Behavioral and Mental Health Conditions of Childhood
Core conditions
ADHD requires developmentally inappropriate inattention and/or hyperactivity-impulsivity, present before age 12, in at least two settings, with functional impairment. For preschool children, parent behavioral training is first-line; stimulants are considered only when impairment is severe and behavioral treatment fails. Anxiety and depression are common; pediatric depression requires a two-week period of depressed or irritable mood plus vegetative and cognitive symptoms. ODD involves a persistent pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness. DMDD is chronic, severe irritability with frequent temper outbursts for at least 12 months, beginning before age 10; bipolar disorder is rare in young children.
Other presentations
Tics are common, often transient, and usually do not require medication unless impairing. Enuresis is not diagnosed before age 5; encopresis often reflects constipation. Sleep problems may be behavioral or medical. Trauma, bullying, and family stress can mimic ADHD or depression.
Traps
Do not diagnose ADHD in a 3-year-old from a single classroom report. Do not call episodic rage “bipolar” without distinct mood episodes. Do not overlook hearing loss, sleep apnea, or anxiety when attention is poor. Screening tools such as the Vanderbilt, PSC, and SDQ support but do not replace clinical assessment.
Worked example
A 7-year-old has daily temper outbursts and chronic irritability for 10 months, with no distinct elevated mood or grandiosity. This pattern fits DMDD rather than bipolar disorder. The rule of thumb: chronic irritability is DMDD; episodic mood change with distinct periods is bipolar; ADHD is cross-situational and present before age 12.