CLASSROOM LESSON PLAN

COURSE: MENTAL HEALTH AND PSYCHIATRIC NURSING

TOPIC: DISRUPTION BEHAVIOURS

AUDIENCE: 3RD YEARS QUARTERED STUDENTS

CLASS SIZE: 18

VENUE: ROOM 3

DATE : 28/ 03/2019

TEACHING METHOD: LECTURE/DISCUSSION

AUDIO VISUAL AIDS: WHITE BOARD, BOARD MARKER, PROJECTOR, LAPTOP

DURATION: 1 HOUR

SUPERVISOR: MRS. MUNTAMBO

STUDENT/TEACHER: LUNGU GABRIEL

COMPUTER NUMBER: 2018242806

 Introduction
Disruptive behaviors of relatedness are a common phenomenon among children but can as well be observed in adults. They are
characterized by poorly controlled, impulsive, acting out behavior in situations where self control is expected. The ability to control
one’s behavior depends on a number of skills developed overtime. Those who have not developed these skills, who continue to be
disruptive, impulsive and aggressive, are at high risk for school adjustment difficulties, learning problems and peer rejection. Among
the disruptive behavior disorders, the most important ones are Attention Deficit Hyperactive disorder and conduct disorder.

General objective
At the end of the lecture/discussion, students should gain knowledge and understanding and be able to define disruption of relatedness
and describe the positive relationships.

`Specific objectives
At the end of the lecture/discussion; students should be able to:
1. Describe the characteristics of Disruptive Behaviors.
2. Review the neurobiology of disruptive behavior
3. Mention the conditions associated with disruptive behaviors
4. State the treatment goals in disruptive disorders
5. Discuss the management of disruptive behaviors

Specific Content Ava Teachers Students Evaluation

objectives activities activities
Describe the According DSM 5. Disruptive behaviors are characterized by the LCD/ Explaining, Listening, What are the
characteristics following. Laptop asking and taking notes, characteristics of
of disruptive Excessive levels of activity: answering asking and disruptive
behaviors.  Fidgeting, squirming, and running around when questions. answering behaviors?
inappropriate, incessant talking. questions.
Distractibility and difficulty concentrating:
 Makes careless mistakes cannot follow instructions,
forgetful.
 May have difficulty with peer interactions
 Others behaviors include, temper tantrums, physical
aggression such as attacking other children, excessive
argumentativeness, stealing, and other forms of defiance or
resistance to authority.
 Children with conduct disorder engage in severe repeated
acts of aggression that can cause physical harm to
themselves and others and frequently violate the rights of
others.

