Attention Deficit Hyperactivity Disorder in Children and Adolescents Clinical Features and Diagnosis

Attention deficit hyperactivity disorder in children and adolescents: Cli... https://www.uptodate.com/contents/attention-deficit-hyperactivity-diso...
Official reprint from UpToDate®

www.uptodate.com ©2018 UpToDate, Inc. and/or its affiliates. All Rights Reserved.
Attention deficit hyperactivity disorder in children and adolescents: Clinical features and
diagnosis
Author: Kevin R Krull, PhD

Section Editor: Marilyn Augustyn, MD
Deputy Editor: Mary M Torchia, MD
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: May 2018. | This topic last updated: Feb 27, 2018.
INTRODUCTION — Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in

childhood with symptoms of hyperactivity, impulsivity, and/or inattention. The symptoms affect cognitive,
academic, behavioral, emotional, and social functioning [1]. (See 'Diagnostic criteria' below.)
This topic review focuses on the clinical features and evaluation of ADHD. The epidemiology,
pathogenesis, management, and prognosis of ADHD in children and adolescents and ADHD in adults are
discussed separately:
● (See "Attention deficit hyperactivity disorder in children and adolescents: Epidemiology and
pathogenesis".)
● (See "Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and
prognosis".)
● (See "Pharmacology of drugs used to treat attention deficit hyperactivity disorder in children and
adolescents".)
● (See "Attention deficit hyperactivity disorder in children and adolescents: Treatment with
medications".)
● (See "Cardiac evaluation of patients receiving pharmacotherapy for attention deficit hyperactivity
disorder".)
● (See "Attention deficit hyperactivity disorder in adults: Epidemiology, pathogenesis, clinical features,
course, assessment, and diagnosis".)
CLINICAL FEATURES
Core symptoms — ADHD is a syndrome with two categories of core symptoms: hyperactivity/impulsivity
and inattention. Each of the core symptoms of ADHD has its own pattern and course of development. The
complaint regarding symptoms of ADHD may originate from the parents, teachers, or other caregivers [2].
Hyperactivity and impulsivity — Hyperactive and impulsive behaviors almost always occur together
in young children. The predominantly hyperactive-impulsive subtype of ADHD is characterized by the
inability to sit still or inhibit behavior.
Symptoms of hyperactivity and impulsivity may include [1]:
1 sur 28 14/06/2018 à 20:30

● Excessive fidgetiness (eg, tapping the hands or feet, squirming in seat)
● Difficulty remaining seated when sitting is required (eg, at school, work, etc)
● Feelings of restlessness (in adolescents) or inappropriate running around or climbing in younger

children
● Difficulty playing quietly
● Difficult to keep up with, seeming to always be "on the go"
● Excessive talking
● Difficulty waiting turns
● Blurting out answers too quickly
● Interruption or intrusion of others
Hyperactive and impulsive symptoms typically are observed by the time the child reaches four years of
age and increase during the next three to four years, peaking in severity when the child is seven to eight
years of age [3,4]. After seven to eight years of age, hyperactive symptoms begin to decline; by the
adolescent years, they may be barely discernible to observers, although the adolescent may feel restless
or unable to settle down. In contrast, impulsive symptoms usually persist throughout life. (See "Attention
deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis", section
on 'Prognosis'.)
The focus of impulsivity is related to the environment. As an example, adolescents with ADHD who are
untreated and in an environment where alcohol and other commonly abused substances are readily
available are at greater risk of engaging in drug use or experimentation than are adolescents without
ADHD [5].
Inattention — The predominantly inattentive subtype of ADHD is characterized by reduced ability to

focus attention and reduced speed of cognitive processing and responding [6,7]. Children with the
inattentive subtype often are described as having a sluggish cognitive tempo and frequently appear to be
daydreaming or "off task" [8]. The typical presenting complaints center on cognitive and/or academic
problems. Among children born at <32 weeks gestational age, symptoms of inattention appear to be more
prominent than hyperactivity and impulsivity [9]. (See "Long-term neurodevelopmental outcome of preterm
infants: Epidemiology and risk factors", section on 'Neurodevelopmental disability and academic
achievement'.)
Symptoms of inattention may include [1]:
● Failure to provide close attention to detail, careless mistakes
● Difficulty maintaining attention in play, school, or home activities
● Seems not to listen, even when directly addressed
● Fails to follow through (eg, homework, chores, etc)
● Difficulty organizing tasks, activities, and belongings
● Avoids tasks that require consistent mental effort
● Loses objects required for tasks or activities (eg, school books, sports equipment, etc)
2 sur 28 14/06/2018 à 20:30

● Easily distracted by irrelevant stimuli
● Forgetfulness in routine activities (eg, homework, chores, etc)
The symptoms of inattention typically are not apparent until the child is eight to nine years of age [3,4].
This delay may relate to reduced sensitivity of assessment of attention problems or increased variability in
the normal development of the cognitive skills. Similar to the pattern of impulsivity, symptoms of inattention
usually are a lifelong problem. (See "Attention deficit hyperactivity disorder in children and adolescents:
Overview of treatment and prognosis", section on 'Prognosis'.)
Impaired functioning — In order to meet criteria for ADHD, core symptoms must impair function in
academic, social, or occupational activities [1]. Social skills in children with ADHD often are significantly
impaired. Problems with inattention may limit opportunities to acquire social skills or to attend to social
cues necessary for effective social interaction, making it difficult to form friendships. Hyperactive and
impulsive behaviors may result in peer rejection [10]. The negative consequences of impaired social
function (eg, poor self-esteem, increased risk for depression and anxiety) may be long standing.
EVALUATION
Overview — The evaluation for possible ADHD includes comprehensive medical, developmental,
educational, and psychosocial evaluation [2,11-17]. Comprehensive evaluation is necessary to confirm the
presence, persistence, pervasiveness, and functional complications of core symptoms, exclude other
explanations for core symptoms (table 1), and identify coexisting emotional, behavioral, and medical
disorders. (See 'Diagnostic criteria' below and 'Differential diagnosis' below and 'Coexisting disorders'
below.)
The evaluation should include review of the medical, social, and family histories; clinical interviews with
the parent and patient; review of information about functioning in school or day care; and evaluation for
coexisting emotional or behavioral disorders [11-16]. The necessary information may be obtained in
several ways, including in-person discussions, questionnaires, and web-based tools, as described below.
The complete evaluation may require several office visits [11]. It is important to discuss safety and injury
prevention at each visit because children with ADHD or symptoms of ADHD are at increased risk of
intentional and unintentional injury compared with children without these symptoms. (See "Attention deficit
hyperactivity disorder in children and adolescents: Overview of treatment and prognosis", section on
'Prognosis'.)
Reevaluation of children with ADHD is warranted whenever symptoms worsen or new symptoms emerge
because the differential diagnosis of ADHD is extensive and comorbidity is common. (See 'Differential
diagnosis' below and 'Coexisting disorders' below.)
Medical evaluation — Important aspects of the medical history include prenatal exposures (eg, tobacco,
drugs, alcohol), perinatal complications or infections, central nervous system infection, head trauma,
recurrent otitis media, and medications [11]. Family history of similar behaviors is important because
ADHD has a strong genetic component. The review of systems should include information about sleep
disturbances [15,18]. It is particularly important to obtain a dietary history (eg, appetite, picking eating) and
history of sleep patterns before initiation of pharmacotherapy to avoid attributing preexisting problems to
medications [19]. It is also important to obtain a thorough child and family cardiac history and cardiac
review of systems before initiating medications. (See "Attention deficit hyperactivity disorder in children
and adolescents: Epidemiology and pathogenesis", section on 'Genetic factors' and "Cardiac evaluation of
patients receiving pharmacotherapy for attention deficit hyperactivity disorder", section on 'Cardiac
evaluation'.)
The pediatric care provider can ask the parents the following questions to elicit concerns regarding school
3 sur 28 14/06/2018 à 20:30

performance and behavior [20]:
● How is your child doing at school?
● Have you or the teacher noticed any problems with learning?
● Is your child happy in school?
● Does your child have any behavioral problems at school or home, or when playing with friends?
● Does your child have problems completing school assignments at school or home?
The physical examination of most children with ADHD is normal. However, the examination is necessary
to evaluate other possibilities in the differential diagnosis. Important aspects of the examination include
[11,20]:
● Measurement of height, weight, head circumference, and vital signs
● Assessment of dysmorphic features and neurocutaneous abnormalities
● A complete neurologic examination, including assessment of vision and hearing
● Observation of the child's behavior in the office setting; however, this isolated assessment of behavior
should be interpreted cautiously; symptoms of ADHD may not be apparent in the structured setting of
the clinic visit, or nervousness/apprehension could be misinterpreted as symptoms of ADHD
Developmental and behavioral evaluation — Important aspects of the developmental and behavioral
history include [11]:
● Specific information about the onset, course, and functional impact of ADHD symptoms
● Emotional, medical, and developmental events that may provide an alternative explanation for the
symptoms (see 'Differential diagnosis' below)
● Developmental milestones, particularly language milestones (table 2)
● School absences
● Psychosocial stressors
● Observation of parent-child interactions
The behavioral assessment is focused on determining the age of onset of the core symptoms of ADHD,
the duration of symptoms, the settings in which the symptoms occur, and the degree of functional
impairment [2,11,12]. This information is necessary to establish the diagnosis of ADHD. (See 'Diagnostic
criteria' below.)
Information about the core symptoms can be obtained through the use of open-ended questions or from
ADHD-specific rating scales. If open-ended questions are used, the examiner must document the
presence of the relevant behaviors from the Diagnostic and Statistical Manual of Mental Disorders Fifth
Edition (DSM-5). (See 'Diagnostic criteria' below.)
Behavior rating scales — Various scales have been developed to collect structured observations of
behavior (table 3). Completion of these scales by parents and teachers during the diagnostic evaluation
helps to establish the presence of core symptoms of ADHD in more than one setting. (See 'Diagnostic
criteria' below.)
● ADHD-specific scales – ADHD-specific rating scales (also called narrow-band scales) focus directly
4 sur 28 14/06/2018 à 20:30

