- Read Dulcan’s pages 1 through 5 & 25-76
- Read DSM-5 TR pages 35-99 and 521 through 541
- Read Carlat Section 3: Interviewing for Diagnosis: The Psychiatric Review of Symptoms and Section 4: Interviewing for Treatment
- Read Morrison and Flegel: Chapter 1 and chapter 2 pay attention to table 1:1 Read chapter 15, chapter 23
6. Read Boland, R., & Verduin Kaplan Chapter 18: Disruptive, Impulse-Control, and Conduct Disorders
7. Read Boland, R., & Verduin Kaplan Chapter 2: Child Psychiatry
8. Read Zuckerman,-Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 2: 2.4, 2.5, 2.6, 2.7, 2.9 Chapter 3: 3.8, 3.18 • Chapter 12: 12.3, 12.4, 12.7, 12.13, 12.14, 12.32
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Compare and contrast oppositional defiant disorder with conduct disorder- be sure to explain how you would be able to use assessment skills to differentiate between the two conditions.
Conduct disorder is generally seen in children as young as two years old. According to Burkey, (2017) the DSM-5 specifies three subtypes of conduct disorder: childhood-onset by which one criterion is demonstrated before age 10. Next is adolescent onset, and finally, unspecified onset. Typically, Delcan et al. (2018) suggest that it begins with ODD in early childhood, leading to conduct disorder by puberty, then antisocial personality disorder by adulthood. In conduct disorder, patients have no regard for the rules. Characteristics of Conduct disorder include bullying, attention deficits, low frustration tolerance, learning disorders, especially in reading, negative mood, sullenness, volatile anger, low self-esteem, impairment in cognition, impaired problem-solving skills, emotional deficits, and impaired interpersonal relations. Children with conduct disorder may intrude on others’ rights and use aggression or even hostility towards loved ones and peers. According to Beland et al. (2018), conduct disorder can present with limited prosocial emotions or callous-unemotional traits. Patients with callous, unemotional traits may lack empathy or remorse; they may be deceitful, manipulative, or grandiose.
Oppositional defiant disorder presents as argumentative, disobedient, and defiant behaviors but does not violate the rights of others. According to Dulcan et al. (2018), the DSM-5 defines Oppositional defiant disorder as a pattern of angry/irritable mood, argumentative/ defiant behavior, or vindictiveness lasting at least six months, during which at least four of the behavioral criteria present at a frequency greater than typical for the child’s age and development level. Characteristics of Oppositional defiant disorder: angry/ irritable mood. Patients may be argumentative and exhibit defiant behaviors such as arguing with authority figures or other adults. They can deliberately annoy others or blame others for their mistakes. Finally, they can be vindictive or spiteful.
Similarly, argumentativeness, defiance, and vindictiveness symptoms are predictors of conduct disorder. However, angry and irritable mood symptoms are more likely to predict the development of anxiety or mood disorders. One key feature seen in Oppositional defiant disorder is the antagonistic stance the children take to make a point. They are often willing to lose privileges rather than back down.
Differentiating between Oppositional defiant disorder and Conduct disorder centers on the repeated display of bad behavior over some time. According to Dulcan et al. (2018), childhood onset of Conduct disorder is seen predominantly in males, with increased aggression, impaired peer relationships, and comorbid ADHD. Clinicians should assess for substance use, sexual behavior, and involvement of law enforcement. Clinicians should assess the child’s relationship with parents and family structure for interactions with younger siblings or inappropriate age-related relationships. Children with conduct disorder rarely have a goal or gain pleasure from their behavior.
Conversely, children with Oppositional defiant disorder may have symptoms for less than six months, and symptoms are not as harsh; they may argue or lose their temper, but they will not actively defy an adult or authority figure. Manifestations of these conditions are seen at home but may not be present in school or with other adults or peers. As with Conduct disorder, clinicians should assess the family structure, specifically interactions between each family member. The child should also be assessed for substance use, mood, or other comorbid conditions such as ADHD.
Reference
Boland, R. J., Verduin, M. L., Ruiz, P., & Sadock, B. J. (2023). Kaplan & Sadock’s Concise Textbook of Clinical Psychiatry (5th ed.). Wolters Kluwer.
Burkey, M. D. (2017). The Developmental Niche and Child Behavior Problems in Rural Nepal: Description and Implications for Definitions and Measurement. https://core.ac.uk/download/424787802.pdfLinks to an external site.
Dulcan, M. K., Lake, M., Ballard, R., Jha, P., & Sadhu, J. (2018). Concise guide to child and adolescent psychiatry (5th ed.). American Psychiatric Association Publishing.