Children with conduct disorder usually have behaviors

characterized by aggression to persons or animals, destruction of
property, deceitfulness or theft, and multiple violations of rules,
such as truancy from school.
These behavior patterns cause distinct difficulties in school life as
 well as in peer relationships.
Review the Neurotransmitters LCD/ Explaining, Listening, What is the role
neurobiology The major neurotransmitters implicated in the pathophysiology of Laptop asking and taking notes, of
of disruptive ADHD are dopamine, nor epinephrine, and possibly serotonin. answering asking and neurotransmitters
behaviors Dopamine and nor epinephrine appear to be depleted in ADHD. questions. answering in disruptive
Serotonin in ADHD has been studied less extensively, but recent questions. behaviors
evidence suggests that it also is reduced in children with ADHD.
Neurotransmitter Functions
Nor epinephrine is thought to play a role in the ability to perform
executive functions, such as analysis and reasoning, and in the
cognitive alertness essential for processing stimuli and sustaining
attention and thought (Hunt, 2006).
Dopamine is thought to play a role in sensory filtering, memory,
concentration, controlling emotions, locomotor activity, and
reasoning.
Deficits in norepinephrine and dopamine have both been implicated
in the inattention, impulsiveness, and hyperactivity associated with
ADHD.
Serotonin appears to play a role in ADHD, although possibly less
significant than norepinephrine and dopamine.
It has been suggested that alterations in serotonin may be related to
the disinhibition and impulsivity observed in children with ADHD.
 It may play a role in mood disorders, particularly depression, which
is a common Comorbid disorder associated with ADHD.
Specific Content Ava Teachers Students Evaluation
objectives activities activities
Mention the Diagnostic and statistical manual of mental disorders 5 (DSM-5) LCD/ Explaining, Listening, Mention the
conditions categorizes disruptive behavioral disorders into Disruptive, impulse Laptop asking and taking notes, conditions
associated control and conduct disorders which include: answering asking and associated with
with questions. answering disruptive
disruptive Oppositional defiant disorder (ODD), Conduct Disorders (CD), questions. behaviors.
behaviors Antisocial Personality Disorder (APD), Intermittent Explosive
Disorders (IED) and Impulse Control Disorder (pyromania and
Kleptomania).
These conditions are characterized with Impulse behaviors and
lack of self control. They begin in Childhood and persist into
adulthood.
1. OPPOSITIONAL DEFIANT DISORDER (ODD):
Are defined by defiant behaviors which are persistent and willful.
Its defining patterns are emotional (resentful and irritable),
behavioral (argues, angry, dislikes, authority) and cognitive
(vindictive and spiteful).
They have enduring patterns of negativistic, disobedient, and
hostile behavior toward authority figures, as well as an inability
to take responsibility for mistakes, leading to placing blame on
others.
Children with this disorder frequently argue with adults and
become easily annoyed by others, leading to a state of anger and
resentment. They may have difficulty in the classroom and with
peer relationships, but generally do not resort to physical
aggression or significantly destructive behavior.
These symptoms must be present for more than 6 months and must
disrupt social interactions.
2. CONDUCT DISORDER (CD)
This condition is characterized by all the behaviors of ODD plus
aggressive behaviors towards people and animals. Such individuals
might destroy property, steal things and hurt pets.
Aggression to People and Animals
 Often bullies, threatens, or intimidates others.
 Often initiates physical fights.
 Has used a weapon that can cause serious physical harm to
others (e.g., a bat, brick, broken bottle, knife, and gun).
 Has been physically cruel to people.
 Has been physically cruel to animals.
 Has stolen while confronting a victim (e.g., mugging, purse
snatching, extortion, armed robbery).
 Has forced someone into sexual activity.
 Destruction of Property
 Has deliberately engaged in fire setting with the intention of
causing serious damage.
 Has deliberately destroyed others’ property (other than by
fire setting).
Deceitfulness or Theft
 Has broken into someone else’s house, building, or car.
 Often lies to obtain goods or favors or to avoid obligations
(i.e., “cons” others).
 Has stolen items of nontrivial value without confronting a
victim (e.g., shoplifting, but without breaking and entering:
forgery).
Serious Violations of Rules
 Often stays out at night despite parental prohibitions,
beginning before age 13 years.
 Has run away from home overnight at least twice while
living in the parental or parental surrogate home, or once
without returning for a lengthy period.
 Is often truant from school, beginning before age 13 years.
The disturbance in behavior causes clinically significant
impairment in social, academic, or occupational functioning.
3. ANTISOCIAL BEHAVIOR (AB)
  They destroy property, steal things and hurt pets.
There are two types:
 Childhood onset: start below 10 years.
 Adulthood onset: 10-18 years
 The earlier the onset, the more SEVERE the problem.
4. ANTISOCIAL PERSONALITY DISORDER (APD)
 They disregards: moral values and societal norms
 They lack empathy and impulse control: they hurt
others, aggressive, will break laws. They exalt
themselves as sociopath or psychopath.
 They are often in prison, substance abusers. Do not
show remorse or responsibility.
WARNING: THEY CAN BE CHARMING AND
MANIPULATIVE.
DIAGNOSIS: must be above 18 years old and must have a conduct
disorder.
5. INTERMITTENT EXPLOSIVE DISORDER (IED)
This disorder is characterized by recurrent explosive out busts
which are brief and spontaneous, intense anger, violence, response
to real or perceived provocation, out of proportion.
Diagnosis: A child should be older than 6 years old and should
occur twice a week for 3 months with damage.
Pyromania and kleptomania:
Pyromania:
 They are purposefully and repetitively start fires but they
are not Arsonists.
 They are motivated by destruction and power. Fire is
happiness; they hang around fire stations and enjoy playing
with fire. It driven by compulsion.
Kleptomania:
 They have strong impulse to steal.
 They steal not out of need.
 Theft is pleasurable and a sense of relief.
 They steal things that have no value as long as they have
stolen something for pleasure and relief.

