MSW 602 FINAL EXAM WITH COMPLETE SOLUTIONS
Disruptive, impulse control & conduct DXs - ANSWER - oppositional defiant DX
- intermittent explosive DX
- conduct DX
- pyromania
- kleptomania
- other specified/unspecified disruptive, impulse control, and conduct DX
Characteristics of Disruptive, impulse control & conduct DXs - ANSWER - externalizing
behaviors
- poor self regulation
- tend to overlap w/ ADHD, disruptive mood dysregulation DX, substance use DXs
Assessment for Disruptive, impulse control & conduct DXs - ANSWER - Detailed history
of presenting problem
- Developmental history
- Medical history
- Affective functioning
- Trauma history
- Family history
- Abuse of substances
- Academic performance
- Psychological testing
Risk factors for Disruptive, impulse control & conduct DXs - ANSWER 1.Having a parent
with a mood or substance abuse disorder
2.History of abuse or neglect
3.Harsh or inconsistent discipline
4.Lack of supervision
5.Parents with a history of ADHD, or conduct problems
,6.Financial problems in the family Peer rejection
7.Exposure to violence
8.Family instability such as multiple moves, changing schools frequently
Oppositional defiant DX - ANSWER Criterion A: At Least 4 symptoms throughout the past
6 months (not only with siblings)
3 Categories
1. Angry or Irritable mood
•Often loses temper
•Often touchy/easily annoyed
•Often angry/resentful
2. Argumentative or defiant behavior
•Often argues with authority or adults
•Often actively defies rules and requests
•Often deliberately annoys others
•Often blames others for own mistakes
3. Vindictiveness
•Spiteful or vindictive 2 + times in the past 6 months
Criterion B: Associated with distress for individual or others, or impacts negatively on
education, social occupation, or other areas
Criterion C: Symptoms do not occur only during course of psychotic, substance use,
depressive, or bipolar disorder. Individual does not meet criteria for disruptive mood
dysregulation disorders.
Severity
Mild: 1 setting
Moderate: 2 settings
Severe: 3+ settings
• Individuals with ODD often don't view themselves as angry, oppositional, or defiant;
they often justify their behavior as a response to unreasonable demands or
circumstances
,• The symptoms of the disorder often are part of a pattern of problematic interactions
with others
Oppositional defiant DX differential DX - ANSWER There is high rates of Comorbidity; be
sure to rule out:
1. Conduct Disorder
• ODD is less 'severe'
• ODD doesn't include: aggression, destruction, theft, deceit
• ODD doe include: emotional dysregulation
2. ADHD
• ODD includes refusal of requests in situations that aren't solely when effort is needed
to sustain attention
3. Depressive and Bipolar Disorders
• ODD includes emotional symptoms that do not occur solely during mood disorder
Conduct DX - ANSWER - Repetitive and Persistent Pattern of Behavior
• The disturbance in behavior causes clinically significant impairment in psychosocial
functioning
• If the individual is age 18 or older, Antisocial Personality Disorder
• Higher in adolescence than childhood and higher among males.
• Treatment: Parent management training, medication, Multi-systemic Therapy (MST)
Requires 3 of the following 15 symptoms within the last 12 months, with at least 1 within
the past 6 months:
1. Aggression to people and animals
2. Intimidates others often
3. Initiates physical fight often
4. Used a dangerous weapon
5. Physically cruel to people or animals
6. Stolen while confronting a victim
7. Forced sex on someone
8. Destruction of property
, 9. Arson
10. Deceitfulness or theft
11. Broken into someone's place
12. Deceives and manipulates others
13. Serious violation of rules
14. Run away from home 2 times
Beginning before age 13
Intermittent explosive DX - ANSWER • Minimum age of at least 6 years
• Recurrent episodes of failing to resist aggressive impulses that manifest as either
verbal and or physical aggression, twice weekly for a 3 months period of time (that do
not result in assault and or property destruction)
• Three physically aggressive behavioral outbursts involving damage or destruction of
property and or injurious to a person or animal over the course of 12 months
• The destructive outburst are impulsive, anger based (not intentional), and not to
achieve some tangible objective (money, power, intimidation)
• The degree of aggression is excessive response to the provocation
• The diagnosis can be made in addition to the diagnosis of ADHD; Conduct Disorder;
Oppositional Defiant Disorder; Autism Spectrum Disorder, when recurrent impulsive
aggressive outburst are in excess of those usually seen in these disorders and warrant
independent clinical attention.
• Associated Features include: Mood disorders, anxiety disorders, and substance use
disorders.