on the symptoms of ADHD and can be used to establish the presence of the core symptoms of
ADHD. The validity of ADHD rating scales in distinguishing children with ADHD from age-matched
control children varies depending upon the age of the child, the scale that is used, and the informant
(eg, parent, teacher, adolescent) [21].
ADHD-specific rating scales have a sensitivity and specificity of greater than 90 percent when used in
an appropriate population [21,22]. However, most of the studies validating the use of rating scales
have taken place in referral rather than primary care settings. The National Initiative for Children's
Healthcare Quality (NICHQ) ADHD toolkit includes the Vanderbilt Assessment Scales, which can be
downloaded and printed from the website. The Vanderbilt Assessment Scales have been validated in
both community and referral settings using longitudinal assessment and follow-up [23-25].
Only the Conners Comprehensive Behavior Rating Scales and the ADHD Rating Scale IV have been
validated in preschool-aged children [2,26]. The Vanderbilt rating scales were not designed for
preschool children but probably can be used in children ≥4 years [27,28].
● Broadband scales – Broadband scales assess a variety of behavioral symptoms, including, but not
limited to, the core symptoms of ADHD; they assess internalizing behaviors (eg, feeling depressed,
anxious, withdrawn) and externalizing behaviors other than ADHD (eg, aggression). Broadband
scales (with the exception of the Conners' Long form) are not recommended to establish the
presence of the core symptoms of ADHD because they are less sensitive and specific (<86 percent)
than ADHD-specific scales [22]. However, broadband scales can help to identify coexisting conditions
and narrow the differential diagnosis [29]. (See "Developmental-behavioral surveillance and
screening in primary care", section on 'Choice of screening test'.)
Educational evaluation — The educational assessment centers on documentation of the core symptoms
in the educational setting. Important aspects of the educational evaluation include [2,15]:
● Completion of an ADHD-specific rating scale (see 'Behavior rating scales' above)
● A narrative summary of classroom behavior and interventions, learning patterns, and functional
impairment
● Copies of report cards and samples of schoolwork
● Review of school-based multidisciplinary evaluations (if such evaluations have been performed)
The teachers who provide the information should have regular contact with the child for a minimum of four
to six months if they are to comment reliably on the persistence of symptoms. In the United States, public
schools are federally mandated to perform appropriate evaluations (eg, language, cognitive) at no cost to
the family if a child is suspected of having a disability that impairs functioning (eg, ADHD or learning
disability). (See "Definitions of specific learning disability and laws pertaining to learning disabilities in the
United States", section on 'Laws affecting the education of students with disabilities' and "Children and
youth with special health care needs", section on 'School-based services'.)
Obtaining information about the core symptoms of ADHD from professionals in after-school programs or
other structured settings also may be helpful [2,15]. This information may be particularly useful in the
evaluation of preschool children and adolescents, or if discrepancies exist between the parents' and
teachers' reports of core symptoms. When such discrepancies occur, environmental factors (eg, different
expectations, levels of structure, or behavior management strategies) may be contributing to the
symptoms. (See 'Differential diagnosis' below.)
Coexisting disorders — The evaluation for ADHD should include assessment for coexisting
behavior/emotional disorders including oppositional defiant disorder, conduct disorder, depression, anxiety
5 sur 28 14/06/2018 à 20:30

disorder, and learning disabilities (table 4) [11,12,16,30-32]. Evaluation for these disorders may include
history, broadband behavior scales (oppositional defiant disorder, conduct disorder, depression, anxiety)
or psychometric testing (learning disability) (table 1).
Up to one-half of children with ADHD have one or more coexisting behavioral-emotional conditions
[32-35]. The coexisting conditions can be primary or secondary (eg, disorders that are exacerbated by the
ADHD). In either case, they require treatment in conjunction with treatment for ADHD [2,31]. (See
"Attention deficit hyperactivity disorder in children and adolescents: Overview of treatment and prognosis",
section on 'Treatment of coexisting conditions'.)
● Anxiety – Anxiety may develop in children with ADHD as a secondary disorder; however, in many
cases anxiety appears to be independent of ADHD [33,36]. (See "Anxiety disorders in children and
adolescents: Epidemiology, pathogenesis, clinical manifestations, and course".)
● Oppositional defiant disorder – Children with the combined or hyperactive-impulsive subtype of

ADHD are at increased risk for developing coexisting behavior problems, including oppositional
defiant disorder [36-38]. Their excessive activity, impulsive response style, and disinhibited emotional
expression frequently put them in conflict with parents and other adults. The increased conflict may
lead to increased discipline and less positive reinforcement for the child. Under these circumstances,
a potentially self-perpetuating pattern of oppositional defiant behavior can emerge (the oppositional
acts bring parental attention, which is reinforcing for the child who rarely receives parental praise)
[38-40].
● Learning disabilities – Learning disabilities are more common in children with the inattentive and
combined subtypes of ADHD [41,42]. (See "Specific learning disabilities in children: Clinical features",
section on 'Comorbidities'.)
● Depression – Depression is common in children with the inattentive and combined subtypes of
ADHD [41,42]. Children with ADHD and comorbid mood disorder may have family members with a
history of major depressive disorder [43]. During adolescence, they are at increased risk for
attempting suicide [44-46]. (See "Pediatric unipolar depression: Epidemiology, clinical features,
assessment, and diagnosis", section on 'Epidemiology' and "Suicidal behavior in children and
adolescents: Epidemiology and risk factors", section on 'Psychiatric disorder'.)
● Substance use – Adolescents with newly diagnosed ADHD should be assessed for substance abuse
[2]. Those with signs and symptoms of substance abuse should undergo evaluation and treatment for
addiction before treatment for ADHD with medications (if possible) [47]. (See "Attention deficit
hyperactivity disorder in children and adolescents: Treatment with medications", section on
'Prerequisites' and "Substance use disorder in adolescents: Epidemiology, pathogenesis, clinical
manifestations, course, assessment, and diagnosis".)
Psychometric testing — Psychometric testing is not necessary in the routine evaluation for ADHD and
does not distinguish children with ADHD from those without ADHD [12,48]. However, psychometric testing
can be valuable in excluding other disorders. The public school system often is the best place to perform
psychometric testing (ie, intellectual and academic testing), though more specialized neuropsychologic
testing requires consultation with a specialist. Testing for learning disabilities can be completed in whole or
in part by the school system. (See 'Differential diagnosis' below.)
Children with learning, language, visual-motor, or auditory processing problems can be difficult to
distinguish from those with ADHD. These problems tend to be pervasive and persistent and can impair
academic function through decreased comprehension or excessive frustration. Children with these
problems may attempt to avoid tasks through inattention, getting out of their seats, or impulsively guessing
at answers. On the other hand, children with ADHD may perform poorly on language and visual-spatial
6 sur 28 14/06/2018 à 20:30

tasks [49-51], particularly those that require sustained mental effort or are sensitive to impulsive
responding (eg, multiple-choice formats).
Comprehensive neuropsychologic testing may help to clarify the diagnosis. Children with learning,
language, visual-motor, or auditory processing problems usually perform poorly only in their particular
problem area, whereas children with ADHD may perform poorly in several areas of evaluation.
Assessment of verbal and nonverbal/performance skills with an intelligence measure such as the
Wechsler Intelligence Scale for Children – Fifth Edition [52] or the Differential Abilities Scale-II [53] will
help to identify language and/or visual-spatial processing deficits. Assessment of academic
skills/achievement testing with a tool such as the Wechsler Individual Achievement Test – Third Edition
[54] or the Wide Range Achievement Test – Fourth Edition [55] will help to identify potential learning
disabilities. (See "Specific learning disabilities in children: Clinical features" and "Specific learning
disabilities in children: Evaluation", section on 'Comprehensive evaluation'.)
Psychometric testing also can help to identify specific problem areas for children with ADHD, including
abstract reasoning, mental flexibility, planning, and working memory, a collection of skills broadly
categorized as "executive functions" [6,7,49,56]. Neuropsychologic assessment of these skills, as well as
direct assessment of attention and behavioral disinhibition, often is desirable to facilitate diagnosis, plan
environmental and behavioral interventions, and track progress of treatment [57-60].
Electroencephalography — Quantitative electroencephalography (qEEG) is a method of analyzing the

