Summary
Definition
History and exam
Key diagnostic factors
- inability to give close attention to details or making "careless" mistakes in schoolwork, work, or other activities
- difficulty sustaining attention in tasks or play activities
- does not seem to listen when spoken to directly
- does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
- often has difficulty organizing tasks and activities
- avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
- often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
- easily distracted by extraneous stimuli
- forgetful in daily activities
- fidgets or taps with hands or feet or squirms in seat
- leaves seat in classroom or in other situations in which remaining seated is expected
- runs about or climbs excessively during inappropriate situations
- difficulty playing or engaging in leisure activities quietly
- often "on the go" or acts as if "driven by a motor"
- often talks excessively
- often blurts out answers before questions have been completed
- often has difficulty awaiting turn
- often interrupts or intrudes on others (e.g., butts into conversations or games)
Other diagnostic factors
- mild mood symptoms (dysphoria, mood lability, irritability, boredom)
- anxiety
- difficulty with peer interactions
- low self-esteem
- working memory (i.e., short-term memory) impairment
- processing speed impairment (i.e., the rate at which information is dealt with)
Risk factors
- family history of ADHD
- male sex
- low birth weight
- epilepsy
- tic disorders
- maternal nicotine use during pregnancy
- maternal acetaminophen use during pregnancy
- obstetric complications in pregnancy or labor
- gestational exposure to stress
- psychosocial adversity
- lead exposure
- traumatic brain injury
- severe early deprivation
- iron deficiency
Diagnostic tests
1st tests to order
- no formal laboratory or imaging studies
Tests to avoid
- hair analysis
Tests to consider
- neuropsychological testing
Treatment algorithm
preschool-age children: 4-6 years
school-age children: 6-18 years
Contributors
Authors
Mark Wolraich, MD
Shaun Walters Professor Emeritus, Pediatrics
Section of Developmental and Behavioral Pediatrics
University Oklahoma Health Sciences
Oklahoma City
OK
Disclosures
MW is on the steering committee and is a faculty member in the REACH Institute, a nonprofit organization training primary care physicians in diagnosing and treating mental health conditions in children. He does not receive remuneration for the steering committee, but does receive compensation for remote training time.
Acknowledgements
Dr Mark Wolraich would like to gratefully acknowledge Dr Lawrence W. Brown, Dr Kristin S. Russell, Dr Howard Y. Liu, and Dr Michael S. Jellinek, previous contributors to this topic.
Disclosures
LWB was reimbursed by Sunovion for participation in a Medical Advisory Board. KSR, HYL, and MSJ declare that they have no competing interests.
Peer reviewers
Joseph F. Hagan, Jr. MD, FAAP
Clinical Professor in Pediatrics
The Larner College of Medicine at the University of Vermont
Burlington
VT
Disclosures
JFH served as Vice-Chairman of the American Academy of Pediatrics' ADHD Clinical Guidelines revision alongside the author of this topic, MW, who was Chairman. They also co-authored the book "ADHD: What Every Parent Needs to Know, 3rd. Ed.", published by the AAP.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
World Health Organization. ICD-11 International statistical classification of diseases and related health problems, 11th revision. Geneva: WHO; 2022.Full text
Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019 Oct;144(4):e20192528.Full text Abstract
Faraone SV, Banaschewski T, Coghill D, et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021 Sep;128:789-818.Full text Abstract
Barbaresi WJ, Campbell L, Diekroger EA, et al. Society for Developmental and Behavioral Pediatrics Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents with Complex Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr. 2020 Feb/Mar;41 Suppl 2S:S35-S57.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Learning/language disorder
- Oppositional defiant disorder
- Depression
More DifferentialsGuidelines
- Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-5-TR)
- Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents
More GuidelinesPatient information
ADHD: what is it?
ADHD in children: what treatments work?
More Patient information
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