Differential & Work-up: Behavioral Problems in Childhood

Question 1

9 yo M presents with a 2-year history of angry outbursts both in school and at home. His mother complains that he runs around“as if driven by a motor.” His teacher reports that he cannot sit still class, regularly interrupts his classmates and has trouble making friends.

Answer 1

1. Attention deficit hyperactivity disorder (ADHD)
2. Oppositional defiant disorder
3. Conduct disorder
4. Manic episode
5. Hyperthyroidism

Question 2

WORK UP FOR:

1. Attention deficit hyperactivity disorder (ADHD)
2. Oppositional defiant disorder
3. Conduct disorder
4. Manic episode
5. Hyperthyroidism

Answer 2

1. Physical exam
2. Mental status exam
3. TSH, FT4

Question 3

12 yo F presents with a 2-month history of fighting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced, she was an average student with no behavioral problems.

Answer 3

1. Adjustment disorder
2. Substance intoxication, abuse, or dependence
3. Oppositional defiant disorder
4. Conduct disorder
5. Manic episode

Question 4

WORK-UP FOR:

1. Adjustment disorder
2. Substance intoxication, abuse, or dependence
3. Oppositional defiant disorder
4. Conduct disorder
5. Manic episode

Answer 4

1. Physical exam
2. Mental status exam
3. Urine toxicology

Question 5

15 yo M presents with a 1-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of his time alone in his room, adding that when he does go out, it is with a new set of friends.

Answer 5

1. Substance abuse
2. Conduct disorder
3. Oppositional defiant disorder
4. Adjustment disorder

Question 6

WORK UP FOR:

1. Substance abuse
2. Conduct disorder
3. Oppositional defiant disorder
4. Adjustment disorder

Answer 6

1. Urine toxicology
2. Physical exam
3. Mental status exam

Question 7

5 yo M presents with a 6-month history of temper tantrums that last 5 to 10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change in appetite, and does not display these behaviors when he is at daycare.

Answer 7

1. Age·appropriate behavior
2. ADHD
3. Oppositional defiant disorder

Question 8

WORK UP FOR:

1. Age·appropriate behavior
2. ADHD
3. Oppositional defiant disorder

Answer 8

1. Physical exam
2. Mental status exam