Last year John fell out of a tree and hit his head requiring a visit to the emergency room. When asked to clean his room or set the table, John complies but quickly gets distracted. He requires multiple reminders to complete tasks. They wonder why they have not been able to effectively improve John's behavior despite using time-out, removal of privileges and rewards and are now spanking him. The symptom complex of inattention, impulsivity and increased activity should cross environments and be present since early childhood.
Psychosocial factors can inhibit the development of coping mechanisms.
Repeated failures can lead to school avoidance, low self-esteem and depression. Stress in the home may be extremely high by the time families arrive in the office. These comorbid conditions must be identified and addressed in the treatment plan. Clinicians must identify the appropriate resources in their community to ensure thorough evaluation and treatment. Testing to rule out a comorbid learning disability can often be arranged with the school psychologist or local private psychologist.