electrical activity of the brain to derive quantitative patterns that may correspond to diagnostic information
and/or cognitive deficits [61].
We do not suggest qEEG for the evaluation of children with ADHD. Although the US Food and Drug
Administration has licensed the first EEG test for assessment of children (6 to 17 years of age) for ADHD
[62] and several studies have demonstrated differences in qEEG between children with ADHD and normal
children [63-68], the studies were limited by nonrandom assignment, lack of blinding, failure to consider
comorbidities, and/or failure to control for pharmacologic therapy [61,66,69]. In addition, the EEG patterns
differ in boys and girls [70]. A 2013 meta-analysis of nine studies (including 1253 children with ADHD and
517 without ADHD) found significant heterogeneity and concluded that EEG profiles (specifically an
increased theta to beta ratio) cannot be used to reliably diagnose ADHD (although they may be helpful for
prognosis) [71]. Evidence is insufficient to support the use of qEEG over clinical evaluation of symptoms
and functional impairment for the diagnosis of ADHD [17,72]. (See 'Diagnosis' below.)
Ancillary evaluation — Other evaluations are not routinely indicated to establish the diagnosis of ADHD
but may be warranted to evaluate conditions remaining in the differential diagnosis after the initial
assessment. (See 'Differential diagnosis' below.) These evaluations may include [11,12,15,73]:
● Speech and language evaluation (language or communication disorder) (see "Evaluation and
treatment of speech and language disorders in children", section on 'Speech and language
evaluation')
● Occupational therapy evaluation (motor coordination disorder) (see "Developmental coordination

disorder: Clinical features and diagnosis", section on 'Clinical features')
● Mental health evaluation (mood disorder, anxiety, oppositional defiant disorder, conduct disorder,
obsessive-compulsive disorder, posttraumatic stress disorder, adjustment disorder) (see 'Coexisting
disorders' above and 'Indications for referral' below)
● Blood lead level (lead poisoning) [74,75] (see "Childhood lead poisoning: Clinical manifestations and
diagnosis")
● Thyroid hormone levels (thyroid disorder) [76,77] (see "Clinical manifestations and diagnosis of
7 sur 28 14/06/2018 à 20:30

Graves disease in children and adolescents", section on 'Diagnostic evaluation')
● Genetic testing and/or genetics consultation (fragile X syndrome) [78,79] (see "Fragile X syndrome:
Clinical features and diagnosis in children and adolescents", section on 'Diagnosis')
● Overnight polysomnography for children with symptoms suggestive of and/or risk factors for
obstructive sleep apnea syndrome or restless legs syndrome (see "Evaluation of suspected
obstructive sleep apnea in children" and "Restless legs syndrome and periodic limb movement
disorder in children")
● Neurology consultation or EEG (neurologic or seizure disorder) (see "Clinical and laboratory
diagnosis of seizures in infants and children")
DIAGNOSIS
Diagnostic criteria
ADHD — The American Psychiatric Association has defined consensus criteria for the diagnosis of
ADHD, which are published in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition
(DSM-5) [1]. For children <17 years, the DSM-5 diagnosis of ADHD requires ≥6 symptoms of hyperactivity
and impulsivity or ≥6 symptoms of inattention. For adolescents ≥17 years and adults, ≥5 symptoms of
hyperactivity and impulsivity or ≥5 symptoms of inattention are required. (See 'Hyperactivity and
impulsivity' above and 'Inattention' above.)
The symptoms of hyperactivity/impulsivity or inattention must [1]:
● Occur often
● Be present in more than one setting (eg, school and home)
● Persist for at least six months
● Be present before the age of 12 years
● Impair function in academic, social, or occupational activities
● Be excessive for the developmental level of the child
In addition, other physical, situational, or mental health conditions that could account for the symptoms
must be excluded. (See 'Differential diagnosis' below.)
Adherence to the DSM-5 criteria can help to minimize over- and under-diagnosis of ADHD. The diagnostic
criteria have high interrater reliability for individual items and for overall diagnosis even though the
behavioral characteristics specified in the definition are subject to different interpretation by different
observers [15,80,81].
Limitations of the DSM-5 criteria include their derivation from studies of children who were evaluated in
psychiatric rather than primary care settings and lack of data supporting the number of items required for
diagnosis. In addition, the criterion that symptoms of hyperactivity/impulsivity or inattention be present
before the age of 12 years is controversial. (See "Attention deficit hyperactivity disorder in adults:
Epidemiology, pathogenesis, clinical features, course, assessment, and diagnosis", section on 'Course'.)
The response to stimulant medication cannot be used to confirm or refute the diagnosis of ADHD [80].
Stimulant medications improve behavior in children with ADHD, children with conditions other than ADHD
(eg, learning disabilities, depression), and normal control children [82,83].
ADHD subtype — Depending upon the predominant symptoms, ADHD can be categorized into one
8 sur 28 14/06/2018 à 20:30

of the three subtypes listed below [1]. The subtype of ADHD in a given patient can change from one to
another over time [1,84-86].
● Predominantly inattentive – ≥6 symptoms of inattention for children <17 years; ≥5 symptoms for
adolescents ≥17 years and adults (see 'Inattention' above)
● Predominantly hyperactive-impulsive – ≥6 symptoms of hyperactivity-impulsivity for children <17

years; ≥5 symptoms for adolescents ≥17 years and adults (see 'Hyperactivity and impulsivity' above)
● Combined – ≥6 symptoms of inattention and ≥6 symptoms of hyperactivity-impulsivity for children <17

years; ≥5 symptoms in each category for adolescents ≥17 years and adults (see 'Inattention' above
and 'Hyperactivity and impulsivity' above)
Hyperkinetic disorder — In Europe, the diagnosis of hyperkinetic disorder (HKD) is defined by the
International Classification of Diseases (10th edition, ICD-10) criteria (table 5) [11,14]. The ICD-10 criteria
for HKD are more restrictive than the DSM-5 criteria for ADHD, requiring that at least six symptoms of
inattention, at least three symptoms of hyperactivity, and at least one symptom of impulsivity are present
in more than one setting [14]. HKD is subdivided into HKD with and without conduct disorder.
Diagnosis in preschool children — The diagnostic criteria for ADHD (without subtyping) can be applied
to children as young as four years of age [2,87]. Longitudinal studies suggest that severe hyperactivity,
which is present in only a small subset of preschool children, persists into the school years [88-91].
The criterion that impairment is present in at least two settings may be difficult to meet if the child does not
attend preschool or a child care program [2]. In such circumstances, clinicians who suspect ADHD can
recommend that the parents attend a parent training program or that the child be enrolled in a qualified
preschool program (eg, Head Start, public prekindergarten programs, Early Childhood Special Education
services) [2]. The clinician can then obtain information about core symptoms of ADHD and functional
impairment from the instructors of the preschool program or the parenting program (if the child is directly
observed).
Diagnosis in adolescents — Establishing a new diagnosis of ADHD in adolescents can be challenging.

Adolescents may underreport core symptoms or functional impairment and may spend too little time at
home for parents to be accurate informants [2,92]. In such cases, it is important for clinicians to obtain
information from at least two teachers and/or other adults with whom the adolescent interacts (eg,
guidance counselor, coaches, etc) [2]. Strict adherence to the criterion that symptoms of
hyperactivity/impulsivity or inattention be present before the age of 12 years may fail to identify
adolescents and adults with more subtle attentional or organizational problems or adolescents who have
above average cognitive abilities. (See "Attention deficit hyperactivity disorder in adults: Epidemiology,
pathogenesis, clinical features, course, assessment, and diagnosis", section on 'Diagnosis'.)
When considering a diagnosis of "late onset" ADHD in adolescents and young adults, it is particularly
important to obtain a psychiatric history and assessment of current functioning, ideally from multiple
sources. In long-term follow-up of a randomized trial, 239 individuals without childhood ADHD underwent
at least two comprehensive assessments for ADHD between baseline (mean age 10 years) and young
adulthood (mean age 24 years) [93]. Although 143 screened positive on symptom checklists in
adolescence or young adulthood, late-onset ADHD was excluded in approximately 95 percent by lack of
clinical impairment, lack of cross-situational confirmation (eg, parents, teachers, other informants), or an
alternative explanation for symptoms (eg, substance use, another mental illness).
DIFFERENTIAL DIAGNOSIS — The symptoms of ADHD overlap with a number of other conditions,
including developmental variations, neurologic or developmental conditions, emotional and behavioral
disorders, psychosocial or environmental factors, and certain medical problems (table 1) [1,2,94-96].
Some of these conditions can coexist with ADHD and may or may not be responsible for some of the
9 sur 28 14/06/2018 à 20:30

symptoms (eg, children who have learning disabilities may develop inattention as a result of an inability to
understand new information) [97]. These conditions usually can be differentiated from ADHD with a
thorough history and/or the use of a broadband behavior rating scale. If the diagnosis remains uncertain,
psychometric testing or a mental health evaluation may be necessary. (See 'Coexisting disorders' above.)
● Developmental variations – Developmental variations include intellectual disability, giftedness, and

behaviors that are within the normal range for the child's level of development and do not impair
function (eg, a short-attention span or increased motor activity in a preschool child; occasional
impulsivity in a school-age child) [94,95,98]. (See "Intellectual disability in children: Definition,
diagnosis, and assessment of needs" and "Intellectual disability in children: Evaluation for a cause".)
When considering behaviors that are within the normal range for the child's level of development, age
and maturity are more important than grade level [99]. In observational studies, younger age for a
particular grade level has been associated with increased diagnosis of ADHD [95,100-103],
suggesting that developmental immaturity may account for some behaviors that are attributed to
ADHD.
Children with developmental variations do not meet the full criteria for ADHD. (See 'Diagnostic criteria'
above.)
● Neurologic or developmental conditions – Neurodevelopmental conditions that can mimic or co-

occur with ADHD include [94,104,105]:
• Learning disabilities (see "Specific learning disabilities in children: Clinical features")
• Language or communication disorders (see "Etiology of speech and language disorders in

children")
• Autism spectrum disorders (ASD); it is particularly important to consider ASD in preschool

children with symptoms of ADHD [105] (see "Autism spectrum disorder: Clinical features")
• Neurodevelopmental syndromes (eg, fragile X syndrome, fetal alcohol syndrome, Klinefelter

syndrome) (see "Fragile X syndrome: Clinical features and diagnosis in children and
adolescents" and "Fetal alcohol spectrum disorder: Clinical features and diagnosis")
• Seizure disorder (see "Seizures and epilepsy in children: Classification, etiology, and clinical
features")
• Sequelae of central nervous system infection or trauma (see "Bacterial meningitis in children:
Neurologic complications", section on 'Neuropsychologic impairment')
• Metabolic disorders (eg, adrenoleukodystrophy, mucopolysaccharidosis type III) (see

