significant dysfunction of family life (see Case Studies in Box 3, below).16 The pressure on the family can cause parental anxiety/depression and parents may feel that they are failing. Children and adolescents with ADHD may be unable to fulfil their learning potential and often achieve poor academic outcomes: there is a higher incidence of truancy, dropping out of school, and expulsion.

Box 3: Example case histories

DannyDanny was a 14-year-old boy whose parents mentioned their concerns about his difficult and unruly behaviour to the GP over the years. He had been given a second fixed-term exclusion from school. From an early age, Danny was argumentative and oppositional, very black and white in his points of view and never wrong. It was always someone else’s fault. At preschool, his parents thoughtthat he was very bright. He spoke early, took great interest in things around him, and had lots of friends. As the years went by, he very much underachieved. His self-esteem was low and he really did not enjoy anything much in life.

The GP referred Danny for an assessment and he was diagnosed with ADHD, which had been masked by his giftedness. A trial of psychostimulant medication strengthened his concentration and impulse control and over the next few months there was a clear improvement in his academic standard, self-esteem, and motivation.

BridgetBridget was a 7-year-old girl whose parents expressed their concern to their GP that she was saying she was not good at anything, she did not want to go to school, and she had no friends. They noted