Rosh Psychiatry Board Practice Exam

When diagnosing a child with suspected attention-deficit/hyperactivity disorder, which factor in his history is most relevant?

1. He acts out at school but not at home for at least one year

2. He has been acting out at school for at least three months

3. He has been acting out both at school and at home for at least six months

4. His sister also has similar behavior at school

The correct answer is: He has been acting out both at school and at home for at least six months

When diagnosing a child with suspected attention-deficit/hyperactivity disorder (ADHD), the most pertinent factor is the duration and consistency of the symptoms across different settings. For a diagnosis of ADHD to be made according to established criteria, including those set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms must be present in two or more settings (e.g., home and school) and must persist for at least six months. In this case, the child exhibiting symptoms at both school and home for a period of six months aligns with the criteria for making a diagnosis of ADHD. This duration is crucial, as it helps differentiate between transient behavioral issues that may not indicate an underlying disorder and more pervasive patterns that suggest consistent difficulties with attention or hyperactivity-impulsivity. The other options do not meet these critical criteria. Acting out at school but not at home or for shorter durations fails to demonstrate the necessary pattern across settings and time. Familial behavior, such as having a sister with similar issues, may provide context and suggest a potential genetic or environmental component, but it does not serve as a diagnostic criterion by itself. Therefore, the history of persistent, cross-setting behavioral issues for at least six months is the most relevant factor