"Adrenoleukodystrophy" and "Mucopolysaccharidoses: Clinical features and diagnosis", section
on 'MPS type III (Sanfilippo syndrome)')
• Motor coordination disorders (see "Developmental coordination disorder: Clinical features and
diagnosis")
These disorders usually can be distinguished from ADHD through history and examination.
Specialized testing may be necessary in some circumstances (eg, psychometric testing for
learning disabilities; genetic testing for fragile X syndrome; electroencephalography for seizure
disorder; occupational therapy evaluation for motor coordination disorder, etc).
● Emotional and behavioral disorders – Emotional and behavioral disorders that can mimic or co-
occur with ADHD include anxiety disorder, mood disorders, oppositional defiant disorder, conduct
10 sur 28 14/06/2018 à 20:30

disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and adjustment disorder. The
use of a broadband behavior scale may be helpful in the assessment of these disorders. However,
evaluation by a mental health professional generally is necessary for diagnosis. (See 'Coexisting
disorders' above and 'Behavior rating scales' above and 'Indications for referral' below.)
● Psychosocial and environmental factors – Environmental factors that can contribute to inattention,
impulsivity, or hyperactivity include a stressful home environment or an inappropriate educational
setting. In contrast to ADHD, psychosocial and environmental factors generally affect behavior only in
one setting (eg, at home but not at school, or at school but not at home). Parent-child temperament or
"personality" mismatch and parental mental health conditions (particularly maternal depression) can
contribute to parent report of ADHD-type symptoms in the home setting. However, mothers of ADHD
children with limited resources or support may also develop stress-related mental health conditions; in
such circumstances, multiple respondent (eg, teacher, coach) reports help to confirm the diagnosis of
ADHD.
● Medical conditions – Medical conditions that may have clinical features that mimic ADHD include
hearing or visual impairment, lead poisoning, thyroid abnormalities, sleep disorders (eg, obstructive
sleep apnea, restless leg/periodic limb movement disorder), medication effects (eg, albuterol), and
substance abuse disorders [15,18,106]. These conditions usually can be differentiated from ADHD
because their symptoms fluctuate with the disease course or exposure to medication. In contrast, the
symptoms in ADHD are persistent and pervasive.
INDICATIONS FOR REFERRAL — Evaluation by a pediatric specialist (eg, a psychologist, psychiatrist,

neurologist, educational specialist, or developmental-behavioral pediatrician) is indicated for children in
whom the following diagnoses are of concern [2]:
● Intellectual disability (mental retardation)
● Developmental disorder (eg, speech or motor delay)
● Learning disability
● Visual or hearing impairment
● History of abuse
● Severe aggression
● Seizure disorder
● Coexisting learning and/or emotional problems
● Chronic illness that requires treatment with a medication that interferes with learning
● Children who continue to have problems in functioning despite treatment (see "Attention deficit
hyperactivity disorder in children and adolescents: Overview of treatment and prognosis", section on
'Response to treatment')
RESOURCES — The National Initiative for Children's Healthcare Quality (NICHQ), in conjunction with
North Carolina's Center for Child Health Improvement, and the American Academy of Pediatrics (AAP),
has developed a toolkit to assist primary care practitioners in the evaluation and management of children
with ADHD. The toolkit includes information for parents, copies of ADHD-specific questionnaires for
parents and teachers, and an initial primary care evaluation form. It can be downloaded without charge
through the NICHQ but requires registration. A revised edition of the toolkit, which also includes tools and
resources for preschool children and adolescents, is available for purchase through the AAP.
11 sur 28 14/06/2018 à 20:30

Resources for families of children with ADHD are provided in the table (table 6).
Information for teachers of children with ADHD is available through the National Resource Center on
ADHD.
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected
countries and regions around the world are provided separately. (See "Society guideline links: Attention
deficit hyperactivity disorder".)
INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The
Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the
5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a
given condition. These articles are best for patients who want a general overview and who prefer short,
easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and
more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients
who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or email
these topics to your patients. (You can also locate patient education articles on a variety of subjects by
searching on "patient info" and the keyword[s] of interest.)
● Basics topics (see "Patient education: Attention deficit hyperactivity disorder (ADHD) in children (The
Basics)")
● Beyond the Basics topics (see "Patient education: Symptoms and diagnosis of attention deficit
hyperactivity disorder in children (Beyond the Basics)" and "Patient education: Treatment of attention
deficit hyperactivity disorder in children (Beyond the Basics)")
SUMMARY AND RECOMMENDATIONS
● Attention deficit hyperactivity disorder (ADHD) is a behavioral condition with persistent and pervasive
core symptoms of inattention, hyperactivity, and impulsivity. The symptoms affect cognitive,
academic, behavioral, emotional, and social functioning. (See 'Clinical features' above.)
● The differential diagnosis for ADHD includes developmental variations, neurologic or developmental
conditions, emotional and behavioral disorders, psychosocial or environmental factors, and certain
medical problems (table 1). Most of these conditions may coexist with ADHD and require
simultaneous treatment. (See 'Differential diagnosis' above and 'Coexisting disorders' above.)
● The diagnosis of ADHD requires that the child meet the criteria defined by the Diagnostic and
Statistical Manual of Mental Disorders Fifth Edition (DSM-5). The response to stimulant medication
cannot be used to confirm or refute the diagnosis. (See 'Diagnostic criteria' above.)
● Evaluation for ADHD requires comprehensive medical, developmental, educational, and psychosocial
evaluation to confirm the presence, persistence, pervasiveness, and functional complications of core
symptoms, exclude other causes of core symptoms (table 1), and identify coexisting learning and
psychiatric disorders (table 4). (See 'Overview' above and 'Coexisting disorders' above.)
● The evaluation for ADHD requires information about the child's behavior in more than one setting (eg,
home and school or after-school program). ADHD-specific behavior scales (table 3) can be used to
gather this information from the parents and teacher(s). (See 'Educational evaluation' above and
'Behavior rating scales' above.)
● Psychometric testing is not necessary in the routine evaluation for ADHD. However, it is valuable in
narrowing the differential diagnosis and planning the approach to management. (See 'Psychometric
12 sur 28 14/06/2018 à 20:30

testing' above.)
● The evaluation for ADHD does not require blood lead levels, thyroid hormone levels, neuroimaging,
or electroencephalography unless these tests are indicated by findings in the clinical evaluation. (See
'Ancillary evaluation' above.)
● Reevaluation of children with ADHD is warranted whenever symptoms worsen or new symptoms
emerge because the differential diagnosis of ADHD is extensive and comorbidity is common. (See
'Differential diagnosis' above and 'Coexisting disorders' above.)
Use of UpToDate is subject to the Subscription and License Agreement.
REFERENCES
1. American Psychiatric Association. Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistic

al Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, Arlington, VA 2013. p
.59.
2. Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality
Improvement and Management, Wolraich M, et al. ADHD: clinical practice guideline for the
diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and
adolescents. Pediatrics 2011; 128:1007.
3. Applegate B, Lahey BB, Hart EL, et al. Validity of the age-of-onset criterion for ADHD: a report from
the DSM-IV field trials. J Am Acad Child Adolesc Psychiatry 1997; 36:1211.
4. Lahey BB, Applegate B, McBurnett K, et al. DSM-IV field trials for attention deficit hyperactivity
disorder in children and adolescents. Am J Psychiatry 1994; 151:1673.
5. Levin FR, Kleber HD. Attention-deficit hyperactivity disorder and substance abuse: relationships and
implications for treatment. Harv Rev Psychiatry 1995; 2:246.
6. Nigg JT, Blaskey LG, Huang-Pollock CL, Rappley MD. Neuropsychological executive functions and
DSM-IV ADHD subtypes. J Am Acad Child Adolesc Psychiatry 2002; 41:59.
7. Weiler MD, Bernstein JH, Bellinger DC, Waber DP. Processing speed in children with attention
deficit/hyperactivity disorder, inattentive type. Child Neuropsychol 2000; 6:218.
8. Carlson CL, Mann M. Sluggish cognitive tempo predicts a different pattern of impairment in the
attention deficit hyperactivity disorder, predominantly inattentive type. J Clin Child Adolesc Psychol
2002; 31:123.
9. Brogan E, Cragg L, Gilmore C, et al. Inattention in very preterm children: implications for screening
and detection. Arch Dis Child 2014; 99:834.
10. Hoza B. Peer functioning in children with ADHD. Ambul Pediatr 2007; 7:101.
11. Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder -- first
upgrade. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1:I7.
12. Pliszka S, AACAP Work Group on Quality Issues. Practice parameter for the assessment and
treatment of children and adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child
Adolesc Psychiatry 2007; 46:894.
13. National Institutes of Health Consensus Development Conference Statement: diagnosis and
treatment of attention-deficit/hyperactivity disorder (ADHD). J Am Acad Child Adolesc Psychiatry
2000; 39:182.
14. National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder: Diagnosi
13 sur 28 14/06/2018 à 20:30

