A 10-year-old boy is referred for behavioral problems at school. He frequently defies teacher instructions, argues with adults, deliberately annoys classmates, and blames others for his mistakes. These behaviors have been present for at least 8 months and occur primarily at school, not at home. His academic performance is otherwise adequate. He has never destroyed property, stolen, or seriously violated others' rights. What is the most likely diagnosis?

• A Conduct disorder
• B Intermittent explosive disorder
• C Oppositional defiant disorder ✓
• D ADHD, predominantly hyperactive-impulsive type

Explanation

Oppositional defiant disorder (ODD) is characterized by a persistent pattern (at least 6 months) of angry/irritable mood, argumentative/defiant behavior, and vindictiveness directed primarily at authority figures. Crucially, ODD does not involve the serious violations of others' rights or societal norms — such as aggression toward people, property destruction, theft, or deceitfulness — that define conduct disorder. The DSM-5-TR added a contextual specifier when behaviors occur in only one setting. ODD frequently co-occurs with ADHD, but the core symptoms here are oppositional rather than attentional or hyperactive.

Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.

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Written and medically reviewed by the StethoPrep medical team.