A 12-year-old boy with no history of trauma or emotional problems recently began screaming and crying out at night. He does not fully wake up after these episodes, and he has little to no recall as to what he was dreaming about. Which of the following diagnoses is most likely in this scenario?

Choice A reason: Nightmare disorder involves vivid, frightening dreams that occur during REM sleep and typically awaken the child, who can recall the dream content. In this case, the child does not fully wake and has no memory of the episode, which is inconsistent with nightmare disorder. Choice B reason: Sleep terrors, also known as night terrors, are episodes of intense fear, screaming, and autonomic arousal that occur during non-REM sleep, usually within the first few hours of sleep. Children experiencing sleep terrors are difficult to awaken, appear confused, and typically have no memory of the event. This matches the boy’s presentation precisely. Choice C reason: Insomnia is characterized by difficulty initiating or maintaining sleep, or waking too early. It does not involve screaming, crying, or episodes of confusion during sleep. The boy’s symptoms are not consistent with insomnia. Choice D reason: REM sleep behavior disorder involves physically acting out dreams due to loss of normal REM atonia. It is more common in older adults and involves purposeful movements rather than screaming or crying. The child’s age and presentation make this diagnosis unlikely.