Functional Consequences:
• Social (Loss of friends, relatives, marital instability)
• Occupational (Demotion, loss of employment)
• Financial (Due to value of objects destroyed)
Disruptive, impulse control & conduct DXs - ANSWER - oppositional defiant DX
- intermittent explosive DX
- conduct DX
- pyromania
- kleptomania
- other specified/unspecified disruptive, impulse control, and conduct DX
Characteristics of Disruptive, impulse control & conduct DXs - ANSWER - externalizing
behaviors
- poor self regulation
- tend to overlap w/ ADHD, disruptive mood dysregulation DX, substance use DXs
Assessment for Disruptive, impulse control & conduct DXs - ANSWER - Detailed history
of presenting problem
- Developmental history
- Medical history
- Affective functioning
- Trauma history
- Family history
- Abuse of substances
- Academic performance
- Psychological testing
Risk factors for Disruptive, impulse control & conduct DXs - ANSWER 1.Having a parent
with a mood or substance abuse disorder
2.History of abuse or neglect
3.Harsh or inconsistent discipline
4.Lack of supervision
5.Parents with a history of ADHD, or conduct problems
,6.Financial problems in the family Peer rejection
7.Exposure to violence
8.Family instability such as multiple moves, changing schools frequently
Oppositional defiant DX - ANSWER Criterion A: At Least 4 symptoms throughout the past
6 months (not only with siblings)
3 Categories
1. Angry or Irritable mood
•Often loses temper
•Often touchy/easily annoyed
•Often angry/resentful
2. Argumentative or defiant behavior
•Often argues with authority or adults
•Often actively defies rules and requests
•Often deliberately annoys others
•Often blames others for own mistakes
3. Vindictiveness
•Spiteful or vindictive 2 + times in the past 6 months
Criterion B: Associated with distress for individual or others, or impacts negatively on
education, social occupation, or other areas
Criterion C: Symptoms do not occur only during course of psychotic, substance use,
depressive, or bipolar disorder. Individual does not meet criteria for disruptive mood
dysregulation disorders.
Severity
Mild: 1 setting
Moderate: 2 settings
Severe: 3+ settings
• Individuals with ODD often don't view themselves as angry, oppositional, or defiant;
they often justify their behavior as a response to unreasonable demands or
circumstances
,• The symptoms of the disorder often are part of a pattern of problematic interactions
with others
Oppositional defiant DX differential DX - ANSWER There is high rates of Comorbidity; be
sure to rule out:
1. Conduct Disorder
• ODD is less 'severe'
• ODD doesn't include: aggression, destruction, theft, deceit
• ODD doe include: emotional dysregulation
2. ADHD
• ODD includes refusal of requests in situations that aren't solely when effort is needed
to sustain attention
3. Depressive and Bipolar Disorders
• ODD includes emotional symptoms that do not occur solely during mood disorder
Conduct DX - ANSWER - Repetitive and Persistent Pattern of Behavior
• The disturbance in behavior causes clinically significant impairment in psychosocial
functioning
• If the individual is age 18 or older, Antisocial Personality Disorder
• Higher in adolescence than childhood and higher among males.
• Treatment: Parent management training, medication, Multi-systemic Therapy (MST)
Requires 3 of the following 15 symptoms within the last 12 months, with at least 1 within
the past 6 months:
1. Aggression to people and animals
2. Intimidates others often
3. Initiates physical fight often
4. Used a dangerous weapon
5. Physically cruel to people or animals
6. Stolen while confronting a victim
7. Forced sex on someone
8. Destruction of property
, 9. Arson
10. Deceitfulness or theft
11. Broken into someone's place
12. Deceives and manipulates others
13. Serious violation of rules
14. Run away from home 2 times
Beginning before age 13
Intermittent explosive DX - ANSWER • Minimum age of at least 6 years
• Recurrent episodes of failing to resist aggressive impulses that manifest as either
verbal and or physical aggression, twice weekly for a 3 months period of time (that do
not result in assault and or property destruction)
• Three physically aggressive behavioral outbursts involving damage or destruction of
property and or injurious to a person or animal over the course of 12 months
• The destructive outburst are impulsive, anger based (not intentional), and not to
achieve some tangible objective (money, power, intimidation)
• The degree of aggression is excessive response to the provocation
• The diagnosis can be made in addition to the diagnosis of ADHD; Conduct Disorder;
Oppositional Defiant Disorder; Autism Spectrum Disorder, when recurrent impulsive
aggressive outburst are in excess of those usually seen in these disorders and warrant
independent clinical attention.
• Associated Features include: Mood disorders, anxiety disorders, and substance use
disorders.
Functional Consequences:
• Social (Loss of friends, relatives, marital instability)
• Occupational (Demotion, loss of employment)
• Financial (Due to value of objects destroyed)
