The 4 P's + Biopsychsocial
DSM-V Diagnoses
Differential Diagnoses/Rule-Outs
Evidence-Based Interventions
OCD
100

A child becomes more anxious over time because parents consistently answer reassurance questions and allow avoidance

What is a perpetuating factor?

100

This diagnoses requires symptoms occur in at least two settings and be present before age 12

What is ADHD?

100

A child worries about grades, making friends, health, and family safety across multiple settings.

What is NOT social anxiety disorder? What is generalized anxiety disorder?

100

This is the most appropriate first-line treatment for pediatric OCD.

What is Exposure and Response Prevention (ERP)

100

A child repeatedly washes their hands due to fear of germs and illness even when there is no real contamination. 

What is contamination OCD?

200

After starting middle school, a child begins experiencing panic attacks.

What is a precipitating factor?

200

A child has severe temper outbursts and persistent irritability most days for over a year across settings

What is DMDD?

200

A child refuses to speak at school but also avoids eating in front of peers and fears embarrassment.

What is selective mutism and/or social anxiety disorder?

200

A parent-focused intervention that uses reinforcement, planned ignoring, and consistent consequences

What is Parent Management Training (PMT)?

200

A child checks doors and locks multiple times to prevent harm, despite knowing they already checked.

What is checking OCD?

300

A child was born prematurely and has a history of early developmental delays

What is a biological predisposing factor? 

300

A child shows defiance, arguing, and refusal to comply but does not exhibit severe outbursts or pervasive irritability

What is ODD

300

A child avoids touching certain textures because they feel uncomfortable, not because of fear of germs or illness.

What is NOT OCD? What is a sensory sensitivity?

300

This treatment involves coaching parents live to improve child behavior and parent-child interactions.

What is PCIT?

300

A child feels intense distress about throwing away objects and keeps items of little value "just in case"

What is hoarding-related OCD?

400

A family is highly consistent with behavioral strategies and child responds well to reinforcement systems.

What is a protective factor?

400

A child refuses to speak in class but participates socially in the form of gestures, eye contact and play.

What is selective mutism?

400

A child develops anxiety after a move, but symptoms persist for over a year with no improvement.

What is NOT Adjustment Disorder? What is consider another anxiety disorder?

400

A child with autism and anxiety requires modifications to standard CBT

What are adaptations such as visual supports, concrete language, and parent involvement?

400

A child has intrusive thoughts about doing something morally wrong and engages in excessive praying or confessing

What is scrupulosity OCD?

500

A child has a genetic syndrome associated with developmental delays but receives early intensive intervention services. 

What are both predisposing and protective factors?

500

A child develops sadness, irritability and school refusal within 2 months of parental divorce. Symptoms do not meet full criteria for Major Depressive Disorder and resolve within several months. 

What is Adjustment Disorder with depressed mood?

500

A child restricts food intake due to low appetite and weight loss during a depressive episode.

What is NOT ARFID? What is a Major Depressive Disorder related appetite disturbance?

500
This intervention teaches emotional regulation, distress tolerance, and interpersonal effectiveness skills. 

What is DBT?

500

A child has intrusive thoughts about harming a sibling and avoids being alone with them, despite no desire to act on the thoughts.

What is harm OCD?