Conduct and oppositional disorders — structured clinical viva

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]