pediatrics
Attention Deficit Hyperactivity Disorder (ADD, ADHD)
Symptoms and Signs of ADHD
Onset often occurs before age 4 and invariably before age 12. The peak age for diagnosis is between ages 8 and 10; however, patients with the predominantly inattentive type may not be diagnosed until after adolescence. Core symptoms and signs of ADHD involve Inattention Impulsivity Hyperactivity Inattentiontends to appear when a child is involved in tasks that require vigilance, rapid reaction time, visual and perceptual search, and systematic and sustained listening. Impulsivityrefers to hasty actions that have the potential for a negative outcome (eg, in children, running across a street without looking; in adolescents and adults, suddenly quitting school or a job without thought for the consequences). Hyperactivityinvolves excessive motor activity. Children, particularly younger ones, may have trouble sitting quietly when expected to (eg, in school or church). Older patients may simply be fidgety, restless, or talkative—sometimes to the extent that others feel worn out watching them. Inattention and impulsivity impede development of academic skills and thinking and reasoning strategies, motivation for school, and adjustment to social demands. Children who have predominantly inattentive ADHD tend to be hands-on learners who have difficulty in passive learning situations that require continuous performance and task completion. Overall, about 20 to 60% of children with ADHD have learning disabilities, but some school dysfunction occurs in most children with ADHD due to inattention (resulting in missed details) and impulsivity (resulting in responding without thinking through the question). Behavioral history can reveal low frustration tolerance, opposition, temper tantrums, aggressiveness, poor social skills and peer relationships, sleep disturbances, anxiety, dysphoria, depression, and mood swings. Although there are no specific physical examination or laboratory findings associated with ADHD, signs can include Motor incoordination or clumsiness Nonlocalized, “soft” neurologic findings Perceptual-motor dysfunctions 