that help the provider see if a person's symptoms and history fit a diagnosis of ADHD.

To make a diagnosis of ADHD, the provider needs to have found all of these things:

• Several symptoms of ADHD that began before age 12.
• Several symptoms of inattention and/or hyperactivity-impulsivity that have lasted for at least 6 months and cause serious problems:
  • For children up to age 16, there must be at least 6 ongoing symptoms.
  • For people 17 and older, there must be at least 5 ongoing symptoms.
  • Symptoms that happen in 2 or more settings, for example, at home and at work or school.
  • Symptoms that clearly get in the way of functioning well at school, work, and/or in social situations.
  • Symptoms aren't caused by another mental health disorder.

What are the treatments for attention deficit hyperactivity disorder (ADHD)?

Although there is no cure for ADHD, treatments may help reduce symptoms and improve functioning. ADHD is commonly treated with:

• Medicines.
• Psychotherapy (talk therapy), including behavior therapy.
• Education or training for parents to give them the skills and strategies to help their child. This is especially important for younger children.
• A combination of these treatments.

Good treatment plans will include close monitoring, follow-ups, and making changes, if needed, along the way.

Having a healthy lifestyle, such as healthy eating and regular exercise, may also help manage symptoms.

For school-aged children, school support is important. This could include classroom-based behavioral interventions such as behavior management plans or teaching your child organizational and study skills. It may also include accommodations such as specific seating in the classroom, reduced classwork, or extended time on tests and exams.

As children grow older, they develop in several different ways. Child development includes physical, intellectual, social, and emotional changes.

Children grow and mature at very different rates. It's hard to say what "normal" is. There can be big differences in height, weight, and build among healthy children. Diet, exercise and genes are all factors. Some children begin puberty or are close to it before they are teenagers.

Children start to become more independent from their parents. They may rebel. They also look outward - to their friends, who are usually of the same sex. Peer approval becomes very important. Your child may try new behaviors to be part of "the group." This can also be the time that parents or teachers recognize learning disabilities or behavioral problems in children. These problems can get worse as time goes on, so it is important to get help early.

It's important to recognize and treat mental illnesses in children early on. Once mental illness develops, it becomes a regular part of your child's behavior. This makes it more difficult to treat.

But it's not always easy to know when your child has a serious problem. Everyday stresses can cause changes in your child's behavior. For example, getting a new brother or sister or going to a new school may cause a child to temporarily act out. Warning signs that it might be a more serious problem include

• Problems in more than one setting (at school, at home, with peers)
• Changes in appetite or sleep
• Social withdrawal or fear of things he or she did not used to be not afraid of
• Returning to behaviors more common in younger children, such as bedwetting
• Signs of being upset, such as sadness or tearfulness
• Signs of self-destructive behavior, such as head-banging or suddenly getting hurt often
• Repeated thoughts of death

To diagnose mental health problems, the doctor or mental health specialist looks at your child's signs and symptoms, medical history, and family history. Treatments include medicines and talk therapy.

Self-harm, or self-injury, is when a person hurts his or her own body on purpose. The injuries may be minor, but sometimes they can be severe. They may leave permanent scars or cause serious health problems. Some examples are

• Cutting yourself (such as using a razor blade, knife, or other sharp object to cut your skin)
• Punching yourself or punching things (like a wall)
• Burning yourself with cigarettes, matches, or candles
• Pulling out your hair
• Poking objects through body openings
• Breaking your bones or bruising yourself

Self-harm is not a mental disorder. It is a behavior - an unhealthy way to cope with strong feelings. However, some of the people who harm themselves do have a mental disorder.

People who harm themselves are usually not trying to kill themselves. But they are at higher risk of attempting suicide if they do not get help.

As a teenager, you go through many physical, mental, emotional, and social changes. The biggest change is puberty, the process of becoming sexually mature. It usually happens between ages 10 and 14 for girls and ages 12 and 16 for boys. As your body changes, you may have questions about sexual health.

During this time, you start to develop your own unique personality and opinions. Some changes that you might notice include

• Increased independence from your parents
• More concerns about body image and clothes
• More influence from peers
• Greater ability to sense right and wrong

All of these changes can sometimes seem overwhelming. Some sadness or moodiness can be normal. But feeling very sad, hopeless, or worthless could be warning signs of a mental health problem. If you need help, talk to your parents, school counselor, or health care provider.

