Behavioral Problems in Childhood

Question 1

What key history would you obtain from a parent concerning behavioral problems in their child?

Answer 1

Onset
Severity
Duration
Triggers
Physical violence or use of weapons
Substance use
Developmental history
Changes in envirionment
School performance

Question 2

What key physical exams would you perform on a child who was having behavioral problems?

Answer 2

Vital signs

Neurologic exam

Question 3

9 yo M presents with a two year history of angry outbursts both in school and at home. His mother complains that he runs around “as if driven by a motor.” His teacher reports that he cannot sit still in class, regularly interrupts his classmates and has trouble making friends. Differentials?

Answer 3

Attention-deficit Hyperactivity Disorder (ADHD)
Oppositional defiant disorder
Manic episode
Conduct disorder

Question 4

9 yo M presents with a two year history of angry outbursts both in school and at home. His mother complains that he runs around “as if driven by a motor.” His teacher reports that he cannot sit still in class, regularly interrupts his classmates and has trouble making friends. Differentials: ADHD, oppositional defiant disorer, manic episode, conduct disorder. Workup?

Answer 4

Physical exam

Mental status exam

Question 5

12 yo F presents with a two-month history of fighting in school, truancy and breaking curfew. Her parents recently divorced and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems. Differentials?

Answer 5

Adjustment disorder
Substance intoxication/abuse/dependence
Manic episode
Oppositional defiant disorder
Conduct disorder

Question 6

12 yo F presents with a two-month history of fighting in school, truancy and breaking curfew. Her parents recently divorced and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems. Differentials: adjustment disorder, substance intoxication/abuse/dependence, manic episode, oppositional defiant disorder, conduct disorder. Workup?

Answer 6

Physical exam
Mental status exam
Urine toxicology

Question 7

15 yo M presents with a one year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out it is with his new set of friends. Differentials?

Answer 7

Substance abuse
Conduct disorder
Oppositional defiant disorder
Adjustment disorder

Question 8

15 yo M presents with a one year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out it is with his new set of friends. Differentials: substance abuse, conduct disorder, oppositional defiant disorder, adjustment disorder. Workup?

Answer 8

Urine toxicology

Mental status exam

Question 9

5 yo M presents with a five month history of temper tantrums that last 5-10 minutes that immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite and does not display these behaviors when he is at day care. Differentials?

Answer 9

Age-appropriate behavior
ADHD
Oppositional defiant disorder

Question 10

5 yo M presents with a five month history of temper tantrums that last 5-10 minutes that immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite and does not display these behaviors when he is at day care. Differentials: age-appropriate behavior, ADHD, oppositional defiant disorder. Workup?

Answer 10

Physical exam

Mental status exam