Attention deficit hyperactivity disorder in children and adolescents: Clinical features andevaluation
AuthorKevin R Krull, PhD Section EditorsMarilyn Augustyn, MDSteven Parker, MD Deputy EditorMary M Torchia, MDLast literature review version 17.1: January 2009 | This topic last updated: February 13,2009 (More)
Attention-deficit/hyperactivity disorder (ADHD) is a disorder that manifestsin early childhood with symptoms of hyperactivity, impulsivity, and/or inattention. Thesymptoms affect cognitive, academic, behavioral, emotional, and social functioning (showtable 1)  .This topic review focuses on the clinical features and evaluation of ADHD. The epidemiology,pathogenesis, management, and prognosis of ADHD in children and adolescents and ADHD inadults are discussed separately. (See "Attention deficit hyperactivity disorder in children andadolescents: Epidemiology and pathogenesis" and see "Overview of the treatment andprognosis of attention deficit hyperactivity disorder in children and adolescents" and see"Pharmacotherapy for attention deficit hyperactivity disorder in children and adolescents" andsee "Adult attention deficit hyperactivity disorder").
ADHD is a syndrome composed of three categories of symptoms:hyperactivity, impulsivity, and inattention. The complaint regarding these symptoms mayoriginate from the parents, teachers, or other caregivers  . The symptoms may not beapparent in the structured setting of the clinic visit, but the pediatric care provider can ask theparents the following questions to elicit concerns regarding school performance and behavior : How is your child doing at school? Have you or the teacher noticed any problems withlearning? Is your child happy in school? Does your child have any behavioral problems atschool, home, or when playing with friends? Does your child have problems completing schoolassignments at school or home?Each of the core symptoms of ADHD has its own pattern and course of development.Hyperactivity
Hyperactive behavior is identified through excessive fidgetiness or talking,difficulty remaining seated when required to do so, difficulty playing quietly, and frequentrestlessness or seeming to be always "on the go" (show table 1).The hyperactive symptoms typically are observed by the time the child reaches four years of age and increase during the next three to four years  . They peak in severity when the childis seven to eight years of age, after which they begin to steadily decline. By the adolescentyears, the hyperactive symptoms are barely discernible.