s and management of ADHD in children, young people and adults. Issued September 2008, last mo
dified March 2013. www.nice.org.uk/CG72 (Accessed on July 17, 2013).
15. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/H
yperactivity Disorder in Children and Adolescents. Process of Care Supplemental Appendix. Availabl
e at: http://pediatrics.aappublications.org/content/128/5/1007/suppl/DC1 (Accessed on January 06, 2
012).
16. Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet 2016; 387:1240.
17. Kemper AR, Maslow GR, Hill S, et al. Attention deficit hyperactivity disorder: Diagnosis and treatmen
t in children and adolescents. Comparative Effectiveness Review No. 203. AHRQ Publication No. 18
-EHC005-EF. Agency for Healthcare Research and Quality, Rockville, MD, January 2018. Available
at: https://effectivehealthcare.ahrq.gov/opics/adhd-update/systematic-review-2018 (Accessed on Jan
uary 30, 2018).
18. Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered
breathing in pediatric populations: a meta-analysis. Sleep Med Rev 2014; 18:349.
19. Wender EH. Managing stimulant medication for attention-deficit/hyperactivity disorder. Pediatr Rev
2001; 22:183.
20. Sleator EK, Ullmann RK. Can the physician diagnose hyperactivity in the office? Pediatrics 1981;
67:13.
21. Collett BR, Ohan JL, Myers KM. Ten-year review of rating scales. V: scales assessing attention-
deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2003; 42:1015.
22. Agency for Healthcare Research and Quality. Diagnosis of Attention-Deficit/Hyperactivity Disorder. C
linical Focus. Rockville, MD, October 1999. www.ahrq.gov/clinic/tp/adhddtp.htm (Accessed on Octob
er 25, 2011).
23. Wolraich ML, Lambert W, Doffing MA, et al. Psychometric properties of the Vanderbilt ADHD
diagnostic parent rating scale in a referred population. J Pediatr Psychol 2003; 28:559.
24. Wolraich ML, Bard DE, Neas B, et al. The psychometric properties of the Vanderbilt attention-deficit
hyperactivity disorder diagnostic teacher rating scale in a community population. J Dev Behav
Pediatr 2013; 34:83.
25. Bard DE, Wolraich ML, Neas B, et al. The psychometric properties of the Vanderbilt attention-deficit
hyperactivity disorder diagnostic parent rating scale in a community population. J Dev Behav Pediatr
2013; 34:72.
26. McGoey KE, DuPaul GJ, Haley E, Shelton TL. Parent and teacher ratings of attention-
deficit/hyperactivity disorder in preschool: the ADHD Rating Scale-IV Preschool Version. J
Psychopathol Behav Assess 2007; 29:269.
27. Dreyer BP. The diagnosis and management of attention-deficit/hyperactivity disorder in preschool
children: the state of our knowledge and practice. Curr Probl Pediatr Adolesc Health Care 2006;
36:6.
28. Kaplan A, Adesman A. Clinical diagnosis and management of attention deficit hyperactivity disorder
in preschool children. Curr Opin Pediatr 2011; 23:684.
29. Biederman J, Monuteaux MC, Kendrick E, et al. The CBCL as a screen for psychiatric comorbidity in
paediatric patients with ADHD. Arch Dis Child 2005; 90:1010.
30. Pastor PN, Reuben CA. Diagnosed attention deficit hyperactivity disorder and learning disability:
United States, 2004-2006. Vital Health Stat 10 2008; :1.
31. Koolwijk I, Stein DS, Chan E, et al. "Complex" attention-deficit hyperactivity disorder, more norm
than exception? Diagnoses and comorbidities in a developmental clinic. J Dev Behav Pediatr 2014;
14 sur 28 14/06/2018 à 20:30

35:591.
32. Tung I, Li JJ, Meza JI, et al. Patterns of Comorbidity Among Girls With ADHD: A Meta-analysis.
Pediatrics 2016; 138.
33. Jensen PS, Hinshaw SP, Kraemer HC, et al. ADHD comorbidity findings from the MTA study:
comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry 2001; 40:147.
34. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder.
The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen
Psychiatry 1999; 56:1073.
35. Levy F, Hay DA, Bennett KS, McStephen M. Gender differences in ADHD subtype comorbidity. J Am
Acad Child Adolesc Psychiatry 2005; 44:368.
36. Pliszka SR. Comorbidity of attention-deficit/hyperactivity disorder with psychiatric disorder: an
overview. J Clin Psychiatry 1998; 59 Suppl 7:50.
37. Neuman RJ, Heath A, Reich W, et al. Latent class analysis of ADHD and comorbid symptoms in a
population sample of adolescent female twins. J Child Psychol Psychiatry 2001; 42:933.
38. Lalonde J, Turgay A, Hudson JI. Attention-deficit hyperactivity disorder subtypes and comorbid
disruptive behaviour disorders in a child and adolescent mental health clinic. Can J Psychiatry 1998;
43:623.
39. Barkley RA, Fischer M, Edelbrock C, Smallish L. The adolescent outcome of hyperactive children
diagnosed by research criteria--III. Mother-child interactions, family conflicts and maternal
psychopathology. J Child Psychol Psychiatry 1991; 32:233.
40. Pliszka SR. Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child
Adolesc Psychiatr Clin N Am 2000; 9:525.
41. Wolraich ML, Hannah JN, Pinnock TY, et al. Comparison of diagnostic criteria for attention-deficit
hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry 1996; 35:319.
42. Wolraich ML, Hannah JN, Baumgaertel A, Feurer ID. Examination of DSM-IV criteria for attention
deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr 1998; 19:162.
43. Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with
conduct, depressive, anxiety, and other disorders. Am J Psychiatry 1991; 148:564.
44. Lam LT. Attention deficit disorder and hospitalization owing to intra- and interpersonal violence
among children and young adolescents. J Adolesc Health 2005; 36:19.
45. Brent DA, Perper JA, Goldstein CE, et al. Risk factors for adolescent suicide. A comparison of
adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry 1988; 45:581.
46. Nasser EH, Overholser JC. Assessing varying degrees of lethality in depressed adolescent suicide
attempters. Acta Psychiatr Scand 1999; 99:423.
47. Riggs PD. Clinical approach to treatment of ADHD in adolescents with substance use disorders and
conduct disorder. J Am Acad Child Adolesc Psychiatry 1998; 37:331.
48. Doyle AE, Biederman J, Seidman LJ, et al. Diagnostic efficiency of neuropsychological test scores
for discriminating boys with and without attention deficit-hyperactivity disorder. J Consult Clin
Psychol 2000; 68:477.
49. Aman CJ, Roberts RJ Jr, Pennington BF. A neuropsychological examination of the underlying deficit
in attention deficit hyperactivity disorder: frontal lobe versus right parietal lobe theories. Dev Psychol
1998; 34:956.
50. Nigg JT, Swanson JM, Hinshaw SP. Covert visual spatial attention in boys with attention deficit
hyperactivity disorder: lateral effects, methylphenidate response and results for parents.
Neuropsychologia 1997; 35:165.
15 sur 28 14/06/2018 à 20:30

51. Purvis KL, Tannock R. Language abilities in children with attention deficit hyperactivity disorder,
reading disabilities, and normal controls. J Abnorm Child Psychol 1997; 25:133.
52. Wechsler D. Wechsler Intelligence Scale for Children: 5th Edition. Pearson, Bloomington, MN 2014.
53. Elliott C. Differential Ability Scales-II. The Psychological Corporation, San Antonio, TX 2007.
54. Wechsler Individual Achievement Test-Third Edition. The Psychological Corporation, San Antonio, T
X 2009.
55. Wilkinson GS, Robertson GJ. Wide Range Achievement Test – 4. Psychological Assessment Resour
ces, Lutz, FL 2006.
56. Rubia K, Taylor E, Smith AB, et al. Neuropsychological analyses of impulsiveness in childhood
hyperactivity. Br J Psychiatry 2001; 179:138.
57. Hale JB, Hoeppner JA, DeWitt MB, et al. Evaluating medication response in ADHD: cognitive,
behavioral, and single-subject methodology. J Learn Disabil 1998; 31:595.
58. Kempton S, Vance A, Maruff P, et al. Executive function and attention deficit hyperactivity disorder:
stimulant medication and better executive function performance in children. Psychol Med 1999;
29:527.
59. Risser MG, Bowers TG. Cognitive and neuropsychological characteristics of attention deficit
hyperactivity disorder children receiving stimulant medications. Percept Mot Skills 1993; 77:1023.
60. Tannock R, Ickowicz A, Schachar R. Differential effects of methylphenidate on working memory in
ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry 1995;
34:886.
61. Krull KR, George MR, Strother D. Quantitative electroencephalography and neurofeedback. In: Pedi
atric Neuropsychological Intervention: A Critical Review of Science & Practice, Hunter SJ, Donders J
(Eds), Cambridge University Press, Cambridge 2007. p.392.
62. US Food and Drug Administration. FDA permits marketing of first brain wave test to help assess chil
dren and teens for ADHD. www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm360811.
htm (Accessed on July 16, 2013).
63. Lazzaro I, Gordon E, Li W, et al. Simultaneous EEG and EDA measures in adolescent attention
deficit hyperactivity disorder. Int J Psychophysiol 1999; 34:123.
64. Lazzaro I, Gordon E, Whitmont S, et al. Quantified EEG activity in adolescent attention deficit
hyperactivity disorder. Clin Electroencephalogr 1998; 29:37.
65. Chabot RJ, Merkin H, Wood LM, et al. Sensitivity and specificity of QEEG in children with attention
deficit or specific developmental learning disorders. Clin Electroencephalogr 1996; 27:26.
66. Snyder SM, Hall JR. A meta-analysis of quantitative EEG power associated with attention-deficit
hyperactivity disorder. J Clin Neurophysiol 2006; 23:440.
67. Swartwood JN, Swartwood MO, Lubar JF, Timmermann DL. EEG differences in ADHD-combined
type during baseline and cognitive tasks. Pediatr Neurol 2003; 28:199.
68. Kuperman S, Johnson B, Arndt S, et al. Quantitative EEG differences in a nonclinical sample of
children with ADHD and undifferentiated ADD. J Am Acad Child Adolesc Psychiatry 1996; 35:1009.
69. Barry RJ, Clarke AR, Johnstone SJ. A review of electrophysiology in attention-deficit/hyperactivity
disorder: I. Qualitative and quantitative electroencephalography. Clin Neurophysiol 2003; 114:171.
70. Dupuy FE, Barry RJ, Clarke AR, et al. Sex differences between the combined and inattentive types
of attention-deficit/hyperactivity disorder: an EEG perspective. Int J Psychophysiol 2013; 89:320.
71. Arns M, Conners CK, Kraemer HC. A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-
analysis. J Atten Disord 2013; 17:374.
16 sur 28 14/06/2018 à 20:30

