A 7-year-old boy presents to the primary care clinic accompanied by his mother, who is concerned about his behavior at school and home. His teacher reports that for the past year, he has had significant difficulty staying in his seat, constantly fidgets with his hands, blurts out answers before questions are finished, and is easily distracted by any noise. At home, his mother notes he rarely follows through on instructions, frequently loses his toys, and acts as if “driven by a motor”.

His academic performance is declining, and he struggles to maintain friendships. His developmental milestones were met on time. Family history is notable for a paternal uncle with similar childhood behaviors. He has no known allergies and takes no daily medications. He is afebrile. His blood pressure is 98/60 mmHg with a heart rate of 88 bpm.