Note:  The persistence and frequency of these behaviors should be used to distinguish
a behavior that is within normal limits from a behavior that is symptomatic. For children
younger than 5 years, the behavior should occur on most days for a period of at least
6 months unless otherwise noted (Criterion A8). For individuals 5 years or older, the
behavior should occur at least once per week for at least 6 months, unless otherwise
noted (Criterion A8). While these frequency criteria provide guidance on a minimal lev-
el of frequency to define symptoms, other factors should also be considered, such as
whether the frequency and intensity of the behaviors are outside a range that is nor-
mative for the individual’s developmental level, gender, and culture.
B. The disturbance in behavior is associated with distress in the individual or others in his or
her immediate social context (e.g., family, peer  group, work colleagues), or it impacts neg-
atively on social, educational, occupational, or other important areas of functioning. 
C. The behaviors do not occur exclusively during the course of a psychotic, substance
use, depressive, or bipolar disorder. Also, the criteria are not met for disruptive mood
dysregulation disorder.
Specify current severity:
Mild:  Symptoms are confined to only one setting (e.g., at home, at school, at work, with
peers).