Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Disruptive behaviour disorder

Clinical Discipline(s)/Organ System(s)
Paediatrics, Psychiatry/Health Psychology, General Practice
Progress Test Topic(s)
Child health, Mental health
An 8 year old NZ European boy is brought by his mother to see you in your General Practice. The staff at her son's school have insisted that she seek help with managing his behaviour after he hit another child with a stick at school. She tells you that her son has been disruptive in class, is making poor progress with reading, gets into fights in the playground at lunchtimes, and is friends with other 'trouble-makers'. At home he is often disobedient, fights with his younger brothers, and never settles to any activity for long. He has always been a very active child and his behaviour has been worse since his father left the marriage 18 months ago.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Current biopsychosocial theories of the causation of disruptive behaviour disorders
   - Developmental patterns of learning disorders
   - Theory and principles of behaviour management, including applied behavioural analysis, setting up a behaviour management programme, parent management training, social skills training
   - Pathophysiology of attention deficit disorder with hyperactivity (ADHD)
   - Mechanism of action and clinical indications for psychostimulant medication in children
   - Effects of parental separation on children's emotional state
Clinical and Communication Skills 
   - Elicit a comprehensive child psychiatric and medical history from a parent and child, focusing on disruptive behaviour
   - Perform a developmentally appropriate mental state examination on an 8 year old child with challenging behaviour
   - Indications for cognitive and learning assessment in a child/adolescent
   - Differential diagnosis of the disruptive behaviour disorders
   - Management of ADHD
   - Management of oppositional behaviour
   - Liaison with school teachers/education system
Personal and Professional Skills 
   - Social and developmental impact of mental illness in childhood
   - Non-judgemental approach to mental illness and reducing stigma
   - Non-judgemental approach to parents and parenting
   - Demonstrate empathetic interviewing
   - Appropriately communicate evidence of treatment options to parents/whanau/teachers, including Practice Guidelines in ADHD
   - Role of Child Mental Health Services, Paediatric Services, Education Services and the multi-disciplinary team in the care of a young person with ADHD and disruptive behaviour disorder
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Awareness of context of educational inequities, especially for Māori boys
   - Awareness and ability to recognise own stereotypes and biases in relation to Māori patients and whānau
Population Health 
   - Providing support and information to parents with practical management strategies
   - Providing additional support for the child with learning difficulties
Conditions to be considered relating to this scenario
attention deficit disorder with hyperactivity (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), specific learning disorder, anxiety disorder, depressive personality disorder, pervasive developmental disorder, child abuse, intellectual disability
Less common but 'important not to miss'
lead poisoning