A 12-year-old girl is brought to the office for an annual checkup. The mother expresses concern about her daughter's behavior and poor grades, and says, "She is stubborn, irritable, overly emotional, and doesn't listen. She also seems resentful of her twin brother and deliberately annoys or upsets him. I can't get her to do chores or her homework, or go to bed on time." Over the past year, the mother has been called several times by the school guidance counselor about her daughter talking back to teachers and skipping classes. The patient says that school is "boring" and blames her behavior on "pointless rules and unreasonable demands," saying that her teachers are all "stupid." Which of the following is the most likely diagnosis in this patient?

Question

A 12-year-old girl is brought to the office for an annual checkup.  The mother expresses concern about her daughter's behavior and poor grades, and says, "She is stubborn, irritable, overly emotional, and doesn't listen.  She also seems resentful of her twin brother and deliberately annoys or upsets him.  I can't get her to do chores or her homework, or go to bed on time."  Over the past year, the mother has been called several times by the school guidance counselor about her daughter talking back to teachers and skipping classes.  The patient says that school is "boring" and blames her behavior on "pointless rules and unreasonable demands," saying that her teachers are all "stupid."  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec160b_3633_5da3_9249_5532a1208cc0_MD0001_00 This patient's pattern of deliberately annoying behavior and defiance of rules and authority figures that causes problems at home and at school suggests a diagnosis of oppositional defiant disorder (ODD). Blaming failures on others and being angry, argumentative or resentful are also characteristic of the disorder. Although the behavior often manifests with family members, it must also be observed during interactions with other individuals. For diagnosis, the oppositional behaviors must be excessive in frequency and duration when compared to normative age-appropriate behaviors. Although adolescents may test boundaries and assert their independence, this patient's 1-year history of persistent defiance, skipping classes, repeated refusal to follow rules, and irritable mood are beyond what would be expected for a 12-year-old girl (Choice E). (Choice A) Antisocial personality disorder is characterized by a pattern of disregard for and violation of the rights of others and is not diagnosed in individuals age <18. (Choice B) Although attention-deficit hyperactivity disorder (ADHD) is commonly comorbid with ODD, this patient does not exhibit characteristic inattentive and hyperactive symptoms. Children with ODD should be assessed and treated for comorbid ADHD and learning disorders. (Choice C) ODD should be differentiated from conduct disorder, in which the problematic behaviors are more severe and aggressive. This patient does not exhibit destruction of property, physical aggression or cruelty toward people or animals, or the typical pattern of stealing or deceit seen in conduct disorder. (Choice D) In disruptive mood dysregulation disorder, patients also present with irritable mood. However, this is accompanied by repetitive temper outbursts (verbal or physical) that are out of proportion to the stimulus and inconsistent with developmental level. Symptoms should manifest prior to age 10. Educational objective: Oppositional defiant disorder is a behavioral disorder of childhood characterized by argumentative and defiant behavior toward authority figures. It does not involve the more severe violations of the basic rights of others seen in conduct disorder. __________ References: Oppositional defiant disorder. (http://www.ncbi.nlm.nih.gov/pubmed/18841736) Common questions about oppositional defiant disorder. (http://www.ncbi.nlm.nih.gov/pubmed/27035043)

A 12-Year-Old Girl Is Brought to the Office for an Annual