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Disorders Seen in Childhood and Adolescence

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A 5-year-old boy is brought to the psychiatrist because he has difficulty paying attention in school. He fidgets and squirms and will not stay seated in class. It is noted that at home he talks excessively and has difficulty waiting for his turn. His language and motor skills are appropriate for his age. Which of the following is the most likely diagnosis?

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a. Oppositional defiant disorder (ODD)

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b. Attention-deficit hyperactivity disorder (ADHD)

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c. Autism spectrum disorder

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d. Separation anxiety disorder

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e. Intellectual developmental disorder

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The answer is b. (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, APA, pp 59-65.) Excessive motor activity, usually with intrusive and annoying qualities, poor sustained attention, difficulties inhibiting impulsive behaviors in social situations and on cognitive tasks, and difficulties with peers are the main characteristics of ADHD, combined type. Symptoms must be present in two or more settings (in this case, home and school) and must cause significant impairment.

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In the case described above, what other criteria must be present in order for this diagnosis to be met?

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a. The child often loses things necessary for tasks or activities (toys, school assignments).

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b. The symptoms must have been present for at least 6 months.

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c. The symptoms must be present in at least three separate settings.

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d. The child often blurts out answers before questions have been completed.

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e. There must be clear evidence of clinically significant impairment in social functioning.

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The answer is b. (DSM-5, pp 59-65.) For a diagnosis of ADHD, six or more symptoms must be present for at least 6 months in at least two settings. While clinically significant impairment must exist for the disorder to be diagnosed, it can occur in social, academic, or occupational functioning (it does not have to occur in social functioning alone). Six or more symptoms of inattention (including losing things necessary for tasks or activities) or six or more symptoms of hyperactivity-impulsivity (including blurting out answers before questions have been completed) must be present for the diagnosis to be made.

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A 4-year-old girl is brought to her pediatrician because her parents think she does not seem to be “developing normally.” The girl's mother states that her daughter seemed normal for at least the first 2 to 3 years of her life. She was walking and beginning to speak in sentences. She ...

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