Differential Diagnosis for 12 y/o Boy Misbehaving at School

Single Most Likely Diagnosis

• Conduct Disorder (CD): This diagnosis is the most likely due to the boy's persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. This is evidenced by his disrespect, rule-breaking, lying, and physical violence towards both adults and students, despite previous disciplinary actions and expulsion from another school.

Other Likely Diagnoses

• Oppositional Defiant Disorder (ODD): Characterized by a pattern of angry/irritable mood or argumentative/defiant behavior, which is less severe than CD but still significant. The boy's behavior of being disrespectful and not following rules could align with ODD, though the presence of physical violence leans more towards CD.
• Attention Deficit Hyperactivity Disorder (ADHD): Often presents with impulsivity and difficulty following rules, which could contribute to the boy's misbehavior. However, ADHD alone does not fully account for the deliberate rule-breaking and physical violence.
• Intermittent Explosive Disorder: Involves recurrent behavioral outbursts representing a failure to control aggressive impulses. This could explain the physical violence but doesn't fully account for the other behaviors like lying and consistent disrespect.

Do Not Miss Diagnoses

• Trauma or Stressor-Related Disorders (e.g., Post-Traumatic Stress Disorder - PTSD): It's crucial to consider if the boy's behavior is a result of or exacerbated by trauma or significant stressors. Identifying and addressing underlying trauma could be critical for effective intervention.
• Neurodevelopmental Disorders (e.g., Autism Spectrum Disorder): Sometimes, behaviors that appear as misconduct can be manifestations of difficulties with social interactions, communication, or rigid thinking patterns. It's essential to assess for these conditions to provide appropriate support.
• Substance Use Disorders: Although less common in 12-year-olds, substance use can lead to significant behavioral changes, including increased aggression and rule-breaking.

Rare Diagnoses

• Neurodegenerative Disorders (e.g., Frontotemporal Dementia): Extremely rare in children, these disorders can lead to significant changes in behavior, including aggression and loss of social norms understanding. However, they would be accompanied by other significant cognitive and physical declines.
• Psychotic Disorders: Conditions like schizophrenia can present with behavioral disturbances, but they are rare in pre-teens and would typically include other symptoms like hallucinations or delusions.

Each of these diagnoses requires a comprehensive evaluation, including psychological assessments, behavioral observations, and possibly medical evaluations to rule out underlying conditions that could be contributing to the boy's behavior.