Disruptive Behavioral Disorders

Board Review Prep

DISCLAIMER

The content provided in this Substack post is for entertainment and informational purposes only and is not intended to serve as medical advice. The views and opinions expressed herein are those of the writer and should not be taken as definitive or authoritative. Readers should not rely solely on the information provided in this post to make decisions about patient care. Instead, use this content as a starting point for further research and consult a qualified healthcare professional before making any changes to treatment or medication regimens.

Part 1: Board Prep Review Questions

1. Which of the following is a primary feature of oppositional defiant disorder (ODD)?

   1. Persistent irritability and frequent violent outbursts

   2. A pattern of violating the rights of others or societal norms

   3. A pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness

   4. Frequent episodes of extreme temper tantrums that are out of proportion to the situation

2. Disruptive mood dysregulation disorder (DMDD) is diagnosed primarily in which age group?

A. Preschool-aged children

B. School-aged children and adolescents

C. Adolescents and young adults

D. Adults

3. Which of the following behaviors is more characteristic of conduct disorder than oppositional defiant disorder?

A. Arguing with authority figures

B. Cruelty to animals

C. Losing one's temper easily

D. Blaming others for one's mistakes

4. In which setting must the symptoms of oppositional defiant disorder be observed for a diagnosis to be made?

A. School only

B. Home only

C. Both school and home

D. At least one setting, such as school, home, or with peers

5. A child with frequent and severe temper tantrums that are out of proportion to the situation is most likely to be diagnosed with:

A. Oppositional defiant disorder

B. Conduct disorder

C. Disruptive mood dysregulation disorder

D. Attention-deficit/hyperactivity disorder

6. Which of the following treatments is most appropriate for a child with oppositional defiant disorder?

A. Antipsychotic medication

B. Stimulant medication

C. Cognitive-behavioral therapy

D. Mood stabilizers

7. Which disorder is associated with an increased risk of developing antisocial personality disorder in adulthood?

A. Oppositional defiant disorder

B. Conduct disorder

C. Disruptive mood dysregulation disorder

D. Attention-deficit/hyperactivity disorder

8. A child who has persistent irritability and frequent episodes of extreme temper tantrums, but does not display any significant defiant behavior or vindictiveness, is most likely to be diagnosed with:

A. Oppositional defiant disorder

B. Conduct disorder

C. Disruptive mood dysregulation disorder

D. Attention-deficit/hyperactivity disorder

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1. Which of the following is a primary feature of oppositional defiant disorder (ODD)?

Answer: C Rationale: ODD is characterized by a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness, which distinguishes it from other disruptive behavioral disorders.

2. Disruptive mood dysregulation disorder (DMDD) is diagnosed primarily in which age group?

Answer: B Rationale: DMDD is typically diagnosed in school-aged children and adolescents, with symptoms typically appearing before the age of 10.

3. Which of the following behaviors is more characteristic of conduct disorder than oppositional defiant disorder?

Answer: B Rationale: Cruelty to animals is more indicative of conduct disorder, as it involves a pattern of violating the rights of others or societal norms. ODD primarily involves defiant behavior and angry/irritable mood.

4. In which setting must the symptoms of oppositional defiant disorder be observed for a diagnosis to be made?

Answer: D Rationale: Symptoms of ODD must be observed in at least one setting, such as school, home, or with peers. The presence of symptoms in multiple settings can indicate a more severe form of the disorder.

5. A child with frequent and severe temper tantrums that are out of proportion to the situation is most likely to be diagnosed with:

Answer: C Rationale: DMDD is characterized by frequent and severe temper tantrums that are out of proportion to the situation and inconsistent with the child's developmental level.

6. Which of the following treatments is most appropriate for a child with oppositional defiant disorder?

Answer: C Rationale: Cognitive-behavioral therapy is an evidence-based treatment for ODD that focuses on helping the child develop more adaptive thoughts and behaviors.

7. Which disorder is associated with an increased risk of developing antisocial personality disorder in adulthood?

Answer: B Rationale: Conduct disorder is associated with an increased risk of developing antisocial personality disorder in adulthood, as both disorders involve a pattern of violating the rights of others and societal norms.

8. A child who has persistent irritability and frequent episodes of extreme temper tantrums, but does not display any significant defiant behavior or vindictiveness, is most likely to be diagnosed with:

Answer: C

Rationale: DMDD is characterized by persistent irritability and frequent episodes of extreme temper tantrums, but not significant defiant behavior or vindictiveness, which are more indicative of ODD.

Content Review: Disruptive Behavioral Disorders

Disruptive behavioral disorders encompass a group of conditions characterized by persistent patterns of disruptive, defiant, or aggressive behaviors that interfere with an individual's social, academic, and occupational functioning. Three of the most common disruptive behavioral disorders are Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD), and Conduct Disorder (CD).

Oppositional Defiant Disorder (ODD)

ODD is characterized by a pattern of angry, irritable mood, argumentative, defiant behavior, or vindictiveness lasting for at least six months. Symptoms typically emerge before the age of eight and include frequent temper tantrums, excessive arguing with adults, refusing to follow rules, and blaming others for their mistakes. ODD affects approximately 3.3% of children and adolescents, with higher prevalence rates in males and younger children.

Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is characterized by severe and recurrent temper outbursts that are disproportionate to the situation or provocation, occurring three or more times per week for at least one year. Additionally, the individual displays a persistent irritable or angry mood between outbursts. DMDD typically emerges before the age of 10 and is diagnosed in children between 6 and 18 years old. The prevalence of DMDD is estimated to be around 2-5% among children and adolescents, with similar rates among males and females.

Conduct Disorder (CD)

CD is characterized by a repetitive and persistent pattern of behavior that violates the basic rights of others or societal norms, such as aggression towards people or animals, destruction of property, deceitfulness or theft, and serious rule violations. CD affects approximately 4% of children and adolescents, with higher prevalence rates in males. CD is considered a more severe form of ODD and often represents a progression of the disruptive behaviors seen in ODD.

Differentiating Between Disorders:

While there is some overlap in the symptoms of these disorders, they can be differentiated based on the nature and severity of the behavioral patterns:

• ODD is primarily characterized by argumentative and defiant behavior, while CD involves more severe violations of others' rights and societal norms.

• DMDD is differentiated from ODD and CD by the presence of severe and recurrent temper outbursts, as well as persistent irritability between outbursts.

When assessing and diagnosing disruptive behavioral disorders, it is essential to consider the individual's age, the duration and severity of symptoms, and the degree to which the behaviors interfere with their functioning. Early intervention and appropriate treatment can help to improve outcomes for individuals with these disorders and reduce the risk of progression to more severe conditions, such as antisocial personality disorder, in adulthood.

Patient Scenario:

Tommy, a 12-year-old boy, was referred to a PMHNP by his school counselor due to concerns about his behavior. Tommy frequently argues with his teachers and parents, blames others for his mistakes, and has been involved in several fights with classmates. Additionally, he has been caught stealing from his peers on multiple occasions.