Behavioral problems in childhood

Question 1

Key history in behavioral problems in childhood

Answer 1

Onset, severity, duration, triggers; physical violence or use of weapons; substance use, developmental history,
changes in environment, school performance

Question 2

Key physical exam in behavioral problems in childhood

Answer 2

Vital signs; neurologic exam

Question 3

9 yo M with two-year Hx of angry outbursts at home and school
+ mother complains that he runs around “as if driven by a motor”
+ teacher reports he cannot sit still
+ regularly interrupts classmates
+ has trouble making friends

Answer 3

Attention-defi cit hyperactivity
disorder (ADHD)
Oppositional defi ant disorder
Manic episode
Conduct disorder
Hyperthyroidism

Physical exam
Mental status exam
TSH, FT4
EEG

Question 4

12 yo F with two-month Hx of fighting in school, truancy and breaking curfew
+ parents recently divorced
+ just started school in new district
+ before parents divorced, she was an average student with no behavioral problems

Answer 4

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

Physical exam
Mental status exam
Urine toxicology

Question 5

15 yo M with one-year Hx of failing grades, school absenteeism and legal problems, including shoplifting
+ parents report he spends most of his time alone in his room
+ when he goes out, it is with a new set of friends

Answer 5

Substance abuse
Conduct disorder
Oppositional defiant disorder
Adjustment disorder

Urine toxicology
Mental status exam
Physical exam

Question 6

5 yo M with six-month Hx of temper tantrums lasting 5-10 minutes and immediately follow a disappointment or discipline
+ no trouble sleeping
+ no change in appetite
+ does not display these behaviors at day care

Answer 6

Age-appropriate behavior
ADHD
Oppositional defiant disorder

Physical exam
Mental status exam