A 4-year-old boy is referred for evaluation. He has been in daycare since age 2. His teacher reports he is unable to sit still, frequently disrupts class, runs around excessively, and cannot wait for his turn. His parents describe him as 'always on the go' since infancy. IQ is in the normal range (85–95). The minimum duration of symptoms required to diagnose ADHD according to DSM-5 is:
- A 6 months, in at least 2 settings, with onset before age 12 ✓
- B 6 months, in at least 2 settings, with onset before age 7
- C 12 months, in any setting, with onset before age 5
- D 3 months, in school setting only, with onset at school start
Correct answer: A. 6 months, in at least 2 settings, with onset before age 12
Explanation
DSM-5 criteria for ADHD require: ≥6 symptoms of inattention and/or hyperactivity-impulsivity for ≥6 months, in ≥2 settings, with onset of several symptoms before age 12 years (DSM-5 changed the age criterion from <7 years [DSM-IV] to <12 years). The symptoms must cause significant functional impairment. In children ≤16 years, 6+ symptoms are required from either domain; in older adolescents/adults, 5+ symptoms suffice. The change to age 12 in DSM-5 was to capture cases where hyperactivity is prominent in early childhood but inattentiveness only causes impairment in middle school.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.