Review Question - QID 210413

A 15-year-old boy is brought in to his pediatrician's office by his step-mother for uncontrollable behavior. She reports he has an extensive history of detention for outbursts in class. He recently got expelled from school for fist fighting. At home, he punches his younger brother when he’s angry. The family had to give their cat away to a neighbor because the patient tried to set it on fire. The patient’s medical history is significant for bed-wetting until he was 11. His father has adult attention deficit disorder. The patient states that he thinks school is a “joke.” He denies having close friends and says “the kids in my town are stupid anyway.” He calmly describes how he would like to burn down all their houses. He admits to trying alcohol and cocaine but denies any other illicit drugs. The patient’s temperature is 99°F (37.2°C), blood pressure is 110/72 mmHg, pulse is 72/min, and respirations are 11/min with an oxygen saturation of 98% on room air. Which of the following is the patient’s most likely diagnosis?