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Clinical Atlas Prestige · Evidence-first

Psych VivasChild and adolescent psychiatry — disruptive behaviour

Psych Vivas · Child and adolescent psychiatry — disruptive behaviour

Conduct and oppositional disorders — structured clinical viva

Fellowship viva on severe CD: CU traits, ADHD, MST ecology, limited pharmacotherapy, risk and ASPD trajectory.

clinical
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Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CAMHS registrar. A 14-year-old with childhood-onset conduct problems, possible limited prosocial emotions, ADHD on incomplete stimulant adherence, and escalating peer-assisted burglaries is brought by parents who demand 'a tablet to fix his attitude'. Discuss formulation, multiagency plan including MST concepts, medication limits, safeguarding, and adult trajectory counselling.

Interpretation

Reveal interpretation

This is severe multi-domain conduct disorder with possible limited prosocial emotions, incomplete ADHD treatment, antisocial peers and parental demand for a pharmacological quick fix. Do not collude with tablet-only care. Reconfirm CD criteria, onset before age 10, CU features across settings, ADHD adherence barriers, substances, weapons, victimisation of others, and child protection issues.[3]

Psychosocial core. Parent management training elements and school/peer interventions remain necessary; for justice-involved multi-system problems, outline MST ecology: home-based intensity, caregivers as primary agents, dismantling antisocial peer reinforcement, 24/7 crisis availability in true MST models, and fidelity. If branded MST is unavailable, still apply multi-system intensity rather than weekly individual counselling alone.[2][5]

Medication. Optimise ADHD treatment and adherence first. Antipsychotics only for severe residual aggression with monitoring and time limits — not for "attitude."[4]

Trajectory. Childhood-onset CD with CU traits and adversity maps to higher life-course-persistent risk, including adult antisocial outcomes — communicate elevated risk without declaring inevitable ASPD; offer concrete change levers.[1][6]

Key points

No attitude pill

Psychosocial multi-system care first; meds target ADHD or severe aggression with monitoring.

CU traits matter

Limited prosocial emotions mark a higher-risk pathway requiring structured assessment across settings.

MST is ecological

Family, peers, school, neighbourhood — not clinic CBT alone for severe CD.
[2] [3] [4]

References

  1. [1]Moffitt TE Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy Psychol Rev, 1993.PMID 8255953
  2. [2]Henggeler SW, Schaeffer CM Multisystemic Therapy: Clinical Overview, Outcomes, and Implementation Research Fam Process, 2016.PMID 27370172
  3. [3]Frick PJ, White SF Research review: the importance of callous-unemotional traits for developmental models of aggressive and antisocial behavior J Child Psychol Psychiatry, 2008.PMID 18221345
  4. [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. [5]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
  6. [6]Robins LN Deviant children grown up Eur Child Adolesc Psychiatry, 1996.PMID 9010663