concept map 3

Concept Map 3

John Henry is five years old. He was a fussy baby who was difficult to soothe. Now attending his third preschool, he is in jeopardy of being dismissed again for his refusal to follow the rules and for his angry outbursts. He argues with his peers every week and refuses to cooperate with his teachers’ requests. He is disobedient at home as well and seems to annoy others deliberately.

Concept Map Information

1. What is the Main diagnosis for Mary Rose?
2. What are the Key symptoms?
3. What differential diagnoses did you consider and why?
4. What is your treatment recommendation and why?
5. What is the Prognosis?

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Concept Map 3
Diagnosis (DSM-5-TR)
F91.3 Oppositional Defiant disorder.
Signs & Symptoms
–
Frequent temper
tantrums.
Angry outbursts and
irritability.
Argumentativeness and
defiance.
Threatening/aggressive
behavior.
Serious rules violations.
–
–
–
Differential Diagnosis
MSE & Criteria
Often loses temper.
Often easily annoyed.
Often angry and resentful.
Often argue with authority
figures.
Often actively refuse or defy
to comply with requests from
authority figures or with rules.
Often deliberately annoys
others.
Often blames others for his or
her mistakes or misbehavior.
S/S persist over 6 months.
Treatment Guidelines
– Behavioral therapy.
– Parent-Child Interaction Therapy (PCIT).
– Parent management training.
– Group interventions.
– Medications.
F91.1 Conduct Disorder,
childhood-onset type.
F63.81 Intermittent
Explosive disorder
F90.9 Other specified
disorder of psychological
development.
Prognosis
– Emotional consequences.
– Social consequences.
– Legal consequences.
– Occupational, educational, and psychosocial
functioning.
– Family conflicts.
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Concept Map Information
1. Main Diagnosis
Disruptive behavior disorders are characterized by problems in the self-control of
emotions and behavior, which interfere with a child’s ability to function at home and school. The
child violates the rights of others or enters into conflicts with rules or authority figures. DSM-5TR specifies that with at least three of them during more than 6 months the patient can be
diagnosed with the disorder (APA, 2022). In such a case, in John Henry´s case is possible to find
that:
–
Frequent temper tantrums.
–
Angry outbursts and irritability.
–
Argumentativeness and defiance.
–
Threatening or aggressive behavior.
–
Serious rules violations.
Based on his age (5-year-old), his disorder is framed into the childhood-onset. Moreover, he has
limited prosocial emotions due to the lack of remorse, lack of empathy, and the deficient affect.
A child with ODD may have frequent angry outbursts, become easily annoyed, argue often with
parents, refuse to follow rules, blame others for mistakes, deliberately annoy others, or act in
vindictive ways.
2. Key Signs & Symptoms
Symptoms of oppositional defiant disorder include a pattern of:
–
Angry/irritable mood leading to often loses temper, easily annoyed, often angry and
resentful.
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–
Argumentative/defiant behavior where the child often argues with authority figures or
adults, often refuses to comply with requests or rules, deliberately annoys others, blames
others for mistakes or misbehavior.
–
Vindictiveness with the behavior tends to demonstrate spitefulness or vindictiveness.
These behaviors are distressing to the individual and alarming to others. Anger, threatening
behaviors, and spitefulness cause disruption at school or work and affect relationships with
others. Signs of the disorder typically develop during preschool or early elementary school but
can also begin in adolescence.
3. Differential Diagnosis
According to Elmaghraby and Garayalde (2021), the main disorders which can appear as
comorbidity associated with Oppositional defiant disorder (ODD) are:
a) Conduct disorder (CD) where the child with CD may deliberately hurt or threaten to
hurt people or animals, purposely destroy property through vandalism or arson, steal, lie,
run away from home, skip school, or break laws.
b) Intermittent explosive disorder (IED) where the child may have impulsive behavior
outbursts very frequently, or two or more outbursts per week for three months. Outbursts
include temper tantrums, verbal or physical fights, the harming of an animal, or the
damaging of property. Having three or more outbursts within a one-year period resulting
in the damage or destruction of property or injury to an animal or person is also a sign of
IED.
c) Other disruptive, impulse-control and conduct disorders where the child with this
disorder may have some of the problems listed above, and they interfere with the child’s
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functioning at home or school. However, the child does not meet all criteria needed to
qualify for any of the other disorders listed above.
4. Treatment Guidelines and Recommendations
Parents are not necessarily the cause of behavior problems, but they can be the solution.
Behavior problems have many different causes. There are biological and genetic reasons why a
child might have behavioral difficulties. Some children react more strongly to interruptions in
daily rhythms like overreactions to hunger or irritability related to too little sleep. Some children
have real difficulties controlling emotions, difficulties that have been there since infancy as part
of a reactive and highly sensitive temperament.
There is no FDA-approved medication for oppositional defiant disorder (ODD) or
conduct disorder (CD), the diagnoses that apply to this sort of behavior, but medications are
sometimes used as an adjunct to behavioral therapy. Frequently, children with ODD also have a
diagnosis of ADHD. Stimulant medication may be used if a child has difficulty paying attention
to adults, following directions or exhibits excessive impulsivity. Antidepressants may also be
helpful if a child has underlying depression or anxiety that may be contributing to irritability or
problems regulating emotions (Boland, Verdium, & Ruiz, 2021).
Evidence-based practice for treating oppositional defiant disorder (ODD) involves
behavioral parent training. This can come in a number of different forms, such as Parent-Child
Interaction Therapy (PCIT) and Parent Management Training, or group interventions like
Incredible Years. However, the underlying principles are the same: focus on fortifying a positive
relationship with the child, clearly define behaviors that parents would like to change, reinforce
and amplify positive behaviors, withdraw attention from certain minor misbehaviors, and
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sparingly but consistently use appropriate punishment for major misbehavior. In general,
behavioral parent training takes from three to five months (Boland, Verdium, & Ruiz, 2021).
5. Prognosis
In the case of John Henry, the occurrence of ODD has significant negative impacts on his
relationship with the society, in the form of direct behavioral consequences and costs, and on the
individual, in the form of poor academic, occupational and psychosocial functioning and on the
family. The prognosis considers the possible trauma, disruption and psychological problems
caused to the patient by the refusal of acceptance in schools and communities, together with the
financial costs of services to treat the affected individuals, including health services, social
services, psychiatric services, alcohol and drug misuse services, in addition to unemployment
and other required state benefits.
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References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders:
DSM-5-Tr. APA Publishing.
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of Psychiatry.
Wolters Kluwer Health.
Elmaghraby, R., & Garayalde, S. (2021). Disruptive, Impulse Control and Conduct Disorders.
Retrieved from https://www.psychiatry.org/patients-families/disruptive-impulse-controland-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders.