Violation of behavior in children

This section includes a group of behavioral disorders characterized by a persistent type of dissocial, aggressive or challenging behavior, reaching a marked violation of age-appropriate social norms.

Examples of behavior on which the diagnosis is based include excessive pugnacity or hooliganism; cruelty to other people or animals; gross destruction of property; arson, stealing, lying, absenteeism at school and leaving home, unusually frequent and severe outbursts of anger; provoking provocative behavior; constant frank disobedience. Any of these categories with its severity is sufficient for the diagnosis, but isolated acts do not give grounds for diagnosing.

Considering the heterogeneous nature and the complex mechanism of formation included in the rubric of behavioral disorders, it is necessary to conduct an individual survey for their diagnosis aimed at establishing the causal factor with determining the specific gravity of the biological and socio-psychological component. This is the prerogative of a psychiatrist. The pediatrician should have an idea of the main types of behavioral disorders, their clinical features, differentiating primarily socialized and non-specialized forms.

Prior to the transition to ICD-10 in domestic psychiatry, the syndrome of behavioral disorders was isolated using the multi-axis classification proposed by V.V. Kovalev (1985). The classification included the following axes:

• socio-psychological;
• clinico-psychopathological;
• personality-dynamic.

Socio-psychological approach made it possible to qualify various manifestations of behavior as deviant, deviating from accepted in the given society forms for moral and ethical reasons.

Clinical-psychopathological approach included the division of deviant behavior into pathological (according to ICD-10 asocial) and non-pathological (according to ICD-10 socialized) forms of behavior. The main criteria for assigning deviant behavior to manifestations of pathology (VV Kovalev, 1985):

• presence pathocharacterological syndrome (the presence of pathological properties of the character in the subject);
• manifestation of deviant behavior outside the main microsocial groups;
• a combination of behavioral disorders with neurotic disorders (decreased mood background, sleep, appetite disturbance, anxiety, etc.);
• dynamics of deviant behavior with a tendency to pathological transformation of the personality.

The personality dynamic axis makes it possible to attribute behavioral disorders to the three main manifestations of personality dynamics: reactions (characterological, pathocharacterological), development (socio-psychological deformation of the personality in the process of prolonged finding in an abnormal psychosocial situation or in the formation of constitutional nuclear psychopathies in the process of ontogenesis) and states (formed psychopathies and character accentuations).

Unsocialized behavioral disorders

ICD-10 code

F91.1 Unsocialized behavioral disorder.

Type of behavior characterized by a combination of persistent dissocial or aggressive behavior with a significant general disruption of the child's relationship with other children and adults.

These behavior disorders correspond to existing in the domestic psychiatry concepts of pathological forms of deviant behavior. Pathological forms of deviant behavior are most often manifested by typological variants.

• Typological variant with a predominance of increased affective excitability. In the structure of the behavioral disorder, the manifestations of emotional excitability, irritability, inclination to affective discharges with aggressive actions (fights, insults) and subsequent somatopsychic asthenia predominate. Characteristic are strong reactions of active protest, opposition behavior associated with restrictions and prohibitions imposed by teachers or parents. At the same time, children either actively protest against the school regime, or refuse to attend classes.
• For a typological variant with a predominance of mental instability, there is an increased suggestibility, dependence of behavior on external conditions with the predominance of motives for obtaining pleasure, propensity to deceit and stealing, easy attachment to drug use.
• Typological variant with a predominance of impairments includes the most frequent withdrawals and vagrancy, aggressive-sadistic disorders. Dromomaniac tendencies are often combined with violations of sexual desire, often taking the nature of perversion. In girls, sexual disinhibition is the leading sign in the pathology of the behavior of this variant.
• The impulsive-epileptoid variant is expressed in the tendency to prolonged and intense affective outbreaks that occur instantaneously, sometimes on insignificant occasion, accompanied by aggressive acts, in a slow exit from the state of gloomy-malicious affect, vengefulness, stubbornness, reactions of active protest. Against the background of mood swings with a dysphoric tinge, brutal antisocial behavior is often observed as an expression of an angry-aggressive affect.

Treatment

Assistance is rendered in the conditions of inpatient and out-of-hospital forms of psychiatric care (hospitals, semi-hospitals, dispensaries), as well as in nonpsychiatric facilities with a license for the provision of medical services (medical and psychological offices of children's polyclinics, centers for psychological, medical and social support).

Socialized behavioral disorder

ICD-10 code

F91.2 Socialized behavioral disorder.

Include a behavior disorder of the group type; group delinquency; offenses in the conditions of gang membership; theft in company with others.

This type of behavioral disorder is characterized by persistent dissocial and aggressive behavior that occurs in children, usually well integrated in the peer group. The main feature that makes it possible to differentiate them from non-specialized disorders of behavior is the availability of adequate, long-term relationships with peers. They correspond to the existing in the domestic psychiatry concepts of non-pathological forms of deviant behavior.

Treatment

Assistance is rendered in open and closed non-medical establishments engaged in correctional and educational work with difficult children and adolescents (specialized schools, educational complexes for socially disadapted children and adolescents).

Oppositional-causing behavior disorder

ICD-10 code

F91.3 Oppositional disorder causing discomfort.

This type of behavioral disorders is determined by the presence of a negative, hostile, provocative, provocative behavior that is beyond the normal level of behavior of a child of the same age in similar socio-cultural conditions, the absence of more severe dissocial or aggressive actions that violate the law or the rights of others.

This disorder is typical for children under 10 years old. In older children, this kind of violation is usually accompanied by dissocial or aggressive behavior, which exceeds open disobedience, disobedience or brutality.

Treatment

Assistance is rendered in open psychological and medical institutions (centers for psychological, medical and social support, children's counseling centers for a medical psychologist, medical and psychological offices for children's polyclinics).