NORCET 10 Mains: A 15-year-old child is aggressive and not following commands. What is the most likely diagnosis?

NORCET 10 Mains

Mental Health Nursing

Medium

Appeared in: NORCET 10 Mains

Explanation

Conduct disorder is defined by a persistent pattern of behavior that violates the basic rights of others and major age-appropriate societal norms.
The presenting symptoms of aggression towards others and not following commands (a serious violation of rules) are hallmark diagnostic criteria for Conduct Disorder.
This pattern of behavior is enduring and causes significant impairment in social and academic functioning, distinguishing it from isolated acts of misbehavior.

Option B: OCD is primarily an anxiety disorder characterized by obsessions (intrusive thoughts) and compulsions (repetitive actions), not by a persistent pattern of aggression and rule-breaking.
Option C: While children with ADHD can be aggressive, it is typically due to impulsivity rather than a deliberate pattern of violating others' rights. The core features of ADHD are inattention, hyperactivity, and impulsivity.
Option D: Autism Spectrum Disorder is defined by deficits in social communication and the presence of restricted, repetitive behaviors. Aggression, if present, is usually a reaction to sensory overload, frustration, or communication difficulties, not a primary feature.

Clinical Relevance

Nursing practice connection: Use the key finding related to Differential diagnosis of disruptive behavioral disorders in adolescents to guide bedside assessment, documentation, and the next nursing action.
Early diagnosis and intervention for Conduct Disorder are crucial, as it is a significant risk factor for developing Antisocial Personality Disorder in adulthood.
Nurses must conduct a thorough assessment to rule out other conditions and identify comorbidities, such as ADHD, depression, or substance use, which are common with Conduct Disorder.
A key nursing role is to ensure a safe environment for the patient and others, implement behavioral contracts, and provide education and support to the family.

How to Approach the Question

First, identify the key clinical features presented in the scenario: a 15-year-old who is 'aggressive' and 'not following commands'.
Recognize that these are disruptive behaviors that violate social norms and the expectations of authority figures.
Systematically evaluate each option against these core symptoms.
Recall that Conduct Disorder's primary criteria include aggression toward people/animals and serious rule violations, making it a strong match.
Eliminate the other options by identifying their primary, defining features: OCD (obsessions/compulsions), ADHD (inattention/hyperactivity), and Autism (social deficits/repetitive behaviors).
Conclude that Conduct Disorder is the 'most likely' diagnosis as it directly encompasses the presenting behaviors as core diagnostic features.

Concept Tested & Keywords

Concept Tested: Differential diagnosis of disruptive behavioral disorders in adolescents.
Stem keywords: 15-year-old, aggressive, not following commands
Lead-in keywords: most likely diagnosis
Clinical cues: The combination of aggression and defiance of commands is a key indicator for a specific type of disruptive behavior disorder.

Q2sXaDEs9ozhG6CPvH02N2

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) pp. 601-603, 607-609, 606-608