COMMENTARY

Differential Diagnosis of ADHD in School-Age Children

Adelaide S. Robb, MD

Disclosures

September 26, 2006

In This Article

Evaluation and Treatment

A workup for a school-age child presenting with ADHD should include a careful history of the mother's pregnancy and the child's birth, developmental milestones, and medical history, as well as family history of psychiatric and medical illnesses. Any previous educational, achievement, and speech and language testing should be reviewed and, if not available, may be performed, typically by a psychologist, to assist in educational planning.

When indicated, testing to evaluate the differential includes a lead screen, thyroid function tests, HIV and Lyme titers, electroencephalogram, genetic testing, sleep study, and thorough physical exam. A psychiatric history of the child and a review of any psychosocial stressors or losses should be completed. A mental status exam of the child including an evaluation of cognition and memory also should be performed.

Treatment should begin with the primary medical or psychiatric disorder, whether it is ADHD or another disorder on the differential diagnosis.[7] Stabilization of any cardiovascular and neurologic illnesses should be completed first to minimize changes in blood pressure or seizure frequency that might occur with the commonly used ADHD medications.[8,9] A thorough assessment can lead to the correct diagnosis and successful treatment in the school-age patient presenting with symptoms of inattentive or combined type ADHD.

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