Conduct disorder and antisocial behaviour — branching viva

Opening question

Define conduct disorder for me. What distinguishes it from oppositional defiant disorder, and which of the four DSM-5-TR clusters does this boy show? [4]

Branch 1 — Classification and trajectory

Walk me through the Moffitt developmental taxonomy: where does this childhood-onset boy sit, and what is the prognostic implication? [1]

What is the "with limited prosocial emotions" specifier, and how would you assess for it in clinic? How do you grade severity, and why does it matter for the plan? [4]

Branch 2 — Mechanism and risk

Explain the biopsychosocial coercion-loop model, and how the family environment maintains the behaviour. What is the role of low autonomic arousal and prefrontal-amygdala differences in the callous-unemotional subgroup? [1]

How do you assess risk to this child and to others today, and what is your safeguarding obligation given the paternal alcohol misuse? [2]

Branch 3 — Management

Give me your stepped-care plan. Which parenting programme, and what does the Furlong Cochrane review tell you? Why is medication not first-line, and what is the role of treating his ADHD? [5] [6]

When would you escalate to Multisystemic Therapy, and what did the Fast Track prevention evidence show about long-term outcome? [6]

Closing

What would you tell this frightened mother about her son's outlook — honestly, but without therapeutic nihilism? Use the evidence. [2] [5]