Psychosocial screening with validated tools assists in identifying children and youths with core symptoms. A positive result on screening does not by itself indicate a diagnosis of attention-deficit/hyperactivity disorder. Follow the American Academy of Pediatrics attention-deficit/hyperactivity disorder guideline for identifying and evaluating children and teens 4 to 18 years of age.
General Psychosocial Screening/Results Suggesting Inattention, Impulsivity, and Hyperactivity | |
|---|---|
Screening instrument | Score |
Pediatric Symptom Checklist (PSC)-35 | A total score of >=24 for children aged ≤5 y. A total score of >=28 for those 6-16 y. A total score of >=30 for those aged >=17 y. and Further discussing items related to attention and impulse control and/or specific screening for inattention, impulsivity, and hyperactivitya confirm(s) a concern in that area. |
PSC-17 | Attention subscale is >=7. and Further discussing items related to attention and impulse control and/or specific screening for inattention, impulsivity, and hyperactivitya confirm(s) a concern in that area. |
Strengths and Difficulties Questionnaire (SDQ) (double-sided version with impact supplement) | A total symptom score of >19. A hyperactivity scale score of 7-10 (see instructions at www.sdqinfo.org). An impact scale score of 1 (medium impairment) or >=2 (high impairment). and Further discussing items related to attention and impulse control and/or specific screening for inattention, impulsivity, and hyperactivitya confirm(s) a concern in that area. |
a Specific screening tools for inattention, impulsivity, and hyperactivity (examples): Vanderbilt Assessment Scales, Conners’ Rating Scales-Revised (CRS-R).
Adapted from Wissow LS. Inattention and impulsivity. In: Foy JM, ed. Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians. American Academy of Pediatrics; 2018:587.
Condition | Rationale |
|---|---|
All children who seem inattentive should be screened for sensory deficits. | |
Sleep deprivation | Sleep problems can cause inattention and irritability. ADHD may contribute to difficulty sleeping. |
ADHD | Diagnosis requires that a child have symptoms for at least 6 mo, appearing before the age of 12 y and occurring in at least 2 settings (eg, home and school); involving a persistent pattern of inattention (eg, careless with detail, seems not to listen, poorly organized, distractible, forgetful, does not finish tasks, loses things, avoids tasks that require sustained attention) or hyperactivity-impulsivity (eg, fidgety, noisy, talkative, cannot wait one’s turn, has difficulty staying in one’s seat, interrupts, has a high level of motor activity) or both; interfering with functioning or development; and not better explained by some other condition or situation in which the child finds themselves.a |
Learning problems or disabilities | If symptoms of inattention and/or hyperactivity-impulsivity are associated with problems of school performance, the child may be experiencing learning difficulties. |
Developmental problems, including autism spectrum disorder | Children with overall intellectual or developmental limitations may seem less able than their age-mates to control their impulses and to focus and maintain their attention. |
Language impairment or disorder | Children with receptive or expressive language impairment may be frustrated and inattentive at least in part because of difficulty either understanding what others say or being able to express themselves. Similar problems can arise when children are learning a new language and cannot yet fully function at the level of their peers or teachers. |
Depression | May co-occur with ADHD. Marked sleep disturbance, disturbed appetite, low mood, or tearfulness could indicate that depression is a factor contributing to attention difficulties. |
Exposure to adverse childhood experiences | Children who have experienced or witnessed trauma, violence, a natural disaster, separation from a parent, parental divorce or separation, parental substance use, neglect, or physical, emotional, or sexual abuse are at high risk of developing symptoms suggesting inattention and impulsivity. These symptoms may mask or be expressions of emotional difficulties such as adjustment disorder or posttraumatic stress disorder. Some symptoms of posttraumatic stress disorder may resemble symptoms of ADHD (eg, hypervigilance may mimic hyperactivity, dissociation may mimic inattention). These children may also have other forms of anxiety. Inquiring about previous trauma in a confidential setting is important. |
Anxiety | Children who feel anxious may experience difficulty concentrating. |
Bereavement | Most children experience the death of a family member or friend sometime in childhood. Other loss may also trigger grief responses, for example, separated or divorced parents, relocation, changed school, deployed parent in a military service, breakup with a girlfriend or boyfriend, or remarried parent. Such loss is traumatic. It may result in such symptoms as sadness, anxiety, difficulty concentrating, poor impulse control, or academic decline immediately following the loss and, in some instances, more persistent symptoms. |
Physical illness | Medical issues that can mimic or provoke symptoms of inattention and impulsivity include thyroid disease, hypoglycemia, hyperglycemia, unwanted side effects of medications (eg, bronchodilators), and endocrine tumors (eg, rarely, pheochromocytoma). |
Substance use | Youths with symptoms of inattention, impulsivity, and hyperactivity may self-medicate with alcohol, nicotine, or other drugs. Conversely, those using substances may have inattention, impulsivity, hyperactivity, and deteriorating school performance. |
Conduct or oppositional defiant disorder | See 4f, later in this tab, to differentiate these symptoms from problems of inattention and impulsivity and ADHD. |
Tourette syndrome | Children with repetitive movements (tics) should be identified. In children with Tourette syndrome, ADHD symptoms may precede the onset of tics. Stimulant medication may worsen tics. It is important to tailor treatment to the child’s most pressing symptoms before deciding the risks and benefits of using stimulants in children with both problems. |
Abbreviation: ADHD, attention-deficit/hyperactivity disorder.
a For specific criteria, refer to the Diagnostic and Statistical Manual of Mental Disorders.
Adapted from Wissow LS. Inattention and impulsivity. In: Foy JM, ed. Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians. American Academy of Pediatrics; 2018:588-590.
Pediatric clinicians can meaningfully intervene, by using “common elements” of evidence-based approaches such as parent training in behavior management, even in the absence of a diagnosis.
Adapted from Wissow LS. Inattention and impulsivity. In: Foy JM, ed. Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians. American Academy of Pediatrics; 2018:593-594.