An 8-year-old boy presents to his pediatrician. His parents are concerned about increasingly bad reports from his teachers at school as well as his behavior at home. His teachers report that he often does not complete homework or classwork, and the work he does submit is generally incomplete/poorly completed and disorganized. He seems as if he is not listening and has difficulty following directions. He is forgetful and regularly loses things — clothing, homework, school supplies, and personal items. His grades have dropped over the course of the school year. These issues have extended to his friendships. His classmates and friends become frustrated with him because he leaves games abruptly after a short period of time, walking away because he is bored and "doesn't want to play anymore." His peers find him annoying and often call him "a pain." Many children have expressed that they no longer wish to play with him or to invite him to join in group activities.
At home, it is a very similar story. His mother reports that her son is easily bored, has never been particularly interested in school, and loses interest very quickly in any type of activity that requires extended focus. His siblings often get frustrated with him and complain that he is annoying and no fun. His room is very messy, despite continued efforts to help him keep it organized. He often loses toys, clothing, and other belongings and forgets to do things he is asked to do. He does not appear to listen and frequently makes mistakes as a result.
Physical exam reveals that the child seems bored and fidgety. He cannot sit still. He is not following the conversation and has trouble remaining on topic when answering questions. He appears to hear and comprehend the doctor's question. He acts as if distracted. However, his mood is euthymic. His appearance and behavior are otherwise normal. He does know where he is and the date, and his memory appears to be intact.
The patient's medical history is unremarkable. Pregnancy and birth were uneventful, and he has had no major illnesses or events. He is up-to-date on all his vaccinations. There is no family history of mental illness.
