A 9-year-old boy has argued with adults, actively refused to comply with rules, deliberately annoyed his siblings, and blamed others for his mistakes for the past 8 months. He has never been physically aggressive toward people or animals, has never destroyed property, stolen, lied for gain, or been cruel to animals. Academic performance is average. What is the most likely diagnosis?

• A Conduct disorder, childhood-onset type
• B Intermittent explosive disorder
• C Adjustment disorder with disturbance of conduct
• D Oppositional defiant disorder ✓

Explanation

Angry or irritable mood, argumentative or defiant behavior, and vindictiveness lasting at least 6 months define oppositional defiant disorder. The discriminating feature against conduct disorder is the absence of the conduct disorder tetrad: aggression to people or animals, destruction of property, deceitfulness or theft, and serious rule violation such as running away or truancy. Intermittent explosive disorder requires discrete aggressive outbursts grossly disproportionate to provocation, which are not described here.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.