Psych CASC / OSCE · Child and adolescent psychiatry — disruptive behaviour
Explain ODD/CD formulation and parent training plan — CASC communication station
MRCPsych/FRANZCP-style communication station: explain ODD vs CD, developmental risk without fatalism, parent management training rationale, and limited medication role without shaming caregivers.
On this page & tools
Target exams
Station brief
Format. Communication station, approximately 7–10 minutes active time after reading. You are the CAMHS psychiatry registrar. [1]
Candidate instructions. Explain the working diagnosis (likely ODD with risk of progression if untreated drivers continue; clarify that ASPD is not a child diagnosis), outline multi-informant assessment already supporting multi-setting problems, present parent management training as skilled treatment not blame, discuss school collaboration, and address medication expectations honestly. Check understanding and negotiate a collaborative plan. [1][2]
Candidate scenario
Your formulation supports ODD with multi-setting impairment, possible ADHD features still under assessment, coercive parent–child cycles, and no current CD-level serious criminality. You recommend a structured parenting programme and school behaviour plan; medication is not first-line for defiance. Parents fear genetic destiny and want a quick pharmacological fix. [1][3]
Marking domains
- Empathy and non-blaming engagement with exhausted parents
- Accurate plain-language distinction of ODD, CD and adult ASPD
- Clear rationale for parent management training with hope and evidence tone
- Honest limited role of medication and when specialists reconsider it
- Risk/school liaison without catastrophising
- Shared decision-making and next steps [1][2][4]
Reveal assessor key
Open and agenda-set. Name time; acknowledge stress and school pressure; ask priorities (ASPD fear, medication, exclusion). Validate effort without colluding that the child is "just bad blood."[1]
Explain diagnosis. ODD is a pattern of angry/irritable mood, argumentative/defiant behaviour and vindictiveness causing impairment — not a moral insult. It is different from conduct disorder (more serious rule-breaking/aggression criteria). Antisocial personality disorder is an adult diagnosis; childhood problems raise risk for some but do not mean destiny.[1][3][5]
Explain treatment. Structured parent management training teaches specific skills (clear instructions, catching good behaviour, consistent calm consequences) that reduce coercive cycles; programmes can work in real clinical services. School partnership is essential. This is skilled treatment, not saying parents "caused" everything.[2]
Medication. Tablets are not first-line for defiance. If ADHD is confirmed, treating ADHD can help. Antipsychotics are reserved for severe aggression under specialist monitoring — not obedience drugs.[4]
Close. Summarise plan, invite questions, written information, follow-up, crisis contacts if aggression escalates. [1]
References
- [1]Steiner H, Remsing L Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder J Am Acad Child Adolesc Psychiatry, 2007.PMID 17195736
- [2]Scott S, Spender Q, Doolan M, et al. Multicentre controlled trial of parenting groups for childhood antisocial behaviour in clinical practice BMJ, 2001.PMID 11473908
- [3]Moffitt TE Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy Psychol Rev, 1993.PMID 8255953
- [4]Gorman DA, Gardner DM, Murphy AL, et al. Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder Can J Psychiatry, 2015.PMID 25886657
- [5]Robins LN Deviant children grown up Eur Child Adolesc Psychiatry, 1996.PMID 9010663