What is the DSM-5-TR criterion for Major Depressive Disorder in youth?

• A. Five or more symptoms in a 2-week period with distress/impairment; include either depressed mood or anhedonia; irritability in youth.
• B. Four symptoms in 3 weeks with distress/impairment.
• C. Only one symptom for one week.
• D. Symptoms must be mood-related only.

Answer: (A)

The key idea is that Major Depressive Disorder in youth is diagnosed when a child or adolescent shows a cluster of symptoms over at least a two-week period, with clear distress or impairment, and at least one of the core mood symptoms is present. Specifically, you need five or more of the listed symptoms during the same two-week window, and at least one must be either a depressed mood or anhedonia (loss of interest or pleasure). In younger people, irritability can stand in for depressed mood, so irritability counts toward the mood requirement.

This combination—five or more symptoms across the two-week span, plus distress or impairment, and including either depressed mood or anhedonia (with irritability admissible for youth)—is what sets this apart from milder or shorter-lived mood concerns. So the option that matches these criteria is the correct one.

Why the other patterns don’t fit: diagnosing requires at least five symptoms, not four, and not over a shorter period like three weeks. A single symptom for a week is far below the threshold. And the rule isn’t that symptoms must be mood-related only; the full set includes several non-mood symptoms (sleep changes, appetite changes, fatigue, concentration difficulties, etc.), all contributing to impairment. In youth, irritability is an acceptable substitute for depressed mood, which some other options overlook.