Disruptive, Impulsive-Control and Conduct Disorders (Oppositional Defiant Disorder/Conduct Disorder) Flashcards
An 11-year-old boy has shown extreme stubbornness and defiance since early childhood. This behavior is seen primarily at home and does not typically involve significant mood instability or anger, although he occasionally can be spiteful and vindictive. These symptoms have affected his sibling relationships in an extremely negative fashion, and more recently this behavior has been seen with peers and has begun to affect his friendships. His parents demonstrate a somewhat hostile parenting style. Which of the following statements correctly summarizes the appropriateness of a diagnosis of oppositional defiant disorder (ODD) for this patient?
A. The boy does not qualify for a diagnosis of ODD because his symptoms lack a significant mood component and seem to be confined primarily to the home setting.
B. Although the boy does not have a persistently negative mood, he may nevertheless qualify for a diagnosis of ODD if he meets the other symptom criteria.
C. If as a preschooler the boy had demonstrated temper outbursts that occurred on a weekly basis on most days during a 6-week period, he might have received a diagnosis of ODD at that point, as long as he had four or more of the required symptoms for 6 months.
D. The boy does not qualify for a diagnosis of ODD; the hostile parenting style is probably the cause of his oppositional behavior.
E. If the boy meets criteria for ODD, then he probably has begun to acknowledge his own role in overreacting to reasonable demands.
Correct Answer: B. Although the boy does not have a persistently negative mood, he may nevertheless qualify for a diagnosis of ODD if he meets the other symptom criteria.
Explanation: According to DSM-5, some individuals with ODD may not have the negative mood often associated with the disorder, and they may exhibit the symptoms primarily at home. There is a requirement that symptoms be observed with others besides the child’s siblings. DSM-5 emphasizes the need for multiple informants that have observed the child or adolescent in different settings. The hostile parenting style sometimes seen with these individuals is of disruptive, often part of a dynamic process, or in response to the child’s behavior, not necessarily the cause of the behavior. Individuals with ODD generally do not acknowledge their own role in what precipitates their defiance or anger, and typically externalize blame on unreasonable demands or situations as the rationale for their anger or misbehavior.
A 3-year-old boy has rather severe temper tantrums that have occurred at least weekly for a 6-week period. Although the tantrums can sometimes be associated with defiant behavior, they often result from a change in routine, fatigue, or hunger, and he only rarely does anything destructive. He is generally well behaved in nursery school and during periods between his tantrums. Which of the following conclusions best fits this child’s presentation?
A. The boy does not meet criteria for oppositional defiant disorder (ODD).
B. The boy meets criteria for ODD because of the presence of tantrums and defiant behavior.
C. The boy could be diagnosed with ODD as long as it does not appear that his home environment is harsh, neglectful, or inconsistent.
D. The boy’s symptoms more likely represent intermittent explosive disorder than ODD.
E. The boy’s symptoms more likely represent disruptive mood dysregulation disorder than ODD.
Correct Answer: A. The boy does not meet criteria for oppositional defiant disorder (ODD).
The diagnostic criteria for oppositional defiant disorder (ODD) include specifiers for indicating severity of the disorder as manifested by pervasiveness of symptoms across settings and relationships. Which of the following specifiers would be appropriate for an 11-year-old boy who meets Criterion A symptoms in two settings?
A. Mild.
B. Moderate.
C. Severe.
D. Extreme.
E. There is not enough information to code the specifier.
Correct Answer: B. Moderate.
A previously well-behaved 13-year-old girl begins to display extremely defiant and oppositional behavior, with vindictiveness. She is angry, argumentative, and refuses to accept responsibility for her behavior, which is affecting both her home life and school life in a significant way. What is the least likely diagnosis?
A. Major depressive disorder.
B. Bipolar disorder.
C. Oppositional defiant disorder.
D. Adjustment disorder.
E. Substance use disorder.
Correct Answer: C. Oppositional defiant disorder.
