Evaluating the hyperactive child in your office: is it ADHD?

When confronted with the complaints of hyperactivity and impulsivity in a child, the family physician may find it tempting to initiate a complex process leading to the diagnosis of attention-deficit hyperactivity disorder, which is arguably the most prevalent neurobiologic disorder in childhood. While the diagnosis of attention-deficit hyperactivity disorder cannot be made solely on the basis of office visits, a practical strategy for an initial assessment of hyperactivity and impulsivity in the examination room is extremely important. Careful observation of the child's behavior and strategic questioning of the parents can be helpful in differentiating volitional misbehavior from the neurologically based lack of behavioral control in attention-deficit hyperactivity disorder. A skilled initial office assessment allows more effective use of behavioral checklists and neuropsychologic tests, increases diagnostic confidence and provides a yardstick for measuring the effectiveness of treatment.