I have often encountered in my practice children who have severe problems controlling their tempers and who pose diagnostic dilemmas. Usually their lack of self-control began as toddlers, or in the preschool years. After taking a careful history, interviewing the children and perhaps talking to school teachers, it is unclear if the problem with self-control results from ADHD in terms of impulsivity; if it is the result primarily of emotional (affective) dysregulation, or if the lack of self-control reflects a lack of empathy in an overly egocentric child. In the latter case, the diagnosis may be in the area of the Pervasive Developmental Disorders (PDD).
I bring this up here because such children are usually hard to treat and their parents are often frustrated by a lack of diagnostic precision and the different diagnoses that are posed by different psychiatrists. As I have noted elsewhere in my website, our diagnostic categories often overlap and such diagnostic quandaries are not unusual. In this case, the psychiatrist attempts to come up with a primary diagnosis and treat accordingly, but sometimes the lack of self-control seems to reflect all three categories of disorder without there clearly being a primary diagnosis. This does not prevent professionals from choosing a course of treatment.