A healthy 8-year-old boy is brought to the office by his parents for an annual checkup. Both parents express concern about their son's behavior. The mother says, "He never listens and I am always worried that he is going to run out into the street without looking. He rarely sits still and is always running and jumping on the furniture." The father adds, "He talks all the time, interrupts me when I'm speaking, and, despite multiple reminders, forgets to do his chores and misplaces or loses his books or sporting equipment. We thought he would grow out of it as he got older, but it seems to be getting worse." Physical examination is unremarkable. Which of the following would be most helpful in establishing the diagnosis?

Question

A healthy 8-year-old boy is brought to the office by his parents for an annual checkup.  Both parents express concern about their son's behavior.  The mother says, "He never listens and I am always worried that he is going to run out into the street without looking.  He rarely sits still and is always running and jumping on the furniture."  The father adds, "He talks all the time, interrupts me when I'm speaking, and, despite multiple reminders, forgets to do his chores and misplaces or loses his books or sporting equipment.  We thought he would grow out of it as he got older, but it seems to be getting worse."  Physical examination is unremarkable.  Which of the following would be most helpful in establishing the diagnosis?

Quizplus · Accepted Answer

11ec160b_3605_4896_9249_c1618bf5b44a_MD0001_00 This patient's inattention, inability to sit still, and impulsivity are concerning for possible attention-deficit hyperactivity disorder (ADHD). The diagnosis of ADHD is made clinically and requires evidence of symptoms in ≥2 settings (eg, home, school, after-school program). Demonstration of functional impairment due to symptoms (eg, academic difficulties, impaired social relationships, peer rejection) is also required. Obtaining teacher evaluations to determine if the symptoms extend beyond the home environment would be the most helpful step in establishing the diagnosis. Teachers can provide observations of classroom behavior over an extended period (eg, 6 months) and assist in determining if the symptoms are excessive compared to same-age peers (eg, comparative degree of inattentiveness, difficulty staying seated and/or following directions, talkativeness, disruptive classroom behavior). Teacher evaluations may also incorporate validated ADHD-specific rating scales, which can help assess core symptom severity and monitor response to treatment. (Choices A and C) Brain imaging and EEG are not performed routinely in the work-up of ADHD in the absence of other neurological symptoms. They would not be indicated in this patient with no other medical history and a normal physical examination. (Choice B) A hearing test is not routinely performed in the initial evaluation of ADHD, and hearing impairment would have likely been identified by this age. However, a hearing test should be performed if coexisting hearing impairment is suspected. (Choice D) A speech and language evaluation would be warranted if the patient had problems with speech articulation/production or his language development was delayed. (Choice F) Toxicology screening is not routinely performed in the assessment of ADHD. It is less likely to be helpful in the assessment of this patient who lacks any history pointing to medical illness or substance use. Educational objective: Diagnosis of attention-deficit hyperactivity disorder requires evidence of inattentive and/or hyperactive/impulsive symptoms for ≥6 months in ≥2 settings (eg, home, school, after-school program). Teacher evaluations can assist in diagnosis. __________ References: Diagnosis and management of ADHD in children. (http://www.ncbi.nlm.nih.gov/pubmed/25369623)

A Healthy 8-Year-Old Boy Is Brought to the Office by His