Snapshot An 11-year-old boy presents with a chief complaint of poor performance in school. History obtained from the mother reveals that he often is disorganized and turns in assignments late, incomplete, or not at all. He has also had trouble making friends as he cannot participate in organized play, nor can he follow the rules of any games during recess. His father explains that he does not listen at home, cannot sit still to complete his homework, never completes his chores, and is always interupting his siblings at the dinner table. Upon examining the child you discover a fidgety, young boy who talks non-stop and has trouble staying on topic when you ask him questions. Introduction Overview a neurodevelopmental/psychiatric disorder characterized by hyperactivity, impulsivity, and inattention Epidemiology demographics 10:1 male:female ratio onset before age 12 Associated conditions learning disabilities oppositional defiant disorder conduct disorder tic disorders substance abuse Prognosis 50% will have symptoms into adulthood Presentation Symptoms 18 symptoms exist in the DSM-V (6 symptoms must be present in children and 5 in adults for diagnosis) symptoms must occur in at least 2 different settings (e.g., home and school) be present before the age of 12 last for 6 months or longer most common symptoms include hyperactivity and impulsivity login to view 9 more bullets inattention login to view 9 more bullets Treatment Medical cognitive behavioral therapy first-line for preschool-aged children (< 6 years of age) adjunct therapy for school-aged children, adolescents, and adults stimulants first-line therapy for school-aged children (6 years of age or older) increase presynaptic norepinephrine and dopamine by inhibiting the reuptake resulting in increased frontal lobe activity and impulse control login to view 2 more bullets nonstimulants second-line therapy for school-aged children login to view 12 more bullets