A 12-year-old boy is brought to the office due to behavioral problems. His parents are upset about his poor grades and recent school suspension for setting fires in the locker room and stealing another student's cell phone. They say that the boy has always been impulsive, had a lot of energy, and become angry and argumentative easily, but over the past year his aggressive behavior "has gotten out of control." The patient says that the fires were an "accident," although he admits to being angry at the coach for kicking him off the basketball team. Regarding the theft, he jokingly says, "People deserve to have their phones stolen when they are stupid enough to leave them in plain sight." The patient has a history of getting into trouble for talking back to teachers, skipping class, and getting into fights since the fourth grade. He has no medical history. There is a family history of bipolar disorder and alcohol dependence. The patient smokes cigarettes occasionally but denies illicit drug or alcohol use. Which of the following is the most likely diagnosis in this patient?

Question

A 12-year-old boy is brought to the office due to behavioral problems.  His parents are upset about his poor grades and recent school suspension for setting fires in the locker room and stealing another student's cell phone.  They say that the boy has always been impulsive, had a lot of energy, and become angry and argumentative easily, but over the past year his aggressive behavior "has gotten out of control."  The patient says that the fires were an "accident," although he admits to being angry at the coach for kicking him off the basketball team.  Regarding the theft, he jokingly says, "People deserve to have their phones stolen when they are stupid enough to leave them in plain sight."  The patient has a history of getting into trouble for talking back to teachers, skipping class, and getting into fights since the fourth grade.  He has no medical history.  There is a family history of bipolar disorder and alcohol dependence.  The patient smokes cigarettes occasionally but denies illicit drug or alcohol use.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec160b_360f_0ca4_9249_0304f1ba8f6c_MD0001_00 This patient's history of fire setting, stealing, and aggressive behavior is most likely explained by conduct disorder. Conduct disorder is a psychiatric disorder of children and adolescents and is characterized by a pattern of behaviors that violate major societal norms or the rights of others. Other behaviors seen in conduct disorder include bullying, frequent physical fights, using weapons (eg, bat, gun, knife), torturing animals, breaking into houses, and sexual coercion. Conduct disorder generally presents in middle childhood to adolescence and is more common in boys. Children with conduct disorder are at greater risk for developing antisocial personality disorder as adults. (Choice A) Antisocial personality disorder is not diagnosed in individuals under age 18. It involves a pattern of violation of basic societal rules and the rights of others and requires a history of some symptoms of conduct disorder before age 15. (Choice B) This patient does not have enough inattentive and hyperactive symptoms to diagnose attention-deficit hyperactivity disorder, and his overall behavior is more characteristic of conduct disorder. (Choice D) Aggression occurs in both conduct and intermittent explosive disorders. However, in intermittent explosive disorder, aggression is not premeditated or committed to achieve a tangible objective (eg, money, power, intimidation). This disorder would not explain this patient's stealing and fire setting. (Choice E) Oppositional defiant disorder (ODD) involves a pattern of angry/irritable mood and argumentative/defiant behavior toward authority figures. Symptoms of ODD are less severe than those of conduct disorder. ODD does not include physical aggression, stealing, or destruction of property, as seen in this patient. (Choice F) Pyromania is characterized by intentional and repeated fire setting with no obvious motive; it does not involve other behaviors seen in conduct disorder (eg, lying, theft, cruelty to others). A separate diagnosis of pyromania is not given when fire setting occurs as part of conduct disorder. Educational objective: Conduct disorder involves a persistent pattern of violating major societal norms or the rights of others. Behaviors include aggression toward people and animals, deceitfulness or theft, destruction of property, and serious violation of rules. __________ References: Disruptive behavior in preschool children: distinguishing normal misbehavior from markers of current and later childhood conduct disorder. (http://www.ncbi.nlm.nih.gov/pubmed/25598304) Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review. (http://www.ncbi.nlm.nih.gov/pubmed/23796269)

A 12-Year-Old Boy Is Brought to the Office Due to Behavioral