Case history
Case history #1
A 7-year-old boy is brought to the doctor because of academic difficulty at school and behavioural problems that first came to attention in preschool when the teacher was concerned about impulsive aggression. His mother reports that at home he runs around all day, needs multiple requests to pick up his toys, and can only sit still for a few seconds before 'growing bored'. A teacher's note states that he jumps queues, distracts his classmates, and loses his homework assignments, but appears bright and is able to finish his work when he is given individual supervision. His mother is concerned because other children are teasing him for being stupid. However, she reports that he is a sweet and motivated boy who does not talk back to teachers or adults and does not bully anybody. In the surgery, he is jumping up and down in the chair despite multiple requests by his mother to sit still. She notes that his 15-year-old brother was also hyperactive when he was younger and has persistent academic problems.
Case history #2
A 12-year-old girl presents to her general practitioner because of problems with school performance. She attends a large school, and her teacher has reported that she has not been turning in her homework and she is falling behind in maths. Her father hired a tutor and she seems to respond well to individual instruction, but cannot apply the lessons learned at school. In the surgery, it is noted that she is sitting calmly but is constantly fiddling with her mobile phone and is distracted by the toys in the room. She says that she does fine on tests but has difficulty focusing on homework. She still maintains an active social life and reports that her mood is fine.
Other presentations
Presenting symptoms of ADHD change in character as the patient gets older, with hyperactive symptoms prominent at younger ages, and inattentive symptoms more common in adolescents and adults.[10] Atypical presentations include newly recognised symptoms in adolescents and adults. All presentations are associated with comorbid diagnoses, including oppositional defiant disorder (ODD) in up to 54% to 84% of children and adolescents with ADHD, conduct disorder, smoking in 15% to 19% of patients, other substance use, learning or language problems in 25% to 35% of patients, and anxiety and mood disorders such as depression and mania.[4][5][6][7][10][11] Of note, girls more commonly have the inattentive presentation of ADHD and have lower comorbidity with ODD and conduct disorder.[10] Across all presentations, there are common associated symptoms, including irritability, boredom, and difficulty with peer interactions.
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