Explain conduct disorder and the parenting-first plan to a frightened parent — OSCE

Candidate brief (5 minutes to read)

You are the paediatric registrar. The mother of ten-year-old Liam has come to clinic alone and is distressed. Liam has been suspended twice for fighting, the school has raised cruelty to animals, and his mother has discovered him stealing from her purse. [4]

He has an existing diagnosis of ADHD that the family stopped treating six months ago. His father drinks heavily and discipline at home is harsh and inconsistent. His mother believes she has failed and wants "something to calm him down." [2]

Task

In eight minutes, build rapport with a frightened and guilt-laden parent and complete four steps. [1]

First, explain what conduct disorder is in plain language — a recognised, treatable pattern, not her failure. Second, share an honest but hopeful framing of his outlook using the developmental trajectory, without false reassurance. [1] [4]

Third, agree a safety-first plan covering risk to others, means restriction, and safeguarding, and explain the multi-agency involvement. Fourth, explain why a parenting programme — and treating his ADHD — is the first and most effective step, and why a tablet is not the answer she imagined. [2] [5]

Examiner prompts (if the candidate stalls)

His mother asks whether he will end up in prison; answer with the trajectory evidence, neither fatalism nor false reassurance. [1] [2]

She wants medication today; acknowledge her wish, explain the evidence, and frame the plan she is asking about (ADHD treatment) as the medication that genuinely helps. She asks what you are doing about the father's drinking and the home; show safeguarding awareness and the multi-agency plan. [5]