ADD is a disorder characterized by inability to focus attention enough to complete tasks. Patients typically display a persistent pattern of inattention or are very active and impulsive, or both, that is more severe than is typically observed in their peers. The vast majority of ADD children come to the physician’s attention during their primary grades. The task for the physician is to elicit a history from the patient, parents, and teachers that supports the diagnostic criteria. Then the physician must perform a physical examination and possibly laboratory studies that could demonstrate underlying organic problems. Physical examination of the ADD patient is important to rule out other causes of hyperactivity, but no specific features are uniformly noted with ADD. ADD is often misdiagnosed.

Symptoms
At least six of the following symptoms of inattention or hyperactivity-impulsivity must be in evidence for 6 months or longer:

1. Inattention
1. Lack of attention to details or careless mistakes in schoolwork, work, or other activities
2. Difficulty sustaining attention to tasks or play activities
3. Impression of not listening when spoken to directly
4. Failure to follow through on instructions or finish schoolwork or duties
5. Difficulty organizing tasks and activities
6. Avoidance or dislike of tasks that require sustained mental effort, such as schoolwork or homework duties
7. Tendency to lose things necessary for tasks or activities, such as toys, school assignments, pencils, books, or tools.
8. Hyperactivity
9. Fidgeting
10. Excessive talking
11. Impulsivity
12. Difficulty awaiting turn
13. Tendency to interrupt or intrude on others (e.g., butting into conversations or games)
14. Difficulty engaging in leisure activities quietly

Diagnosis
A. Office screening test.
B. Presence of symptoms as above
C. Progress reports by teachers and parents.
D. Standardized questionnaires
E. Not enough history is available in many instances.
F. Problem behavior may not always be observable in the office.
G. Laboratory tests and radiographic tests are of little assistance.

Physical Examination
A. The biggest payoff in the physical examination is to note multiple minor injuries, such as scratches, bruises, and scars, because these patients are accident-prone.
B. Occasionally, it may be noted that the tags have been cut off in the patient’s shirt or underwear. This phenomenon occurs because ADD individuals cannot tolerate the extra stimulus of a tag touching their skin.