[Unusual forms of clinical presentation of attention deficit hyperactivity disorder]

Attention deficit hyperactivity disorder (ADHD) is one of the most frequently observed processes in our Neuropaediatric unit, and in recent years has become one of the leading reason for visits, together with headaches. On occasions, the diagnosis that should be made, in accordance with the criteria included in the DSM IV, is more difficult because initially they are patients who visit because of some other problem that becomes the centre of our clinical attention. Headaches, in our experience, are the main reason for visiting in these cases. A careful review of the patient's history and a physical examination, together with their observation during the interview, lead us to suspect a genuine case of ADHD underlying the problem that presents with other non specific symptoms. These patients are mainly boys and, less frequently, girls who see how the chances of academic and social failure increase and then become worried to such an extent that they start suffering from important tension type headaches. Concentrating the study and the therapy on just solving the problem of the headaches sometimes gives rise to therapeutic failure, which occasionally goes on for months. Other symptoms, such as tics, unspecific dizziness, pains in the abdomen and visual disorders, can also be the reason that brings ADHD patients to visit.

When faced with these symptoms we should always bear in mind (mainly in the case of headaches) the possibility referred to above and special care must be taken not to diagnose ADHD in excess, and always base our judgment on objective proof that meets the criteria required for its diagnosis. Therapy based on pharmacological treatment and a suitable psychopedagogical intervention solves the problem in these cases and significantly reduces the symptomatology that led to the visit.