72. Gloss D, Varma JK, Pringsheim T, Nuwer MR. Practice advisory: The utility of EEG theta/beta power
ratio in ADHD diagnosis: Report of the Guideline Development, Dissemination, and Implementation
Subcommittee of the American Academy of Neurology. Neurology 2016; 87:2375.
73. Zametkin AJ, Ernst M. Problems in the management of attention-deficit-hyperactivity disorder. N
Engl J Med 1999; 340:40.
74. Kahn CA, Kelly PC, Walker WO Jr. Lead screening in children with attention deficit hyperactivity
disorder and developmental delay. Clin Pediatr (Phila) 1995; 34:498.
75. Gittelman R, Eskenazi B. Lead and hyperactivity revisited. An investigation of nondisadvantaged
children. Arch Gen Psychiatry 1983; 40:827.
76. Elia J, Gulotta C, Rose SR, et al. Thyroid function and attention-deficit hyperactivity disorder. J Am
Acad Child Adolesc Psychiatry 1994; 33:169.
77. Weiss RE, Stein MA, Trommer B, Refetoff S. Attention-deficit hyperactivity disorder and thyroid
function. J Pediatr 1993; 123:539.
78. Stephen E, Kindley AD. Should children with ADHD and normal intelligence be routinely screened
for underlying cytogenetic abnormalities? Arch Dis Child 2006; 91:860.
79. Bastain TM, Lewczyk CM, Sharp WS, et al. Cytogenetic abnormalities in attention-
deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2002; 41:806.
80. Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-
deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American
Medical Association. JAMA 1998; 279:1100.
81. Power TJ, Costigan TE, Leff SS, et al. Assessing ADHD across settings: contributions of behavioral
assessment to categorical decision making. J Clin Child Psychol 2001; 30:399.
82. Rapoport JL, Buchsbaum MS, Zahn TP, et al. Dextroamphetamine: cognitive and behavioral effects
in normal prepubertal boys. Science 1978; 199:560.
83. Peloquin LJ, Klorman R. Effects of methylphenidate on normal children's mood, event-related
potentials, and performance in memory scanning and vigilance. J Abnorm Psychol 1986; 95:88.
84. Lahey BB, Pelham WE, Loney J, et al. Instability of the DSM-IV Subtypes of ADHD from preschool
through elementary school. Arch Gen Psychiatry 2005; 62:896.
85. Larsson H, Dilshad R, Lichtenstein P, Barker ED. Developmental trajectories of DSM-IV symptoms of
attention-deficit/hyperactivity disorder: genetic effects, family risk and associated psychopathology. J
Child Psychol Psychiatry 2011; 52:954.
86. Hinshaw SP, Owens EB, Zalecki C, et al. Prospective follow-up of girls with attention-
deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for
suicide attempts and self-injury. J Consult Clin Psychol 2012; 80:1041.
87. Lahey BB, Pelham WE, Loney J, et al. Three-year predictive validity of DSM-IV attention deficit
hyperactivity disorder in children diagnosed at 4-6 years of age. Am J Psychiatry 2004; 161:2014.
88. Campbell SB, Ewing LJ, Breaux AM, Szumowski EK. Parent-referred problem three-year-olds:
follow-up at school entry. J Child Psychol Psychiatry 1986; 27:473.
89. McGee R, Partridge F, Williams S, Silva PA. A twelve-year follow-up of preschool hyperactive
children. J Am Acad Child Adolesc Psychiatry 1991; 30:224.
90. Riddle MA, Yershova K, Lazzaretto D, et al. The Preschool Attention-Deficit/Hyperactivity Disorder
Treatment Study (PATS) 6-year follow-up. J Am Acad Child Adolesc Psychiatry 2013; 52:264.
91. Law EC, Sideridis GD, Prock LA, Sheridan MA. Attention-deficit/hyperactivity disorder in young
children: predictors of diagnostic stability. Pediatrics 2014; 133:659.
17 sur 28 14/06/2018 à 20:30

92. Adler LA, Newcorn JH. Administering and evaluating the results of the adult ADHD Self-Report Scale
(ASRS) in adolescents. J Clin Psychiatry 2011; 72:e20.
93. Sibley MH, Rohde LA, Swanson JM, et al. Late-Onset ADHD Reconsidered With Comprehensive
Repeated Assessments Between Ages 10 and 25. Am J Psychiatry 2018; 175:140.
94. Leslie LK, Guevara JP. Attention-deficit/hyperactivity disorder. In: American Academy of Pediatrics T
extbook of Pediatric Care, McInerny TK (Ed), American Academy of Pediatrics, Elk Grove Village, IL
2009. p.1201.
95. Morrow RL, Garland EJ, Wright JM, et al. Influence of relative age on diagnosis and treatment of
attention-deficit/hyperactivity disorder in children. CMAJ 2012; 184:755.
96. Nomura K, Okada K, Noujima Y, et al. A clinical study of attention-deficit/hyperactivity disorder in
preschool children--prevalence and differential diagnoses. Brain Dev 2014; 36:778.
97. Gilger JW, Pennington BF, DeFries JC. A twin study of the etiology of comorbidity: attention-deficit
hyperactivity disorder and dyslexia. J Am Acad Child Adolesc Psychiatry 1992; 31:343.
98. Hyperactive/impulsive behaviors. In: The Classification of Child and Adolescent Mental Diagnoses in
Primary Care. Diagnostic and Statistical Manual for Primary Care (DSM-PC) Child and Adolescent V
ersion, 1st ed, Wolraich ML (Ed), American Academy of Pediatrics, Elk Grove Village, IL 1996. p.93.
99. Brikell I, Kuja-Halkola R, Larsson JO, et al. Relative Immaturity in Childhood and Attention-
Deficit/Hyperactivity Disorder Symptoms From Childhood to Early Adulthood: Exploring Genetic and
Environmental Overlap Across Development. J Am Acad Child Adolesc Psychiatry 2016; 55:886.
100. Elder TE. The importance of relative standards in ADHD diagnoses: evidence based on exact birth
dates. J Health Econ 2010; 29:641.
101. Chen MH, Lan WH, Bai YM, et al. Influence of Relative Age on Diagnosis and Treatment of
Attention-Deficit Hyperactivity Disorder in Taiwanese Children. J Pediatr 2016; 172:162.
102. Gökçe S, Yazgan Y, Ayaz AB, et al. Association Between Age of Beginning Primary School and
Attention Deficit Hyperactivity Disorder. J Dev Behav Pediatr 2017; 38:12.
103. Sayal K, Chudal R, Hinkka-Yli-Salomäki S, et al. Relative age within the school year and diagnosis
of attention-deficit hyperactivity disorder: a nationwide population-based study. Lancet Psychiatry
2017; 4:868.
104. Wijburg FA, Węgrzyn G, Burton BK, Tylki-Szymańska A. Mucopolysaccharidosis type III (Sanfilippo
syndrome) and misdiagnosis of idiopathic developmental delay, attention deficit/hyperactivity
disorder or autism spectrum disorder. Acta Paediatr 2013; 102:462.
105. Miodovnik A, Harstad E, Sideridis G, Huntington N. Timing of the Diagnosis of Attention-
Deficit/Hyperactivity Disorder and Autism Spectrum Disorder. Pediatrics 2015; 136:e830.
106. Pearl PL, Weiss RE, Stein MA. Medical mimics. Medical and neurological conditions simulating
ADHD. Ann N Y Acad Sci 2001; 931:97.
Topic 624 Version 37.0
18 sur 28 14/06/2018 à 20:30

