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Concept Map

John Henry is five years old. He was a fussy baby who was difficult to soothe. Now attending his third preschool, he is in jeopardy of being dismissed again for his refusal to follow the rules and for his angry outbursts. He argues with his peers every week and refuses to cooperate with his teachers' requests. He is disobedient at home as well and seems to annoy others deliberately.
Concept Map Information

What is the Main diagnosis for Mary Rose?
What are the Key symptoms?
What differential diagnoses did you consider and why?
What is your treatment recommendation and why?
What is the Prognosis?

Full Answer Section

Emotional:
- Angry outbursts.
- Disobedience at home.

3. Differential Diagnoses Considered

Diagnosis	Why Considered?	Why Ruled Out?
ADHD (Combined Type)	Impulsivity, defiance.	No inattention/hyperactivity focus.
Conduct Disorder (CD)	Rule-breaking, aggression.	No aggression toward people/animals or property destruction.
Anxiety Disorder	Irritability may stem from fear.	No avoidance or excessive worry.

4. Treatment Recommendation

Parent-Child Interaction Therapy (PCIT)

Why?
- Evidence-based for ODD (Eyberg, 2018).
- Teaches parents consistent discipline and positive reinforcement.
- Improves teacher-child interactions.

Additional Support:

School-based Behavioral Plan: Token economy for rule-following.
Social Skills Training: Teach conflict resolution.

5. Prognosis

Good with early intervention (70% show improvement within 12 weeks of PCIT).
Risk Factors: If untreated, ODD may progress to Conduct Disorder (CD).

Key Takeaways

ODD is the primary diagnosis due to persistent defiance and anger.
PCIT is the gold-standard treatment for parent-child dynamics.
Prognosis improves with early, structured intervention.

Sample Answer

It appears there is a discrepancy in the case description—John Henry is the child being discussed, not Mary Rose. Assuming this is a typo, the following concept map addresses John Henry’s case.

Concept Map: John Henry (5-Year-Old Boy)

1. Main Diagnosis

Oppositional Defiant Disorder (ODD)

- - Rationale: John exhibits a persistent pattern of angry/irritable mood, argumentative/defiant behavior, and vindictiveness lasting ≥6 months (DSM-5 criteria).

2. Key Symptoms

- Behavioral:
  - Refusal to follow rules (preschool dismissal risk).
  - Frequent arguments with peers.
  - Deliberate annoyance of others.