A phone call from the parent of a 3-year-old child who was asked to leave his preschool because of fighting with the children and teachers, biting his classmates, and “dramatic” temper tantrums that often result in his throwing objects at others. His mother reports that he has “always been a difficult child” and does not respond to verbal redirection and timeouts “like his older brother does.” In addition, he has always been a “physical child” and will often hit and push older children when angered. What disorders do you suspect? What are the appropriate steps to screen and evaluate this patient? What will be your management of this child?

In this case, the behaviors exhibited by the 3-year-old child raise concerns about disruptive behavior disorders. Specifically, the child’s aggressive behavior, difficulty in controlling impulses, and lack of response to typical disciplinary measures suggest a possible diagnosis of oppositional defiant disorder (ODD) or conduct disorder (CD).

To screen and evaluate this patient, it would be important to conduct a comprehensive assessment that includes a detailed developmental history, thorough physical examination, and psychological evaluation. Standardized assessment tools, such as the Child Behavior Checklist (CBCL) or the Disruptive Behavior Disorders Rating Scale (DBD), can be used to gather information from parents, teachers, and other caregivers about the child’s behavior.

Additionally, it may be beneficial to rule out any underlying medical conditions or environmental factors that could be contributing to the child’s behavior. Collaboration with other professionals, such as pediatricians, psychologists, and educators, may be necessary to gather a comprehensive understanding of the child’s functioning (AACAP, 2024).

In terms of management, a multimodal approach that includes behavioral interventions, parent training, and possibly medication may be recommended. Behavioral interventions, such as positive reinforcement, time-out strategies, and social skills training, can help the child learn more adaptive ways to cope with frustration and anger. Parent training programs, such as Parent-Child Interaction Therapy (PCIT), can also be beneficial in teaching parents effective strategies for managing their child’s behavior (Skowron et al., 2024).

If the child’s symptoms are severe and significantly impairing his daily functioning, consultation with a child psychiatrist for medication management may be considered. However, medication should only be used as part of a comprehensive treatment plan and under the close supervision of a qualified healthcare provider.

Overall, early intervention and comprehensive assessment are essential in managing disruptive behavior disorders in young children. Collaborating with a multidisciplinary team and providing support to both the child and family are key components in promoting positive outcomes.

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