Concept Map – What is the Main diagnosis for Mary Rose?

Posted: February 15th, 2023

Concept Map 3

Concept Map Information
1. Main Diagnosis
Disruptive behavior disorders are characterized by problems in the self-control of emotions and behavior, which interfere with a child’s ability to function at home and school. The child violates the rights of others or enters into conflicts with rules or authority figures. DSM-5-TR specifies that with at least three of them during more than 6 months the patient can be diagnosed with the disorder (APA, 2022). In such a case, in John Henry´s case is possible to find that:
– Frequent temper tantrums.
– Angry outbursts and irritability.
– Argumentativeness and defiance.
– Threatening or aggressive behavior.
– Serious rules violations.
Based on his age (5-year-old), his disorder is framed into the childhood-onset. Moreover, he has limited prosocial emotions due to the lack of remorse, lack of empathy, and the deficient affect. A child with ODD may have frequent angry outbursts, become easily annoyed, argue often with parents, refuse to follow rules, blame others for mistakes, deliberately annoy others, or act in vindictive ways.
2. Key Signs & Symptoms
Symptoms of oppositional defiant disorder include a pattern of:
– Angry/irritable mood leading to often loses temper, easily annoyed, often angry and resentful.
– Argumentative/defiant behavior where the child often argues with authority figures or adults, often refuses to comply with requests or rules, deliberately annoys others, blames others for mistakes or misbehavior.
– Vindictiveness with the behavior tends to demonstrate spitefulness or vindictiveness.
These behaviors are distressing to the individual and alarming to others. Anger, threatening behaviors, and spitefulness cause disruption at school or work and affect relationships with others. Signs of the disorder typically develop during preschool or early elementary school but can also begin in adolescence.
3. Differential Diagnosis
According to Elmaghraby and Garayalde (2021), the main disorders which can appear as comorbidity associated with Oppositional defiant disorder (ODD) are:
a) Conduct disorder (CD) where the child with CD may deliberately hurt or threaten to hurt people or animals, purposely destroy property through vandalism or arson, steal, lie, run away from home, skip school, or break laws.
b) Intermittent explosive disorder (IED) where the child may have impulsive behavior outbursts very frequently, or two or more outbursts per week for three months. Outbursts include temper tantrums, verbal or physical fights, the harming of an animal, or the damaging of property. Having three or more outbursts within a one-year period resulting in the damage or destruction of property or injury to an animal or person is also a sign of IED.
c) Other disruptive, impulse-control and conduct disorders where the child with this disorder may have some of the problems listed above, and they interfere with the child’s functioning at home or school. However, the child does not meet all criteria needed to qualify for any of the other disorders listed above.
4. Treatment Guidelines and Recommendations
Parents are not necessarily the cause of behavior problems, but they can be the solution. Behavior problems have many different causes. There are biological and genetic reasons why a child might have behavioral difficulties. Some children react more strongly to interruptions in daily rhythms like overreactions to hunger or irritability related to too little sleep. Some children have real difficulties controlling emotions, difficulties that have been there since infancy as part of a reactive and highly sensitive temperament.
There is no FDA-approved medication for oppositional defiant disorder (ODD) or conduct disorder (CD), the diagnoses that apply to this sort of behavior, but medications are sometimes used as an adjunct to behavioral therapy. Frequently, children with ODD also have a diagnosis of ADHD. Stimulant medication may be used if a child has difficulty paying attention to adults, following directions or exhibits excessive impulsivity. Antidepressants may also be helpful if a child has underlying depression or anxiety that may be contributing to irritability or problems regulating emotions (Boland, Verdium, & Ruiz, 2021).
Evidence-based practice for treating oppositional defiant disorder (ODD) involves behavioral parent training. This can come in a number of different forms, such as Parent-Child Interaction Therapy (PCIT) and Parent Management Training, or group interventions like Incredible Years. However, the underlying principles are the same: focus on fortifying a positive relationship with the child, clearly define behaviors that parents would like to change, reinforce and amplify positive behaviors, withdraw attention from certain minor misbehaviors, and sparingly but consistently use appropriate punishment for major misbehavior. In general, behavioral parent training takes from three to five months (Boland, Verdium, & Ruiz, 2021).
5. Prognosis
In the case of John Henry, the occurrence of ODD has significant negative impacts on his relationship with the society, in the form of direct behavioral consequences and costs, and on the individual, in the form of poor academic, occupational and psychosocial functioning and on the family. The prognosis considers the possible trauma, disruption and psychological problems caused to the patient by the refusal of acceptance in schools and communities, together with the financial costs of services to treat the affected individuals, including health services, social services, psychiatric services, alcohol and drug misuse services, in addition to unemployment and other required state benefits.

References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders: DSM-5-Tr. APA Publishing.
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan and Sadock’s synopsis of Psychiatry. Wolters Kluwer Health.
Elmaghraby, R., & Garayalde, S. (2021). Disruptive, Impulse Control and Conduct Disorders. Retrieved from https://www.psychiatry.org/patients-families/disruptive-impulse-control-and-conduct-disorders/what-are-disruptive-impulse-control-and-conduct-disorders.

Concept Map 3

John Henry is five years old. He was a fussy baby who was difficult to soothe. Now attending his third preschool, he is in jeopardy of being dismissed again for his refusal to follow the rules and for his angry outbursts. He argues with his peers every week and refuses to cooperate with his teachers’ requests. He is disobedient at home as well and seems to annoy others deliberately.

Concept Map Information

What is the Main diagnosis for Mary Rose?
What are the Key symptoms?
What differential diagnoses did you consider and why?
What is your treatment recommendation and why?
What is the Prognosis?

Thank you for the prompt. Let me review the concept map and provide my analysis:
Main Diagnosis: Based on the information provided, the main diagnosis for John Henry is Oppositional Defiant Disorder (ODD).
Key Symptoms: The key symptoms exhibited by John Henry that support an ODD diagnosis include frequent temper tantrums, angry outbursts and irritability, argumentativeness and defiance, and refusal to follow rules both at home and preschool.
Differential Diagnoses: Other potential diagnoses that were considered but ruled out include Conduct Disorder (CD), as John does not exhibit behaviors like deliberately harming others or destroying property. Intermittent Explosive Disorder (IED) was also considered given his angry outbursts, but the outbursts do not meet the frequency criteria of occurring at least weekly for 3 months.
Treatment Recommendation: Evidence-based treatments for ODD like Parent-Child Interaction Therapy (PCIT) or Parent Management Training are recommended. These focus on strengthening the parent-child relationship, clearly defining desired behaviors, reinforcing positives, and consistently applying appropriate consequences for major misbehaviors. Medication may also be considered as an adjunct if other conditions like ADHD are present.
Prognosis: Without treatment, ODD can negatively impact John’s relationships, academic performance, and psychosocial development. It may also increase his risk for other disorders. With early intervention using an evidence-based approach, the prognosis is better in terms of reducing symptoms and improving his functioning.