AccessMedicine's Case of the Week: Attention Deficit Hyperactivity Disorder

From: Vanderbilt’s Internal Medicine and Pediatric Curriculum

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Michael is an 8-year-old who presents with his mother after his teacher told her to have him evaluated for ADHD. He repeated the first grade last year and reads on a "kindergarten level." She receives daily notes from his teacher regarding "acting out" in class, including getting out of his seat, not following directions, and fighting. When she is with him alone at home he is "well-behaved" and can sit still watching TV for hours at a time. She did take him out of Little League for problems with behavior last summer.

He is now sitting quietly in the exam room with his mother.

1) Does Michael have ADHD? What are the criteria for diagnosis?

2) What scales are available for screening?

3) What are the different types of ADHD and what is attention-deficit disorder (ADD)?

The mother returns for a follow-up appointment after she and the teacher have completed the Vanderbilt scales. Both are positive for 7 behaviors in the hyperactive/impulsive category and 6 behaviors in the inattentiveness category. He also scored high on the anxiety/depression questions as well as "problematic" in reading.

4) What are the basic components of a treatment plan for ADHD?

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Julie Grishaw, ACNP

Senior Editor, McGraw-Hill Education