Causal pathways to disruptive behavior disorders, even within the same diagnostic category, are varied. Both equifinality and multifinality pose considerable challenges to uncovering underlying mechanisms and understanding varied developmental trajectories associated with disruptive behavior disorders. Uncovering genetic causes requires improved granularity in how we operationalize presentation and developmental trajectories associated with disruptive behavior disorders. If we want to integrate the study of genetic, environmental, and neurocognitive factors within a longitudinal framework, we need to improve measurement. Furthermore, brain changes associated with disruptive behavior disorders should not simply be understood as outcomes of genetic and environmental influences, but also as factors that reciprocally influence future social environments over time in ways that are important in contributing to risk and resilience. Advancing the field with regard to these challenges will result in more truly integrated investigation of disruptive behavior disorders, which holds the promise of improving our ability to develop more effective preventive and intervention approaches.