Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that commonly affects children and is characterized by persistent patterns of inattentiveness, hyperactivity, or impulsivity (Magnus et al., 2023). Presentation will vary based on age and sex of the patient (Galvez-Contreras et al., 2022). Female patients may present with inattentive behavior while male patients often present with combined inattentive and hyperactive/impulsive behaviors (Galvez-Contreras et al., 2022). As far as age, preschool children are commonly hyperactive-impulsive and adults are inattentive (Galvez-Contreras et al., 2022). Reported inattentive behaviors may include rushing through tasks, poor listening, difficulty with organizing things, failure to finish work, avoidance of tasks that require sustained mental effort such as schoolwork, being forgetful, and losing things (Magnus et al., 2023). With a hyperactive presentation, symptoms reported may include fidgeting, inability to sit still and in a seat, being loud, talking excessively, difficulty waiting for turns, and interrupting or intruding on others (Magnus et al., 2023). The caregivers of children with ADHD may also report they struggle with social interactions and can be easily frustrated and impulsive, which often affects school (Magnus et al., 2023). There may be concerns regarding violations of rules and delinquent behavior among those with ADHD as well (Retz et al., 2021). When these behaviors and symptoms are present on multiple occasions, ADHD is probable.

The diagnosis of ADHD relies heavily on the subjective assessment as this information provides insight regarding the patient’s behavior and how this behavior impacts their daily functioning. Gathering information from various sources including teachers will provide a more comprehensive understanding of the problem and is essential for diagnosis. The Vanderbilt ADHD scale is a valuable tool that assists with this as it includes teacher and parent component (Magnus et al., 2023). The objective assessment and physical examination are not likely to provide information that will confirm a diagnosis of ADHD but are necessary to rule out medical causes and provide guidance on treatment options (Magnus et al., 2023). That said, signs of inattentiveness and hyperactivity from the patient may be observed on exam, which can provide additional support for the diagnosis. This may be observed during annual wellness checks as there are multiple tasks and components of assessment to be completed. In cases like this, in which the parents have not expressed concerns for ADHD, further workup may be required to address if this behavior is present at school and home. Overall, while the diagnosis of ADHD is primarily based on subjective information, the process of diagnosing and developing a treatment plan tailored to the patient’s need is comprehensive and requires collection of both subjective and objective data.