| 1. Compared to his/her peers, the child exhibits markedly increased reactivity to negative emotional stimuli that is manifest verbally or behaviorally. For example, the child responds to frustration with extended temper tantrums (inappropriate for age and/or precipitating event), verbal rages, and/or aggression toward people or property. Such events occur, on average, at least three times a week. |
A. The disorder is characterized by severe recurrent temper outbursts that are grossly out of proportion in intensity or duration to the situation. 1. The temper outbursts are manifest verbally and/or behaviorally, such as in the form of verbal rages or physical aggression towards people or property. 2. The temper outbursts are inconsistent with developmental level. |
| 2. Hyperarousal, as defined by at least three of the following symptoms: insomnia, agitation, distractibility, racing thoughts or flight of ideas, pressured speech, intrusiveness. |
B. Frequency: the temper outbursts occur, on average, three or more times per week. |
| 3. Abnormal mood (specifically anger or sadness), present at least half of the day most days, and of sufficient severity to be noticeable by people in the child's environment (e.g., parents, teachers, peers). |
C. Mood between temper outbursts: 1. Nearly every day, most of the day, the mood between temper outbursts is persistently irritable or angry. 2. The irritable or angry mood is observable by others (e.g., parents, teachers, peers). |
| 4. The symptoms noted in 2-4 above are currently present and have been present for at least 12 months without any symptom-free periods exceeding 2 months. |
D. Duration: criteria A-C have been present for 12 or more months. Throughout that time, the person has not had 3 or more consecutive months without the symptoms of criteria A-C. |
| 5. The symptoms are severe in at least one setting (i.e., violent outbursts, assaultiveness at home, school, or with peers). In addition, there are at least mild symptoms (distractibility, intrusiveness) in a second setting. |
E. Criterion A or C is present in at least two settings (at home, at school, or with peers) and must be severe in at least one setting. |
| 6. Aged 7-17, with the onset of symptoms before age 12. |
F. The diagnosis should not be made for the first time before age 6 or after age 18. |
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G. The onset of criteria A through E is before age 10. |
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H. There has never been a distinct period lasting more than one day during which abnormally elevated or expansive mood was present most of the day, and the abnormally elevated or expansive mood was accompanied by the onset, or worsening, of the three of the B criteria of mania (i.e., grandiosity or inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increase in goal directed activity, or excessive involvement in activities with a high potential for painful consequences). Abnormally elevated mood should be differentiated from developmentally appropriate mood elevation, such as occurs in the context of a highly positive event or its anticipation. |
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I. The behaviors do not occur exclusively during an episode of major depressive disorder and are not better accounted for by another mental disorder (e.g., autism spectrum disorder, posttraumatic stress disorder, separation anxiety disorder, dysthymic disorder).* The symptoms are not due to the effects of a drug or to a general medical or neurological condition. |