DBDs are disorders in which children or teens have trouble controlling their emotions and behavior. Their behavior may be very defiant, and they may strongly conflict with authority figures. Their actions may be aggressive and destructive. All children have mild behavior problems now and then, but DBDs are more severe and continue over time.

DBDs can start when a child is young. Children or teens with a DBD who do not receive treatment often have serious behavior problems at home, at school, or both. They are also more likely to have problems with alcohol or drug use and violent or criminal behavior as they get older.

Examples of DBDs include oppositional defiant disorder, conduct disorder, and intermittent explosive disorder.

Oppositional Defiant Disorder

Children or teens with this disorder may have an angry or irritable mood much of the time. They may argue often and refuse to obey parents, caregivers, teachers, or others. They may also want to hurt someone they think has harmed them.

Conduct Disorder

Children or teens with this disorder may act aggressively toward people, animals, or both. They may bully or threaten someone, start physical fights, use weapons, hurt animals, or force sexual activity on others. They may also destroy property by fire or other means, lie often, or steal. They may stay out late at night, skip school, or run away from home. They may also lack compassion and not feel guilty about harming others.

Intermittent Explosive Disorder

Children or teens with this disorder may have outbursts of aggressive, violent behavior or shouting. They may have extreme temper tantrums and may start physical fights. They often overreact to situations in extreme ways and do not think about consequences. Outbursts happen with little or no warning. They usually last for 30 minutes or less. After the outburst, the child or teen may feel sorry or embarrassed.

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD usually starts before 8 years of age, but no later than by about 12 years of age. Children with ODD are more likely to act oppositional or defiant around people they know well, such as family members, a regular care provider, or a teacher. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

• Often being angry or losing one’s temper
• Often arguing with adults or refusing to comply with adults’ rules or requests
• Often resentful or spiteful
• Deliberately annoying others or becoming annoyed with others
• Often blaming other people for one’s own mistakes or misbehavior

Conduct Disorder (CD) is diagnosed when children show an ongoing pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These rule violations may involve breaking the law and result in arrest. Children with CD are more likely to get injured and may have difficulties getting along with peers.

Examples of CD behaviors include

• Breaking serious rules, such as running away, staying out at night when told not to, or skipping school
• Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals
• Lying, stealing, or damaging other people’s property on purpose

DBDs are one of the most common types of behavioral disorders in children and teens.

• Out of every 100 children in the United States, about 3 of them have a DBD.
• More boys than girls have a DBD.
• DBDs are more common among children aged 12 years and older.

The cause of DBDs is not known. Things that increase the risk for a DBD include:

• Child abuse or neglect
• A traumatic life experience, such as sexual abuse or violence
• A family history of DBDs

Having a child or teen with a DBD can be very stressful for parents, caregivers, and the whole family. But, there are treatments that may help.

To treat your child's or teen's DBD, your health care professional may recommend psychosocial treatment (treatment with a trained therapist). If needed, your child's or teen's health care professional may also suggest taking a medicine with the psychosocial treatment.

Each child or teen responds differently to different treatments. You may need to try several treatments before finding one that is right for your child or teen.

Psychosocial treatment can help improve interactions between you and your child or teen. This is done through programs in which parents and their child or teen meet with a trained therapist. It is important for parents and caregivers to be involved in the treatment.

Some programs focus only on parent training. Other programs also work with the child or teen, the whole family together, or with the child's or teen's teachers.

Parent and child training programs are sometimes done in groups. Sessions usually last 1 to 2 hours and are held each week for 8 to 18 weeks. The programs usually charge a fee. Your insurance may cover some of the costs.

