Attention-deficit/hyperactivity disorder is a neurodevelopmental condition with lasting inattention, hyperactivity or impulsivity that starts before age 12 and gets in the way of school, work or relationships. It often continues into adulthood, and good treatment combines behavior support with medication when needed.
Key symptoms
- Trouble keeping attention, careless mistakes, losing things
- Disorganization, not finishing tasks, forgetfulness
- Fidgeting, leaving the seat, constant motion
- Interrupting, blurting out answers, trouble waiting turns
- Symptoms in two or more settings, such as home and school
What you find on exam
- Observe behavior during the visit; it may look normal in the office
- Growth, blood pressure and heart rate before starting stimulants
- Hearing and vision screen
- Screen for learning disorders, anxiety, depression, sleep problems and substance use
Tests
- Diagnosis is clinical, using DSM-5 criteria
- Rating scales from parents and teachers, such as the Vanderbilt scales
- ECG only if heart disease, fainting or family history of sudden death
- No routine blood tests or brain imaging
Treatment basics
- Preschool age: parent training in behavior management first
- School age and adults: stimulants such as methylphenidate or amphetamine salts
- Non-stimulants: atomoxetine, guanfacine or clonidine
- School supports such as a 504 plan or individualized education program
- Monitor appetite, sleep, growth, heart rate and blood pressure
Red flags
- Chest pain, fainting or palpitations on a stimulant
- Misuse or diversion of stimulant medication
- Suicidal thoughts or new mood or psychotic symptoms
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Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.