A 10-Year-Old Girl Is Brought to the Office by Her

A 10-year-old girl is brought to the office by her mother for evaluation of behavioral problems.  Her mother says, "She was sent to the principal's office last week after telling another student that she was 'stupid' for ignoring her in class.  She blurts out whatever comes into her head, like telling a kid at soccer practice that her shoes were ugly.  It is no wonder she has no friends."  The mother is also concerned that her daughter's grades are poor: "She is always making excuses for not doing her homework.  She loses the instructions for assignments and never brings home the schoolbooks she needs to do the work."  The girl's school reports over the last year have described her as "a disruptive student who doesn't follow directions and speaks out of turn."  During the evaluation, the patient interrupts her mother to argue that it is not her fault the teacher doesn't explain what to do for homework and that people have "ugly shoes."  She is easily distracted by noises from outside the examination room, and the physician has to repeat questions a number of times.  Which of the following is the most likely diagnosis in this patient?

A) Attention-deficit hyperactivity disorder
B) Conduct disorder
C) Disruptive mood dysregulation disorder
D) Oppositional defiant disorder
E) Social (pragmatic) communication disorder
F) Tourette syndrome