Parent Programs

These programs can help you:

• Respond in a positive way when your child asks for help or wants attention
• Choose realistic goals for your child
• Better monitor your child's behavior
• Learn more effective parenting skills
• Have more confidence in being able to handle situations
• Reduce your stress

The programs help support you and can teach you specific ways to help change your child's behavior without shouting, threatening, or using physical punishment. You can learn to:

• Set clear rules
• Stay calm when asking your child to do something
• Make sure your instructions are clear and right for your child's age
• Explain the consequences of disruptive behavior to your child
• Respond to disruptive behavior with things such as quiet time or a time-out

You can also learn ways to help support your child and:

• Improve your child's social skills
• Help your child build friendships
• Help your child learn how to control his or her emotions
• Teach your child problem-solving skills
• Help your child learn to be independent

Child Programs

These programs can help children:

• Feel more positive about themselves and their family
• Strengthen their social, communication, and problem-solving skills
• Better communicate feelings and manage anger
• Practice good behaviors

Teen Programs

For teens, a trained therapist may meet with parents and also with the whole family together. The therapist may look for patterns in the way family members interact that could cause tension and problems. The therapist can then help your family learn new ways to communicate to avoid conflict.

The therapist can help you learn how to:

• Be more involved with your teen
• Set clear rules and consequences for breaking the rules
• Improve your leadership, communication, and problem- solving skills
• Support your teen

Teacher Programs

These programs can help teachers learn how to:

• Manage behavior in the classroom
• Improve students' social and emotional skills
• Work with parents and keep them involved

What have researchers found about medicines for DBDs?

Medicines are usually given to children or teens with a DBD only if psychosocial treatment alone does not help enough. Medicines are usually taken together with psychosocial treatment.

Several types of medicines have been used to treat DBDs (see the chart on the next page). These medicines cannot cure DBDs. They are used to reduce symptoms and improve quality of life. The medicines work by changing the way certain chemicals act in the brain.

Medicines work differently in different children or teens. You may have to try several medicines to find one that works for your child or teen.

Note: The U.S. Food and Drug Administration (FDA) approves medicines for certain uses. Health care professionals often prescribe medicines for conditions other than their FDA-approved uses.

What have researchers found about medicines to treat DBDs?

What are possible side effects of medicines to treat DBDs?

The FDA lists these possible side effects for medicines to treat DBDs. Just because side effects are possible does not mean your child or teen will have them.

Possible Side Effects of Medicines to Treat DBDs

There are several things to think about when deciding which treatment may help your child or teen. As your child or teen grows and develops, his or her treatment may need to be changed. You will need to continue to work with your child's or teen's health care professional over time.

You may want to talk with your child's or teen's health care professional about:

• Psychosocial treatment programs
• Whether a medicine may help your child or teen
• The possible risks of the medicine

Ask your child's or teen's health care professional

• How might psychosocial treatment help my child or teen?
• How do I sign up for a psychosocial treatment program? Which program do you recommend? Why?
• How often would I meet with a therapist and for how long? Would my child or teen meet with the therapist as well?
• Would the therapist interact with our whole family or with my child's or teen's teachers?
• How will we know if my child or teen may need medicine?
• If my child or teen needs medicine, which medicine might be best?
• How long would my child or teen need to take the medicine?
• What are the risks of taking the medicine?
• How will I know if my child or teen is having a serious side effect? What should I watch for, and when should I call you?
• How long might it take for my child's or teen's treatment to start helping?
• Are there local support groups that could help me?

Being healthy is important for all children and can be especially important for children with behavior or conduct problems. In addition to behavioral therapy and medication, practicing certain healthy lifestyle behaviors may reduce challenging and disruptive behaviors your child might experience. Here are some healthy behaviors that may help:

• Engaging in regular physical activity, including aerobic and vigorous exercise
• Eating a healthful diet centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
• Getting the recommended amount of sleep each night based on age
• Strengthening relationships with family members

It is not known exactly why some children develop disruptive behavior disorders. Many factors may play a role, including biological and social factors. It is known that children are at greater risk when they are exposed to other types of violence and criminal behavior, when they experience maltreatment or harsh or inconsistent parenting, or when their parents have mental health conditions like substance use disorders, depression, or attention-deficit/hyperactivity disorder (ADHD). The quality of early childhood care also can impact whether a child develops behavior problems.

Although these factors appear to increase the risk for disruptive behavior disorders, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:

• Positive parenting strategies for young children
• Positive parenting tips
• Child maltreatment prevention
• Youth violence prevention
• Bullying prevention
• Mental health in adults
• Finding high quality child care