GRAPHICS
Differential diagnosis for attention-deficit hyperactivity disorder in children

and adolescents*
Methods to distinguish from ADHD
Developmental variations
Intellectual disability Psychometric testing
Giftedness Psychometric testing
Normal variation History
Neurologic or developmental disorders
Learning disability Psychometric testing
Language or communication disorder Psychometric testing
Autism spectrum disorders History; structured observation
Neurodevelopmental syndromes (eg, fetal alcohol History; examination; genetic testing

syndrome, fragile X syndrome)
Seizure disorder History; electroencephalography if clinically indicated
Sequelae of central nervous system trauma or History

infection
Motor coordination disorder History; examination; occupational therapy evaluation
Emotional/behavioral disorders
Depression or mood disorder Broadband behavior scale; mental health evaluation
Anxiety disorder Broadband behavior scale; mental health evaluation
Oppositional defiant disorder Broadband behavior scale; mental health evaluation
Conduct disorder Broadband behavior scale; mental health evaluation
Obsessive compulsive disorder Broadband behavior scale; mental health evaluation
Posttraumatic stress disorder Broadband behavior scale; mental health evaluation
Adjustment disorder Broadband behavior scale; mental health evaluation
Psychosocial or environmental problems
Child abuse or neglect Medical history; psychosocial history; examination
Stressful home environment Psychosocial history
Inadequate or punitive parenting Psychosocial history
Parental psychopathology or substance abuse Psychosocial history
Inappropriate educational setting Symptoms occur at school but not at home
Frequent school absence Psychosocial history
Selected medical conditions
Hearing or vision impairment Hearing and vision screen
Sleep disorder History; sleep study as indicated by clinical findings
Iron deficiency anemia Complete blood count and other hematologic studies
as indicated
Lead poisoning Measurement of blood lead level
Endocrine disorders (eg, thyroid disease, diabetes Laboratory studies as indicated by clinical findings
mellitus)
Cardiac disorders (eg, heart failure) Medical history; echocardiograph/pediatric cardiology

consultation as indicated
Substance abuse History; toxicology screening
19 sur 28 14/06/2018 à 20:30

Food allergy History; allergy testing as indicated
Undernutrition Assessment of growth parameters
Medication side effects History
ADHD: Attention deficit hyperactivity disorder.

* These conditions may mimic or co-occur with ADHD.
Data from:
1. Attention-deficit and disruptive behavior disorders. In: Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition Text Revision, 4 th ed, American Psychiatric Association, Washington, DC 2000. p.85.
2. Leslie LK, Guevara JP. Attention-deficit/hyperactivity disorder. In: American Academy of Pediatrics Textbook of
Pediatric Care, McInerny TK (Ed), American Academy of Pediatrics, Elk Grove Village, IL, 2009. p.1201.
3. Subcommittee on attention-deficit/hyperactivity disorder, Steering committee on quality improvement and
management. ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-
Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics 2011: 128:1007.
Graphic 69771 Version 3.0
20 sur 28 14/06/2018 à 20:30

Major speech, language, and communication milestones*
Expressive language Receptive language Gestural

Age
skill skill communication skill
Birth to Cries Turns toward sound -

2
months
2 to 4 Coos (makes open vowel Social smile -

months sounds: "ooh"; "aah")
Watches faces intently
6 Babbles (repetitive consonant- Responds to name -

months vowel combinations ("bababa";
"mamama")
12 Says first word/word Follows one-step verbal Visually follows adult's pointing
months approximation command with gesture (eg,
"Give me the ball")
Uses jargon/babbles with Responds to "no" (eg, stops Points to request (12 to 14
inflection activity) months)
Repeats sounds or gestures to Starts to use gestures (eg,

get attention shaking head "no")
15 to 18 Points to common body parts Follows one-step verbal Points to share

months when named command without gesture attention/enjoyment with
another person (not just to
request things)
Shows objects to another

person
18 to 24 Uses ¶ two-word phrases Points to objects or people -

months ("Mommy milk"; "go outside") when named
24 to 36 Answers simple questions Follows two-step verbal -

months ("What's your name?"; "Who's command
that?")
50% intelligible
36 to 48 Uses four- to five-word Understands placement in -

months sentences space (on, in, under)
Uses pronouns and some

plurals
75% intelligible
48 to 72 Uses full sentences with Follows three-step verbal -

months grammatical markings (eg, command
plurals, verb endings)
100% intelligible
* A general knowledge of skills that are typical for age (milestones/50 th percentile skills) is important in order to
conduct general developmental surveillance in primary care. However, milestones are not particularly helpful in
making decisions about which children may require more formal evaluation or closer monitoring. This is because of the
significant variability in the normal range of development of different skills in young children. Red flags (usually the
90 th percentile for skill attainment) are more helpful in clinical decision-making [1].
¶ Young children's use of words implies spontaneous expression of words or word approximation to communicate a
request or to interact with another person. Echoing or immediately repeating words spoken by a caregiver does not
constitute having or using words in the meaning of the milestone.
Reference:
1. Sices L. Use of developmental milestones in pediatric residency training and practice: time to rethink the
meaning of the mean. J Dev Behav Pediatr 2007; 28:47.
21 sur 28 14/06/2018 à 20:30

Ratings scales in the assessment and monitoring of ADHD
Scales Behaviors assessed
Broadband assessment
Conners 3 rd Edition [1] Inattention, hyperactivity/impulsivity, learning problems, executive

functioning, aggression, peer relations, DSM-IV symptoms scales for
inattentive, hyperactive-impulsive and combined type of ADHD (DSM-5
scoring is also available as a supplement), ODD, conduct disorder
Behavior Assessment System Hyperactivity, aggression, conduct problems, anxiety, depression,

for Children (BASC) [2] somatization, atypicality, withdrawal, attention problems, learning problems,
lack of adaptability/social/leadership/study skills
Child Behavior Somatic complaints, social/thought/attention problems, anxiety/depression,

Checklist/Teacher Report aggressive/delinquent behavior, withdrawal
Form [3,4]
Narrow-band assessment
ADHD Comprehensive Attention problems, hyperactivity, lack of social skills, oppositional

Teacher's Rating Scale
(ACTeRS): Boys' and girls'
form [5]
ADHD Rating Scale [6] Symptoms of ADHD according to DSM-IV criteria
Childhood Attention Problems Combined measure of attention problems, impulsivity, hyperactivity

Scale [7]
Conners 3 rd Edition: Short Selected items from the long version to measure inattention,
version [1] hyperactivity/impulsivity, learning problems, executive function, aggression,
and peer relations
BASC Monitor Rating Scale [8] Attention/adaptive problems, hyperactivity, problems with internalizing
Disruptive Behavior Rating DSM-IV symptoms of ODD, ADHD, and CD (parent form only)
Scale [9]
Vanderbilt Assessment Symptoms of ADHD according to DSM-IV criteria; screen for comorbid
Scales [10,11] conditions (ODD, CD, anxiety, depression)
Assessment of medication side effects
Side Effects Rating Scale [9] Sleeping/appetite problems, staring/daydreaming, withdrawal, anxiety,
irritability, somatic complaints, emotional lability, dizziness, tics
ADHD: attention-deficit hyperactivity disorder; DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, fourth
edition; DSM-5: Diagnostic and Statistical Manual of Mental Disorders, fifth edition; ODD: oppositional-defiant
disorder; CD: conduct disorder.
References:
1. Conners CK. Conners 3 rd Edition. Toronto, Multi-Health Systems, Inc., 2008.
2. Reynolds CF, Kamphaus RW. Behavior Assessment System for Children-Second Edition. Minneapolis, MN, NC
Pearson, Inc., 2004.
3. Achenbach TM. Manual for the Child Behavior Checklist. University of Vermont, Department of Psychiatry,
Burlington, 1991.
4. Achenbach TM. Manual for the Teachers Report Form. University of Vermont, Department of Psychiatry,
Burlington, 1991.
5. Ullmann RK, Sleator EK, Sprague RL. A new rating scale for diagnosis and monitoring of ADD children.
Psychopharmacol Bull 1984; 20:160.
6. DuPaul GJ. Parent and teacher ratings of ADHD symptoms: Psychometric properties in a community based
sample. J Clin Child Psychol 1991; 20:242.
7. Edelbrock C. Child Attention Problems Scale (unpublished manuscript). Penn State University, University Park,
1978.
8. Kamphaus RW, Reynolds CR. BASC Monitor for ADHD: Manual and Software Guide. American Guidance Service,
Circle Pine, MN 1998.
9. Barkley RA, Murphy KR. Attention Deficit Hyperactivity Disorder: A Clinical Workbook. Guilford Press, New York
1998.
10. Wolraich ML, Feurer ID, Hannah JN, et al. Obtaining systematic teacher reports of disruptive behaviors utilizing
22 sur 28 14/06/2018 à 20:30

DSM-IV. J Abnorm Child Psychol 1998; 26:141.

