When to use this diagnosis

• Behavioural disturbance clearly causes functional impairment but does not meet full DSM/ICD criteria for a named disruptive disorder.
• Insufficient history or assessment (e.g., brief emergency presentation) but clinician wishes to record that disruptive behaviour is the primary concern.
• Temporary or atypical presentations where a watchful waiting approach with early follow‑up is appropriate.

Core presenting features

• Frequent temper outbursts or aggression towards people or property.
• Impulsive actions, difficulty controlling anger, low frustration tolerance.
• Rule‑breaking, deceitful behaviour or significant oppositionality affecting school, family or peers.
• Functional decline: school exclusion, family breakdown, legal involvement or risk to safety.

Assessment checklist

1. Detailed history: onset, frequency, triggers, context (home, school, peers), developmental milestones, trauma, and family history.
2. Risk assessment: self‑harm, harm to others, weapon access, substance use and legal issues.
3. Collateral information: parents, teachers, school reports, juvenile justice records where relevant.
4. Mental state and neurodevelopmental screen: ADHD, autism spectrum disorder, intellectual disability and learning difficulties commonly co‑occur and influence management.
5. Consider medical contributors: head injury, seizure, infections, thyroid disease, or medication side effects.

Differential diagnosis

• Oppositional Defiant Disorder, Conduct Disorder, Intermittent Explosive Disorder.
• ADHD, Autism Spectrum Disorder, Mood disorders (depression, bipolar), PTSD and anxiety disorders.
• Substance‑induced aggression, personality disorders in older adolescents/ adults, and neurocognitive disorders.

Management principles

• Prioritise safety: immediate risk to self/others requires urgent intervention, possible admission and involvement of child protection or police as appropriate.
• Use a biopsychosocial approach: combine behavioural interventions, family‑based therapies and school support.
• Target co‑occurring conditions: treat ADHD, mood disorders or trauma reactions which can reduce behavioural problems.
• Brief parenting interventions: positive parenting, consistent boundaries, and contingency management (rewards/limits) are highly effective.
• Consider structured programs: parent–child interaction therapy (PCIT), collaborative problem solving (CPS), or multisystemic therapy (MST) for high‑risk cases.
• Pharmacotherapy: reserved for targeted symptoms (e.g., stimulants for ADHD, SSRIs for comorbid anxiety/depression); antipsychotics may be considered short‑term for severe aggression but require careful monitoring and clear plan to taper.

When to refer

• Ongoing severe aggression, harm to others, criminal behaviour or failure of basic community interventions.
• Suspected neurodevelopmental disorders, complex trauma, or when specialist child and adolescent mental health services (CAMHS) input is needed.
• Significant family dysfunction or parental mental illness affecting child safety—consider social work and family services involvement.

Key takeaways

• Use the unspecified label pragmatically when information or criteria are incomplete — plan timely follow‑up for full assessment.
• Address immediate safety, gather collateral, treat co‑occurring conditions and prioritise family/school‑based behavioural interventions.
• Refer early to specialist child/adolescent mental health or social services for complex or high‑risk cases.