ABSTRACT
This chapter provides a case of a 14-year-old boy who presents to casualty with cuts on his hand that require stitches. It transpires that the injury was sustained in a fight with a friend because he killed the hamster of his friend's younger sibling. He is uncooperative and impatient, demanding his injury be dealt with immediately so he can leave. The differential diagnosis is conduct disorder, oppositional defiant disorder, attention deficit hyperactivity disorder, anxiety, depression, social phobia, substance misuse, learning disability and any combination of these disorders. Exposure to the antisocial behaviour of a caregiver is a particularly important risk factor. It is long-standing and is usually associated with psychosocial adversity and poor parenting. It has a worse prognosis than short-lived adolescent problems, where behaviours may be reflective of adolescent development such as risk taking and experimenting. Youth groups can sometimes provide healthy peer influences and role models.
