ABSTRACT
This chapter presents a case of a 7-year-old boy who appears in the accident and emergency department having banged his head after falling from a garage roof. He vomited once after this but has not become unconscious or had any loss of power or sensation. His teachers report to the parents that he is a fidget, up and down out of his chair, and that he has very poor concentration. Organic problems also need to be considered including epilepsy, fragile X syndrome and neurodegenerative disorders. It is not a diagnostic test because it improves concentration in most children, but can be particularly helpful for children with ADHD. Drug holidays at least every year are helpful during summer breaks to review progress and check the need for ongoing medication. A variety of second-line medications have been used if stimulants are not effective, including clonidine, atomoxetine, and tricyclics.
