A 13-year-old boy presents to the PMHNP accompanied by his mother, who complains of a change in behavior for the past 2 months. The mother says her son frequently loses his temper, is easily angered, is resentful, and is spiteful toward her. This behavior started approximately 4 weeks after she and the boy's father separated and the father moved out of the home. Which of the following helps the PMHNP to rule out oppositional defiant disorder (ODD)?

Choice A reason: Onset prior to age 12 is true for ODD, but it alone is insufficient to rule out the diagnosis without considering symptom duration and severity. Choice B reason: ODD is a recognized DSM-5 diagnosis, not just a behavioral issue, so this statement is incorrect. Choice C reason: While symptom count and minimum duration are part of criteria, 3 months is shorter than the DSM-5 required 6-month duration. Choice D reason: ODD requires at least six months of consistent patterns of anger, irritability, argumentative, defiant, or vindictive behavior, with at least four specific symptoms. Because this boy’s symptoms have been present for only 2 months, this helps the PMHNP rule out ODD.