Chapter 13: Disruptive Behavior and Attachment

Raskin examines disruptive behavior and attachment problems, exploring how developmental issues such as ADHD, autism, oppositionality, and conduct problems emerge, are diagnosed, and understood across competing perspectives. Externalizing behaviors (impulsivity, rule breaking, aggression) are contrasted with internalizing behaviors (withdrawal, loneliness, anxiety, depression), both forms of distress that shape childhood and adolescent functioning. DSM-5-TR groups ADHD under neurodevelopmental disorders and ODD, conduct disorder, intermittent explosive disorder, pyromania, and kleptomania under disruptive/impulse-control disorders, while ICD-11 uses similar but slightly restructured categories. Autism spectrum disorder (ASD) is defined as involving deficits in communication, social reciprocity, and restricted/repetitive behaviors, with ICD distinguishing levels of severity and intellectual functioning. DSM also includes social (pragmatic) communication disorder (SPCD). Critics argue that ADHD and disruptive behavior diagnoses risk pathologizing normal rebellion and overdiagnosing children due to lowered thresholds, while controversy surrounds DSM-5’s elimination of Asperger’s disorder. Alternative frameworks like HiTOP and RDoC emphasize dimensional models, while PDM-2 focuses on relational dynamics, and PTMF reframes behaviors as meaningful responses to social oppression. Historical perspectives trace ADHD from 18th-century descriptions of “lack of attention,” Hoffman’s Fidgety Philip, Still’s “defective moral control,” and Bradley’s discovery of stimulants, to DSM’s evolution from hyperkinetic disorder to ADD to ADHD, now recognized in adults as well as children. Autism history highlights Leo Kanner’s and Hans Asperger’s seminal accounts, the discredited “refrigerator mother” theory, and the rise and fall of Asperger’s as a diagnosis. Biological perspectives review ADHD’s dopamine and catecholamine hypotheses, stimulant and non-stimulant medications (Ritalin, Adderall, Strattera), serotonin’s role in conduct problems, and autism’s excitatory-inhibitory imbalance hypothesis (GABA and glutamate), early overgrowth brain hypothesis, oxytocin’s role in social bonding, and genetic heritability (70–80% for ADHD, ~80% for autism). Evolutionary accounts include mismatch theories of ADHD (hunter-farmer, response readiness, wader, fighter) and Baron-Cohen’s extreme male brain (EMB) theory of autism. Immune theories link ADHD and ASD to inflammation, autoimmune conditions, gut microbiota, and maternal infections, while the vaccine-autism controversy is debunked as fraudulent. Psychological perspectives include psychodynamic accounts linking disruptive behavior to attachment problems and ego dysfunction, relational psychodynamic therapy for ADHD, and psychodynamic case studies for autism. Cognitive-behavioral approaches highlight behavioral modification, CBT for ADHD, applied behavior analysis (ABA), discrete trial training (DTT), early intensive behavioral intervention (EIBI), and CBT adaptations for autism. Humanistic approaches emphasize child-centered play therapy (CCPT), narrative therapy, and reframing autism as an “autistic process” rather than disorder, aligning with the neurodiversity movement. Sociocultural perspectives critique gender and racial bias in diagnoses, over-medicalization of childhood behaviors, links to poverty, environmental toxins, dietary factors (sugar, additives, gluten/casein-free diets), and courtesy stigma affecting families. Service user perspectives highlight identity debates around Asperger’s, while systems perspectives present multisystemic therapy (MST) as addressing family, school, and community-level factors. Closing reflections emphasize the neurodiversity model, which views ADHD and autism as differences, not disorders, urging a balance between medical treatment and valuing diverse ways of being.