A 9-year-old boy is brought to the pediatrician due to poor school performance and difficulty making friends. His parents say he always had "very high energy," but they noticed that this got worse after they moved 8 months ago, which they attributed to a normal adjustment period. Over the past several months, however, the parents have received repeated phone calls from his teachers, reporting that he does not listen in class, has difficulty staying in his seat, turns in assignments late without his name, and frequently disrupts the class by talking out of turn. At home the boy forgets to do his daily chores, regularly loses his books and homework, and delays the family by taking too long getting ready for school in the morning. When his older brother teases him about this, the patient becomes irritable, and on a few occasions has shouted profanities and tried to hit his brother. Which of the following is the most likely explanation for this patient's behavior?

Question

A 9-year-old boy is brought to the pediatrician due to poor school performance and difficulty making friends.  His parents say he always had "very high energy," but they noticed that this got worse after they moved 8 months ago, which they attributed to a normal adjustment period.  Over the past several months, however, the parents have received repeated phone calls from his teachers, reporting that he does not listen in class, has difficulty staying in his seat, turns in assignments late without his name, and frequently disrupts the class by talking out of turn.  At home the boy forgets to do his daily chores, regularly loses his books and homework, and delays the family by taking too long getting ready for school in the morning.  When his older brother teases him about this, the patient becomes irritable, and on a few occasions has shouted profanities and tried to hit his brother.  Which of the following is the most likely explanation for this patient's behavior?

Quizplus · Accepted Answer

11ec160b_3603_25b4_9249_c9ac4bf7a3a7_MD0001_00 Attention-deficit hyperactivity disorder (ADHD) is a common behavioral disorder characterized by a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning in ≥2 settings (eg, school, home). Diagnosis requires the presence of symptoms before age 12 with ≥6 inattentive and/or hyperactive/impulsive symptoms for ≥6 months. This patient's combination of inattentive symptoms (ie, forgetful, disorganized, loses things) and hyperactive/impulsive symptoms (ie, difficulty staying seated, interrupts others) is characteristic of the combined subtype. ADHD is more common in boys; girls are more likely to have the inattentive subtype. (Choice A) Adjustment disorders are diagnosed when symptoms develop within 3 months of an identifiable stressor. This child's symptoms predated the family move. (Choice C) Although this child occasionally tries to hit his sibling when frustrated, he does not exhibit behavior that consistently violates major societal norms or the basic rights of others (eg, repeated aggression, property destruction, theft, deceitfulness, rule violations), which would characterize conduct disorder. (Choice D) Children with ADHD often experience difficulty with peer relationships due to their impulsive and disruptive behaviors. However, this child does not exhibit the excessive social anxiety and fear of negative peer evaluation that is characteristic of social anxiety disorder. (Choice E) Oppositional defiant disorder (ODD) involves a pattern of angry/irritable mood and argumentative/defiant behavior toward authority figures or vindictiveness. Although ODD may occur as a comorbid diagnosis with ADHD, this child's difficulty completing tasks, inability to sit still, and interrupting others at school are more likely related to his ADHD symptoms than to willfully defiant behavior. Educational objective: Attention-deficit hyperactivity disorder is characterized by a pattern of inattention and/or hyperactivity/impulsivity that interferes with functioning in ≥2 settings. __________ References: Attention-deficit/hyperactivity disorder (ADHD). (http://www.ncbi.nlm.nih.gov/pubmed/23202886)

A 9-Year-Old Boy Is Brought to the Pediatrician Due to Poor