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Can the physician diagnose hyperactivity in the office?

Office diagnosis of hyperactivity can present a problem to the pediatrician because only about 20% of the potential patients show hyperactive behavior during office examination. Exclusion of the children who appear normal in the physician's office can eliminate from medical treatment a large number of patients for whom treatment is appropriate. Eighty percent of the children ultimately accepted into the project on the basis of home and school reports showed exemplary behavior and no sign of hyperactivity in the office. Nonetheless, at a three-year follow-up, these children were rated the same as those who were obviously hyperactive in the presence of the pediatrician. The groups appeared no different on school grade, teachers' ratings of classroom behavior, amount of stimulant medication prescribed, or duration of drug treatment. The reported outcome data indicate that the physician can have confidence in historical information from the parents combined with current teacher reports as reliable aids in the diagnostic process with hyperactive children.