ADHD: Model Clinical Case and Viva Q&A

Clinical Case of ADHD

Clinical Case: 8-year-old boy with ADHD

Patient: Alex, an 8-year-old boy

Presenting Complaints:

  • Difficulty concentrating in class
  • Frequent fidgeting and inability to sit still
  • Impulsive behavior, often interrupting others
  • Poor academic performance despite normal intelligence

History:

Alex's parents report that he has always been an energetic child, but his behavior has become increasingly problematic since starting school. His teacher notes that he often daydreams during lessons, has trouble following instructions, and frequently disrupts the class. At home, Alex struggles to complete homework and chores, often losing or forgetting necessary items.

Clinical Observations:

  • Constantly moving or fidgeting during the examination
  • Difficulty maintaining eye contact
  • Easily distracted by external stimuli
  • Interrupts the examiner frequently

Assessment:

Based on the clinical presentation, history, and observations, Alex meets the DSM-5 criteria for Attention-Deficit/Hyperactivity Disorder, Combined Presentation. Further neuropsychological testing and a detailed evaluation of his academic performance are recommended to rule out any comorbid conditions and to develop an appropriate treatment plan.

Management Plan:

  1. Initiate behavioral therapy focusing on organizational skills and impulse control
  2. Consider pharmacological treatment with methylphenidate after discussing risks and benefits with parents
  3. Implement classroom accommodations (e.g., preferential seating, frequent breaks)
  4. Parent training in behavior management techniques
  5. Regular follow-up to monitor progress and adjust treatment as needed


Clinical Presentations of ADHD

Varieties of Clinical Presentations of ADHD

  1. Predominantly Inattentive Presentation:

    • Difficulty sustaining attention in tasks or play
    • Appears not to listen when spoken to directly
    • Fails to follow through on instructions and finish schoolwork
    • Easily distracted by extraneous stimuli
    • Forgetful in daily activities

  2. Predominantly Hyperactive-Impulsive Presentation:

    • Fidgets with hands or feet, squirms in seat
    • Leaves seat in situations where remaining seated is expected
    • Runs about or climbs excessively in inappropriate situations
    • Difficulty engaging in leisure activities quietly
    • Talks excessively and blurts out answers
    • Difficulty waiting turn and often interrupts others

  3. Combined Presentation:

    • Exhibits symptoms from both inattentive and hyperactive-impulsive presentations
    • Struggles with focus, organization, and impulse control
    • Displays physical restlessness and verbal interruptions

  4. ADHD with Emotional Dysregulation:

    • Exhibits intense emotional reactions
    • Struggles with mood swings and irritability
    • Has difficulty regulating emotions in social situations
    • May display temper outbursts or periods of sadness

  5. ADHD with Executive Function Deficits:

    • Significant difficulties with planning and organization
    • Poor time management skills
    • Struggles with prioritizing tasks
    • Difficulty initiating and completing complex tasks

  6. ADHD with Learning Disorders:

    • Presents with comorbid specific learning disorders (e.g., dyslexia, dyscalculia)
    • Academic performance significantly below expected level
    • May have difficulties in reading, writing, or mathematics

  7. ADHD with Anxiety:

    • Displays symptoms of anxiety alongside ADHD
    • May exhibit excessive worry or fear
    • Physical symptoms such as restlessness or muscle tension
    • Social anxiety may be prominent

  8. ADHD in Adolescents:

    • Symptoms may become more subtle or internalized
    • Increased risk-taking behaviors
    • Academic and social difficulties become more pronounced
    • May struggle with time management and long-term planning


Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30


Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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