Case Study
Patient Demographic: Client Age: 8 Sex: Female Gender: Female Grade: 3rd Ethnicity: African American Counseling Setting: School-based Type of Counseling: Individual and Family Presenting Problem: Defiance Diagnosis: Oppositional Defiant Disorder 313.81 (F91.3)
Mental Status Exam: Mental Status Exam: The client displays an angry affect and sits with her arms crossed. She is well dressed and well groomed. The client’s PGM repeatedly prompts her to say, “yes ma’am” and “no ma’am” when answering questions. The client sits slumped in her chair. She agrees to color in a feelings thermometer that reflects increased anger, sadness, and fear. Her insight is poor. The client often refuses to eat school lunch, and the PGM reports that the client is a picky ea
Presenting Problem: You are a school-based mental health counselor conducting an initial intake with an 8-year-old African American female in the 3rd grade. The client presents today with her paternal grandmother (PGM), the client’s legal guardian. The PGM states that the client is argumentative, refuses to take responsibility for her actions, and has a tantrum when she receives a consequence for her behavior. She reports that the client is restricted from “every single privilege indefinitely.” The client has been told she can regain privileges once she “learns to act her age.” The client states she is treated unfairly and “blamed for everything” at home and school. The client’s teacher reports that she has difficulty following directions, is easily annoyed by her classmates, and frequently loses her temper. The client’s grades are poor, and she is below grade level in reading. However, she enjoys art and proudly reports that one of her pictures came in 1st place and is hanging in the library.
Other Contexts:    ter. F amily History: The client’s paternal grandmother received legal guardianship when the client was in 1st grade due to parental neglect. The client’s mother and father have had ongoing issues with substance abuse. The client’s father is currently incarcerated for drug-related offenses. The PGM reports that the client’s mother continues to “run the streets” and shows up periodically asking for money. The PGM states that the client’s mother abused drugs while pregnant and that the client was born prematurely. In addition, the client’s father had similar school difficulties and dropped out of high school in the 10th grade. History of Condition: The client’s disruptive behavior began in early childhood. When the client was four years old, her tantrums were so severe that she disrupted two daycare placements and was not allowed to return. In kindergarten, the client was given a stimulant by her primary care provider to assist with symptoms of ADHD. The PGM says she is no longer on the medication and believes the client chooses to misbehave, explaining, “she is strong-willed, just like her father.” The client’s school records show she has an individualized education plan (IEP) and receives limited services for developmental delays in reading and written expression

Question: Using the DSM-5-TR criteria, how would you differentiate oppositional defiant disorder (ODD) from conduct disorder (CD)?
(A): ODD includes destruction of property, while CD does not.
(B): ODD includes cruelty to animals, while CD does not.
(C): ODD includes conflict with authority, while CD does not.
(D): ODD includes emotional dysregulation, while CD does not.

Correct Answer: ODD includes emotional dysregulation, while CD does not.
Explanation: Criteria for ODD include emotional dysregulation, while CD does not. Both ODD and CD include the criterion of conflict with authority. Only CD includes the destruction of property and cruelty to animals. It is important to distinguish between ODD and CD, and the DSM-5-TR makes that distinction in the differential diagnosis section. The differential diagnosis section can be found after the diagnostic criteria, along with additional text descriptions such as diagnostic features. According to the DSM-5-TR, both conduct disorder and ODD are related to issues of behavior as it relates to conflict with figures of authority, but ODD behaviors are generally less severe than those of conduct disorder and do not target animals or property. Additionally the DSM-5-TR describes ODD to include issues with regulating emotions. Therefore, the correct answer is (A)
Competency: intake, assessment, and diagnosis