Explanation: Oppositional defiant disorder is an unlikely diagnosis if the onset is in adolescence after a childhood marked by compliant behavior. In this case, the relatively acute onset suggests a mood disorder (major depressive disorder or bipolar disorder), an adjustment disorder (to a stressor not described in the vignette), or a substance use disorder.
Which of the following statements about prevalence/course of and risk factors for oppositional defiant disorder (ODD) is false?
A. ODD is more prevalent in boys than in girls by a ratio of 1.4:1.
B. Harsh, inconsistent, or neglectful child-rearing practices are common in the families of individuals with ODD.
C. ODD tends to be moderately stable across childhood and adolescence.
D. Individuals with ODD as children or adolescents are at higher risk as adults for difficulties with antisocial behavior, impulse-control problems, anxiety, substance abuse, and depression.
E. Biological factors such as lower heart rate and skin conductance reactivity, reduced basal cortisol reactivity, and abnormalities in the prefrontal cortex and the amygdala have been associated with ODD and can be used diagnostically.
Correct Answer: E. Biological factors such as lower heart rate and skin conductance reactivity, reduced basal cortisol reactivity, and abnormalities in the prefrontal cortex and the amygdala have been associated with ODD and can be used diagnostically.
Explanation: Although a number of neurobiological markers (e.g., lower heart rate and skin conductance reactivity; reduced basal cortisol reactivity; abnormalities in the prefrontal cortex and amygdala) have been identified in association with ODD, they cannot be used diagnostically because the vast majority of studies have not separated children with ODD from those with conduct disorder. Thus, it is unclear whether there are markers specific to ODD.
A 16-year-old boy with a long history of defiant behavior toward authority figures also has a history of aggression toward peers (gets into fights at school), toward his parents, and toward objects (punching holes in walls, breaking doors). He frequently lies, and he has recently begun to steal merchandise from stores and money and jewelry from his parents. He does not seem pervasively irritable or depressed, and he has no sleep disturbance or psychotic symptoms. What is the most likely diagnosis?
A. Oppositional defiant disorder (ODD).
B. Conduct disorder.
C. Attention-deficit/hyperactivity disorder (ADHD).
D. Major depressive disorder.
E. Disruptive mood dysregulation disorder.
Correct Answer: B. Conduct disorder.
A 15-year-old boy has a history of episodic violent behavior that is out of proportion to the precipitant. During a typical episode, which will escalate rapidly, he will become extremely angry, punching holes in walls or destroying furniture in the home. There seems to be no specific purpose or gain associated with the outbursts, and within 30 minutes he is calm and “back to himself,” a state that is not associated with any predominant mood disturbance. What diagnosis best fits this clinical picture?
A. Bipolar disorder.
B. Disruptive mood dysregulation disorder (DMDD).
C. Intermittent explosive disorder (IED).
D. Conduct disorder.
E. Attention-deficit/hyperactivity disorder (ADHD).
Correct Answer: C. Intermittent explosive disorder (IED).
A 17-year-old boy with a history of bullying and initiating fights using bats and knives has also stolen from others, set fires, destroyed property, broken into homes, and “conned” others. This pattern of disturbed conduct covers all of the Criterion A behavior categories except
A. Aggression to people and animals.
B. Destruction of property.
C. Deceitfulness or theft.
D. Serious violations of rules.
E. Malevolent intent.
Correct Answer: D. Serious violations of rules.
Explanation: The essential feature of conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major ageappropriate societal norms or rules are violated (Criterion A). These behaviors fall into four main groupings: aggressive conduct that causes or threatens physical harm to other people or animals (Criteria A1– A7); nonaggressive conduct that causes property loss or damage (Criteria A8– A9); deceitfulness or theft (Criteria A10– A12); and serious violations of rules (Criteria A13– A15). According to DSM-5, serious violations of rules include the following: often stays out at night despite parental prohibitions, beginning before age 13 years; has run away from home overnight at least twice while living in the parental or parental surrogate home, or once without returning for a lengthy period; and is often truant from school, beginning before age 13 years. “Malevolent intent” is not one of the conduct disorder criteria.