11. Wolraich ML, Lambert W, Doffing MA, et al. Psychometric properties of the Vanderbilt ADHD diagnostic parent
rating scale in a referred population. J Pediatr Psychol 2003; 28:559.
23 sur 28 14/06/2018 à 20:30

Emotional and behavioral disorders that commonly coexist with attention

deficit hyperactivity disorder in children and adolescents
Conduct disorder
Repetitive and persistent violation of age-appropriate societal norms, rules, or basic rights of others;
includes:
Aggression to people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
Anxiety disorder
Persistent, excessive, difficult to control worry about events or activities; associated with:
Restlessness
Easy fatigability
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance
Depression
Persistent disturbance in emotions, ideation, or somatic symptoms as indicated by ≥5 of the following
symptoms; at least one of the symptoms in bold must be present:
Depressed or irritable mood
Markedly diminished interest or pleasure in almost all activities
Change in appetite or weight
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or guilt
Impaired concentration, indecisiveness
Recurring thoughts of death or suicide
Learning disability
Intrinsic cognitive difficulty that results in lower academic achievement than expected for intellectual
potential; examples include:
Reading disorder
Disorder of written language
Mathematics disorder
Learning disorder, not otherwise specified
Oppositional defiant disorder

Recurrent negative, defiant, disobedient, and hostile behavior toward authority figures, including:
Losing temper
Arguing with adults
Actively defying or refusing to comply with adults' requests or rules
Deliberately annoying people
Blaming others for his or her mistakes or misbehavior
Being touchy or easily annoyed by others
Being angry and resentful
Being spiteful or vindictive
Data from:
1. Attention-deficit and disruptive behavior disorders. In: Diagnostic and Statistical Manual of Mental Disorders
Fourth Edition Text Revision, 4 th ed, American Psychiatric Association, Washington, DC 2000. p.85.
2. Anxiety disorders. In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, 4 th
24 sur 28 14/06/2018 à 20:30

ed, American Psychiatric Association, Washington, DC 2000. p.429.

3. Mood disorders. In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, 4 th ed,
American Psychiatric Association, Washington, DC 2000. p.345.
4. Oppositional defiant disorder. In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text
Revision, 4 th ed, American Psychiatric Association, Washington, DC 2000. p.100.
5. Conduct disorder. In: Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision, 4 th
ed, American Psychiatric Association, Washington, DC 2000. p.93.
25 sur 28 14/06/2018 à 20:30

International classification of disease (10 th edition) diagnostic criteria for

hyperkinetic disorder
Inattentive symptoms (at least six)

Often fails to give close attention to details, or makes careless errors in school work, work or other activities.
Often fails to sustain attention in tasks or play activities.
Often appears not to listen to what is being said to him or her.
Often fails to follow through on instructions or to finish school work, chores, or duties in the workplace (not
because of oppositional behavior or failure to understand instructions).
Is often impaired in organizing tasks and activities.
Often avoids or strongly dislikes tasks, such as homework, that require sustained mental effort.
Often loses things necessary for certain tasks and activities, such as school assignments, pencils, books, toys, or
tools.
Is often easily distracted by external stimuli.
Is often forgetful in the course of daily activities.
Hyperactive symptoms (at least three)

Often fidgets with hands or feet or squirms on seat.
Leaves seat in classroom or in other situations in which remaining seated is expected.
Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, only
feelings of restlessness may be present).
Is often unduly noisy in playing or has difficulty in engaging quietly in leisure activities.
Exhibits a persistent pattern of excessive motor activity that is not substantially modified by social context or
demands.
Impulsivity symptoms
Often blurts out answers before questions have been completed.
Often fails to wait in lines or await turns in games or group situations.
Often interrupts or intrudes on others (eg butts into others' conversations or games).
Often talks excessively without appropriate response to social constraints.
Additional criteria
At least six inattentive symptoms, three hyperactive symptoms, and one impulsivity symptom have persisted for
at least six months, to a degree that is maladaptive and inconsistent with the developmental level of the child.
Onset of the disorder is no later than the age of seven years.
Criteria should be met for more than one setting (eg, at home and school).
The symptoms cause clinically significant distress or impairment in social, academic, or occupational functioning.
The patient does not meet criteria for pervasive developmental disorders, manic episode, depressive episode, or
anxiety disorders.
Adapted from International Statistical Classification of Diseases and Related Health Problems (ICD-10), 10 th edition,
American Psychiatric Association, 1992.
26 sur 28 14/06/2018 à 20:30

Resources for families of children with attention deficit hyperactivity disorder
Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD)

CHADD is a national advocacy organization for individuals affected by AD/HD and organizes local chapters for
information and support.
www.chadd.org
National Alliance for the Mentally Ill (NAMI)

NAMI is a national advocacy organization for individuals affected by mental illness. NAMI provides general
information and support opportunities for many mental illnesses.
www.nami.org
National Attention Deficit Disorder Association (ADDA)

ADDA is a non-profit, national organization that advocates for the needs of ADHD individuals and their families.
ADDA is a resource for a variety of information and current research and policy updates.
www.add.org
National Institute of Mental Health (NIMH)

The NIMH provides a number of booklets about ADHD that can be downloaded free of charge.
www.nimh.nih.gov/health/publications/adhd-listing.shtml
The United States Department of Education

The United States Department of Education, Office of Special Education Programs provides information on
educational policy and research related to ADHD.
www2.ed.gov/about/offices/list/osers/index.html
The American Academy of Child and Adolescent Psychiatry (AACAP)

The American Academy of Child and Adolescent Psychiatry provides fact sheets about AD/HD.
www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-Who-Cant-Pay-Attention-
Attention-Deficit-Hyperactivity-Disorder-006.aspx
ADHD: Attention deficit hyperactivity disorder.
27 sur 28 14/06/2018 à 20:30

Contributor Disclosures
Kevin R Krull, PhD Nothing to disclose Marilyn Augustyn, MD Nothing to disclose Mary M Torchia,
MD Nothing to disclose
Contributor disclosures are reviewed for conflicts of interest by the editorial group. When found, these are
addressed by vetting through a multi-level review process, and through requirements for references to be
provided to support the content. Appropriately referenced content is required of all authors and must
conform to UpToDate standards of evidence.
Conflict of interest policy
28 sur 28 14/06/2018 à 20:30

Attention Deficit Hyperactivity Disorder in Children and Adolescents Clinical Features and Diagnosis

Загружено:

Сведения о документе

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Attention Deficit Hyperactivity Disorder in Children and Adolescents Clinical Features and Diagnosis

Загружено:

Авторское право:

Доступные форматы

Attention deficit hyperactivity disorder in children and adolescents: Cli... https://www.uptodate.com/contents/attention-deficit-hyperactivity-diso...

Official reprint from UpToDate®

Author: Kevin R Krull, PhD

INTRODUCTION — Attention deficit hyperactivity disorder (ADHD) is a disorder that manifests in

Symptoms of hyperactivity and impulsivity may include [1]:

1 sur 28 14/06/2018 à 20:30

● Excessive fidgetiness (eg, tapping the hands or feet, squirming in seat)

● Feelings of restlessness (in adolescents) or inappropriate running around or climbing in younger

● Difficulty playing quietly

● Difficult to keep up with, seeming to always be "on the go"

● Difficulty waiting turns

● Blurting out answers too quickly

● Interruption or intrusion of others

Inattention — The predominantly inattentive subtype of ADHD is characterized by reduced ability to

Symptoms of inattention may include [1]:

● Failure to provide close attention to detail, careless mistakes

● Difficulty maintaining attention in play, school, or home activities

● Seems not to listen, even when directly addressed

● Fails to follow through (eg, homework, chores, etc)

● Difficulty organizing tasks, activities, and belongings

● Avoids tasks that require consistent mental effort

2 sur 28 14/06/2018 à 20:30

● Easily distracted by irrelevant stimuli

● Forgetfulness in routine activities (eg, homework, chores, etc)

3 sur 28 14/06/2018 à 20:30

performance and behavior [20]:

● How is your child doing at school?

● Have you or the teacher noticed any problems with learning?

● Is your child happy in school?

● Measurement of height, weight, head circumference, and vital signs

● Assessment of dysmorphic features and neurocutaneous abnormalities

● A complete neurologic examination, including assessment of vision and hearing

● Developmental milestones, particularly language milestones (table 2)

● Observation of parent-child interactions

4 sur 28 14/06/2018 à 20:30

● Completion of an ADHD-specific rating scale (see 'Behavior rating scales' above)

● Copies of report cards and samples of schoolwork

5 sur 28 14/06/2018 à 20:30

● Oppositional defiant disorder – Children with the combined or hyperactive-impulsive subtype of

6 sur 28 14/06/2018 à 20:30

Electroencephalography — Quantitative electroencephalography (qEEG) is a method of analyzing the

● Occupational therapy evaluation (motor coordination disorder) (see "Developmental coordination

7 sur 28 14/06/2018 à 20:30

Graves disease in children and adolescents", section on 'Diagnostic evaluation')

The symptoms of hyperactivity/impulsivity or inattention must [1]:

● Be present in more than one setting (eg, school and home)

● Persist for at least six months

● Be present before the age of 12 years

● Impair function in academic, social, or occupational activities

● Be excessive for the developmental level of the child

8 sur 28 14/06/2018 à 20:30

● Predominantly hyperactive-impulsive – ≥6 symptoms of hyperactivity-impulsivity for children <17

● Combined – ≥6 symptoms of inattention and ≥6 symptoms of hyperactivity-impulsivity for children <17

Diagnosis in adolescents — Establishing a new diagnosis of ADHD in adolescents can be challenging.

9 sur 28 14/06/2018 à 20:30

● Developmental variations – Developmental variations include intellectual disability, giftedness, and

● Neurologic or developmental conditions – Neurodevelopmental conditions that can mimic or co-

• Learning disabilities (see "Specific learning disabilities in children: Clinical features")

• Language or communication disorders (see "Etiology of speech and language disorders in

• Autism spectrum disorders (ASD); it is particularly important to consider ASD in preschool

• Neurodevelopmental syndromes (eg, fragile X syndrome, fetal alcohol syndrome, Klinefelter

• Metabolic disorders (eg, adrenoleukodystrophy, mucopolysaccharidosis type III) (see

10 sur 28 14/06/2018 à 20:30

INDICATIONS FOR REFERRAL — Evaluation by a pediatric specialist (eg, a psychologist, psychiatrist,