These disorders, which include Oppositional Defiant disorder

(ODD), conduct Disorder (CD) and Attention Deficit Hyperactive
Disorder (ADHD), they often first attract notice when they interfere
with school performance or family and peer relationships, and
frequently intensify over time.
Behaviors typical of disruptive behavior disorders can closely
resemble ADHD particularly where impulsivity and hyperactivity
are involved but ADHD, ODD, and CD are considered separate
 conditions that can occur independently. About one third of all
children with ADHD have coexisting ODD, and up to one quarter
have coexisting CD. Children with both conditions tend to have
more difficult lives than those with ADHD alone because their
defiant behavior leads to so many conflicts with adults and others
with whom they interact.
State the The treatment is focused on behavior and not Pharmaceutical and LCD/laptop Explains/asks Listen/take What the focus
Treatment include; cognitive behavioral therapy, social skills training, anger questions notes/answer of treatment for
goals in management and parent teaching(teaching parents how to respond) and asks disruptive
disruptive NOTE: medical treatment is considered in severe case. questions. behaviors?
behaviors.
Specific Content Ava Teachers Students Evaluation
objectives activities activities
Discus the Medical management LCD/ Explaining, Listening, Mention the drug
management Medications for ADHD Laptop asking and taking notes, used in
CNS Stimulants
of Disruptive  Amphetamines (dextroamphetamine, methamphetamine, answering asking and disruptive
behaviors and mixtures): cause the release of norepinephrine from questions. answering behaviors
central noradrenergic neurons. At higher doses, dopamine questions.
may be released in the mesolimbic system.
 Methylphenidate and dexmethylphenidate: block the
reuptake of norepinephrine and dopamine into the
presynaptic neuron and increase the release of these
 monoamines into the extraneuronal space.
 Side effects include restlessness, insomnia, headache,
palpitations, weight loss, and suppression of growth in
children (with long-term use), increased blood pressure,
abdominal pain, anxiety, tolerance, and physical and
psychological dependence.
Others
 Atomoxetine: selectively inhibits the reuptake of
norepinephrine by blocking the presynaptic transporter.
Side effects include headache, upper abdominal pain,
nausea and vomiting, anorexia, cough, dry mouth,
constipation, increase in heart rate and blood pressure, and
fatigue.
 Bupropion: inhibits the reuptake of norepinephrine and
dopamine into presynaptic neurons.
Side effects include headache, dizziness, insomnia or
sedation, tachycardia, increased blood pressure, dry mouth,
nausea and vomiting, weight gain or loss, and seizures (dose
dependent).

CNS stimulants increase levels of neurotransmitters (probably

norepinephrine, dopamine, and serotonin) in the CNS. They
 produce CNS and respiratory stimulation, dilated pupils, increased
motor activity and mental alertness, diminished sense of fatigue,
and brighter spirits. The CNS stimulants include:
 Dextroamphetamine sulfate (Adderall) 5–60
 Methamphetamine-5–25mg
 Lisdexamphetamine-30–70mg
 Methylphenidate (Ritalin)- 10–60mg
 Atomoxetine0.5–1.4 mg/kg
 Bupropion-3 mg/kg (ADHD); 100–300(depression)
Amphetamine mixtures, methylphenidate, and dexmethylphenidate.
Their action in the treatment of ADHD is unclear.
Atomoxetine inhibits the reuptake of norepinephrine, and
bupropion blocks the neuronal uptake of serotonin, norepinephrine,
and dopamine.
The exact mechanism by which these drugs produce the therapeutic
effect in ADHD is unknown.

Nursing management
See the nursing care plan.

SUMMARY
We have looked at disruptive behaviors namely, Oppositional defiant disorder (ODD), Conduct Disorders (CD), Antisocial
Personality Disorder (APD), Intermittent Explosive Disorders (IED) and Impulse Control Disorder (pyromania and
Kleptomania).These conditions are characterized with Impulse behaviors and lack of self control. They begin in Childhood and persist
into adulthood. They are very important to the mental health field as they define the current behavioral pattern. Teachers in school are
at a critical point to identify and refer children with conditions to specialized therapeutic centres and placement in special schools.
Therefore it is critical and important for the mental health personnel to acquaint themselves with skills to identify behaviors that
characterize the abnormality.
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