Child and Adolescent Psychiatry
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Direct answer
Child and adolescent psychiatry covers the emotional and behavioural disorders of the young, anchored for NEET-PG by conduct disorder, oppositional defiant disorder, enuresis and encopresis, separation anxiety and school refusal, and elective mutism. Conduct disorder is a repetitive, persistent pattern of violating others' rights or age-appropriate norms through aggression, destruction, deceitfulness or serious rule-breaking; oppositional defiant disorder stops short of rights violation with defiant, angry, spiteful behaviour. Primary enuresis is treated first with the buzzer alarm, and the overall approach across these disorders is family-based behavioural intervention before medication.
What you must remember
- Conduct disorder rule: at least three of fifteen behaviours in the past year across aggression, destruction of property, deceitfulness or theft, and serious rule violation; onset before 16 with persistence beyond 18 permits antisocial personality disorder.
- Oppositional defiant disorder: at least four symptoms of angry-irritable mood, argumentative-defiant behaviour or vindictiveness for six months — but without aggression, destruction or violation of others' rights, the dividing line from conduct disorder.
- Enuresis: repeated voiding into bed or clothes at least twice weekly for three months in a child developmentally at least five years old; primary means never dry, secondary means relapse after six months dry; first-line is the buzzer alarm and behavioural measures, with desmopressin and imipramine (cardiotoxic in overdose) as drugs; screen for infection, constipation and stress.
- Encopresis: repeated passage of faeces in inappropriate places monthly for three months after developmental age four; usually overflow around constipation — treat with a bowel programme, not punishment.
- Separation anxiety disorder: excessive fear of separation from attachment figures for at least four weeks in children, with school refusal and morning somatic symptoms; treated with graded exposure, family work and, if needed, an SSRI.
- Elective (selective) mutism: consistent failure to speak in specific social situations despite speaking elsewhere for at least one month; graded behavioural speaking tasks are the mainstay.
- Other high-yield names: anxiety-driven school refusal versus conduct-driven truancy; pica beyond two years of age; Tourette syndrome with motor and vocal tics for over a year.
Common confusion
Oppositional defiant disorder versus conduct disorder is the classic split: the ODD child argues, defies and tantrums but does not steal, destroy property or assault; crossing into rights violation upgrades the label. School refusal versus truancy is the second discriminator — the refusing child stays home with parental knowledge and anxiety symptoms, whereas the truanting child conceals absence. Secondary enuresis points to stress or organic disease, changing the work-up.
Exam-focused takeaway
NEET-PG gives a 12-year-old with fighting, lying, truancy and stealing — conduct disorder, risking antisocial personality disorder after 18; the defiant-but-not-cruel child earns oppositional defiant disorder. One-liners test the buzzer alarm for enuresis, desmopressin and imipramine as drugs, the five-year criterion for enuresis, four weeks for separation anxiety, and the speak-at-home-but-not-at-school pattern of elective mutism.
Frequently asked questions
How does conduct disorder differ from oppositional defiant disorder?
Conduct disorder violates others' rights; oppositional defiant disorder is defiant and spiteful without those violations.
What is the first-line treatment for primary enuresis?
The buzzer alarm with behavioural routines; desmopressin and imipramine are reserved.
What age defines enuresis as a disorder?
Developmental age of five years or more, wetting twice weekly for three months or causing distress.
What distinguishes school refusal from truancy?
Anxiety-driven absence with parental knowledge versus concealed absence with conduct problems.
What is elective mutism?
Failure to speak in specific situations (classically school) for at least one month; graded exposure treats it.
When does conduct disorder become antisocial personality disorder?
At 18 or older, with conduct disorder before 15 and pervasive adult disregard for others' rights.