A 15-year-old girl with a history of cruelty to animals, stealing, school truancy, and running away from home shows no remorse when caught, or when she is confronted with how her behavior is affecting the rest of her family. She disregards the feelings of others and seems to not care that her conduct is compromising her school performance. The behavior has been present for over a year and in multiple relationships and settings. Which of the following components of the “With limited prosocial emotions” specifier is absent in this clinical picture?
A. Lack of remorse or guilt.
B. Callous— lack of empathy.
C. Lack of concern about performance.
D. Shallow or deficient affect.
E. The required time duration.
Correct Answer: D. Shallow or deficient affect.
Which of the following does not qualify as aggressive behavior under Criterion A definitions for the diagnosis of conduct disorder?
A. Cyberbullying.
B. Forcing someone into sexual activity.
C. Stealing while confronting a victim.
D. Being physically cruel to people.
E. Aggression in the context of a mood disorder.
Correct Answer: E. Aggression in the context of a mood disorder.
In order to be considered a symptom of conduct disorder, running away must have occurred with what frequency?
A. At least three times.
B. At least five times.
C. Only once if the individual did not return for a lengthy period.
D. Twice, in response to physical or sexual abuse.
E. Six times over a 3-month period.
Correct Answer: C. Only once if the individual did not return for a lengthy period.
Which of the following statements about childhood versus adolescent-onset of conduct disorder (CD) is true?
A. Compared with individuals with adolescent-onset CD, those with childhood-onset CD are more often female and tend to get along better with peers.
B. Compared with individuals with adolescent-onset CD, those with childhood-onset CD are less aggressive and less likely to have oppositional defiant disorder (ODD) or attention-deficit/hyperactivity disorder (ADHD).
C. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are more likely to have CD that persists into adulthood.
D. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are more likely to display aggressive behaviors and to have disturbed peer relationships.
E. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are less likely to have CD that persists into adulthood.
Correct Answer: E. Compared with individuals with childhood-onset CD, those with adolescent-onset CD are less likely to have CD that persists into adulthood.
Which of the following statements about individuals who qualify for the “With limited prosocial emotions” specifier for conduct disorder is true?
A. These individuals generally display personality features such as risk avoidance, fearfulness, and extreme sensitivity to punishment.
B. These individuals are less likely than other individuals with conduct disorder to engage in aggression that is planned for instrumental gain.
C. These individuals generally exert more effort in their activities compared with other individuals with conduct disorder, and consequently are more successful.
D. These individuals are more likely to have a severity specifier rating of mild.
E. These individuals are more likely to have the childhood-onset type of conduct disorder.
Correct Answer: E. These individuals are more likely to have the childhood-onset type of conduct disorder.
Explanation: To qualify for the “with limited prosocial emotions” specifier, an individual must have displayed at least two of the listed characteristics— lack of remorse or guilt, callousness/lack of empathy, unconcern about performance, and shallow or deficient affect— persistently over at least 12 months and in multiple relationships and settings. These characteristics must reflect the individual’s typical pattern of interpersonal and emotional functioning over this period and not just occasional occurrences in some situations.
Which of the following statements about the prevalence of conduct disorder is true?
A. One-year prevalence rates range from 5% to 15%, with a median of 7%.
B. The prevalence varies widely across countries that differ in race and ethnicity.
C. Prevalence rates are higher among males than among females.
D. Callous unemotional traits are present in more than half of individuals with conduct disorder.
E. Prevalence rates remain fairly constant from childhood to adolescence.
Correct Answer: C. Prevalence rates are higher among males than among females.
Which of the following statements about the onset and developmental course of conduct disorder is true?
A. Onset may occur as early as the preschool years and is rare after age 16 years.
B. Onset typically occurs in adolescence.
C. Age at onset has no bearing on the developmental course of the disorder.
B. Oppositional defiant disorder is generally not a precursor to the childhood-onset type of conduct disorder.
E. Those with the adolescent-onset type of conduct disorder are less likely to adjust successfully as adults.
Correct Answer: A. Onset may occur as early as the preschool years and is rare after age 16 years.
