Summary
Definition
History and exam
Key diagnostic factors
- failure 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)
- 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
- maternal nicotine use during pregnancy
- tic disorders
- maternal alcohol use during pregnancy
- stress during pregnancy and labor
- psychosocial adversity
- lead exposure
- traumatic brain injury
- severe early deprivation
- iron deficiency
Diagnostic investigations
1st investigations to order
- no formal laboratory or imaging studies
Investigations to consider
- neuropsychological testing
Treatment algorithm
preschool-age children: 4-6 years
school-age children: 6-18 years
Contributors
Authors
Mark Wolraich, MD
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
Brian P. Daly, PhD
Assistant Professor
College of Health Professions
Temple University
Philadelphia
PA
Disclosures
BPD declares that he has no competing interests.
Mohammed Munib Haroon, MBChB
Academic Specialist Registrar
Academic Department of Paediatrics and Obstetrics and Gynaecology
Leeds University
Leeds
UK
Disclosures
MMH declares that he has no competing interests.
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 leaflets
ADHD: what is it?
ADHD in children: what treatments work?
More Patient leaflets
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