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Disruptive, problematic behavior is ubiquitous and an integral aspect of normal development. In fact, the natural drive of children to increasingly assert their autonomy as they grow older and more independent inevitably sets them on a path leading to disagreement and conflict with their caregivers. Of course, children vary greatly in their frustration tolerance, their overall self-regulation, and their need to assert themselves. Such interindividual differences interact with environmental responses, particularly in the caregiving environment, which itself may vary greatly in terms of sensitivity and responsiveness to children’s developmental needs, capacity to promote trust and social learning, and ability to provide effective models in such areas as prosocial behavior; coping with frustration, stress, and conflict; and problem solving. This complex interaction between biologically based motivational dispositions and environmental responses shapes, organizes, and reinforces developmental trajectories in which normative conflict can turn into disruptive behavioral disorder.


Temperament typically refers to the innate (ie, biological) aspects of one’s personality. Children differ substantially in their temperamental traits, which can be observed as early as birth, although they are more reliably appreciated after the first few weeks of life. Traits include such characteristics as activity level, frustration tolerance, assertiveness, attention, emotional reactivity/intensity, impulsivity, fearfulness, and propensity to respond to soothing. A simple review of this list makes it apparent how temperament may play a key role in determining the child’s inclination for engaging in behavior that could precipitate conflict. For instance, an impulsive, risk-taking child is more likely to break rules due to failure to plan his or her actions and consider their consequences. Of course, as executive functions are still developing during childhood, traits such as impulsivity must be evaluated in an age-appropriate manner.


A complex process such as disruptive behavior is virtually never the product of a single factor. Instead, it results from the interaction of a number of factors that may contribute, in varying degrees, to different behaviors in the same child over time and across different children at the same developmental stage. Importantly, for a behavior to persist, it must be rewarded or “reinforced”; otherwise, it will more likely be extinguished. In behavioral terms (ie, operant conditioning), contingencies of reinforcement consist of 3 components: antecedents, behaviors, and consequences (referred to as the ABCs of behavior). Antecedents are stimuli, settings, and contexts that precede and influence the onset of a behavior, while consequences are the events that follow. Consequences could have no impact on the recurrence of a behavior, but they can also increase it or decrease it. Positive reinforcers are events that follow a behavior and make it more likely to recur. For instance, when an infant is comfortable (ie, antecedent) and smiles (ie, behavior), even if exhibiting a reflexive social smile, the parents feel excited and respond with increased attention to and engagement with the ...

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