Conduct disorder and antisocial behaviour — formative SAQs

SAQ 1 (10 marks)

A nine-year-old boy is referred after his second school suspension for fighting. His mother describes cruelty to the family cat, stealing from her purse, and staying out until after midnight twice in the last month. She is frightened of him. There is a history of harsh, inconsistent discipline, paternal alcohol misuse, and an ADHD diagnosis made at age seven that is currently untreated. [4] [2]

a) State the DSM-5-TR definition of conduct disorder and the four symptom clusters, and identify which clusters this child shows. (3 marks) [4]

b) Using the Moffitt developmental taxonomy and the DSM-5-TR onset subtype, classify this child's likely trajectory and explain the prognostic implication. (2 marks) [1]

c) Name the features you would actively assess to apply the "with limited prosocial emotions" (callous-unemotional) specifier, and explain why it changes the plan. (2 marks) [4]

d) Outline the immediate safety-first assessment and the stepped-care management plan, citing the evidence base. (3 marks) [5] [9]

SAQ 2 (10 marks)

A four-year-old girl is referred by her childcare for severe, persistent aggression toward peers that has not responded to normal behavioural management. [5]

a) Why is the pre-school window considered the period of greatest intervention leverage, and what does the prevention evidence add? (3 marks) [1] [5]

b) Name two evidence-based parenting programmes with trial support for early-onset conduct problems and describe what each delivers. (4 marks) [5] [9]

c) What comorbidities and unmet needs must you assess for before finalising the plan, and why is medication not first-line? (3 marks) [4]

Model answer pointers

For SAQ 1: the definition is a persistent (at least twelve-month), impairing pattern of violating the rights of others or major age-appropriate norms, across the clusters of aggression, destruction, deceit/theft, and serious rule-breaking; this child shows aggression, deceit/theft, and serious rule-violation. [4]

He is childhood-onset and, given the harsh environment and paternal substance use, sits on the life-course-persistent trajectory with a poorer prognosis. Assess remorse, guilt, empathy, unconcern about performance, and shallow affect for the callous-unemotional specifier; its presence marks a severe, treatment-resistant form needing specialist multimodal care. [1]

Safety-first means same-day safeguarding review, a risk-to-others plan, and means restriction; stepped care starts with structured parent training plus child problem-solving work, vigorous treatment of the comorbid ADHD, and specialist CAMHS involvement. [2] [9]

For SAQ 2: early-childhood leverage rests on plasticity and the still-forming coercion loop. Incredible Years and Triple P are the two named programmes; both are behavioural and cognitive-behavioural parenting interventions. Assess for ADHD, trauma and attachment disruption, language and developmental disorder, and safeguarding; medication is not first-line because the psychosocial evidence is stronger and the harms lower. [5]