Snapshot An 8-year-old boy is brought to the pediatrician by his mother for behavioral concerns. His mother states that she has always had trouble with him at home. He cannot sit still, he loses things all the time, and he is very disorganized. Sometimes when she reprimands him it seems like he is not even paying attention. He has also had trouble making friends. Recently, the patient's teacher called because he has not been turning in assignments, he blurts out things without being called on, and he disrupts the students next to him by talking. Introduction Overview a neurodevelopmental/psychiatric disorder characterized by hyperactivity, impulsivity, and inattention Epidemiology Demographics 10:1 male:female ratio onset before age 12 years of age ETIOLOGY Associated conditions learning disabilities oppositional defiant disorder conduct disorder tic disorders substance abuse Presentation Symptoms 18 symptoms exist in the DSM-V (6 symptoms must be present in children and 5 in adults for diagnosis) symptoms must occur in at least 2 different settings (e.g., home and school) be present before the age of 12 last for 6 months or longer common symptoms: hyperactivity and impulsivity login to view 9 more bullets inattention login to view 9 more bullets Studies Hearing and vision test to rule out hearing or visual impairments Serum labs thyroid hormone levels consider in patient with other symptoms of thyroid disease DIAGNOSIS Clinical diagnosis by above DSM-V criteria must also rule out other comorbid psychiatric disorders such as learning disabilities, mood disorders, or substance abuse Treatment Medical cognitive behavioral therapy first-line for preschool-aged children (< 6 years of age) adjunct therapy for school-aged children, adolescents, and adults stimulants first-line therapy for school-aged children (6 years of age or older) login to view 2 more bullets nonstimulants second-line therapy for school-aged children login to view 9 more bullets Prognosis ~50% will have symptoms into adulthood