, 1. History of Present Illness (HPI)
Chief Complaint (parent's words):
"Avery just can't seem to focus. Homework takes hours, and the teacher says she's
'in her own world.'"
Symptom Analysis (OLDCARTS):
• Onset: Symptoms noticed since early elementary school (age 6-7), but
worsened significantly in 4th grade due to increased organizational
demands.
• Location: Symptoms occur at school, home, and during structured
activities (sports, chores). Less noticeable during highly engaging tasks
(video games, art).
• Duration: ≥6 months (actually several years per parent recall).
• Character:
o Easily distracted by external stimuli (e.g., pencil tapping, hallway
noise).
o Frequently loses items (homework folder, jacket, water bottle).
o Avoids/dislikes tasks requiring sustained mental effort
(worksheets, reading comprehension).
o Makes careless mistakes in math (e.g., adds instead of multiplies).
o Does not seem to listen when spoken to directly.
o Fails to finish chores or schoolwork.
o Poor time management (takes 2 hours to do 20 minutes of math).
• Alleviating factors: One-on-one instruction, quiet environment, frequent
redirection, movement breaks.
• Radiating/related: No tics. No hyperactivity. No aggression.
• Timing: Symptoms present daily, from morning routine through bedtime.
Worse in the afternoon (mental fatigue).
• Severity: Moderate. Academic performance is 1-2 grades below expected
in math and reading fluency. Socially – has 1-2 friends but often "zones
out" during group play.
Key iHuman Interview Questions to Ask:
• "Does Avery fidget or run around excessively?" → No (rules out
combined/hyperactive type).
• "How is sleep?" → Typically adequate, but procrastination leads to late
bedtimes.
• "Any trouble with transitions?" → Yes, especially switching from a
preferred activity (art) to a non-preferred one (math).
Chief Complaint (parent's words):
"Avery just can't seem to focus. Homework takes hours, and the teacher says she's
'in her own world.'"
Symptom Analysis (OLDCARTS):
• Onset: Symptoms noticed since early elementary school (age 6-7), but
worsened significantly in 4th grade due to increased organizational
demands.
• Location: Symptoms occur at school, home, and during structured
activities (sports, chores). Less noticeable during highly engaging tasks
(video games, art).
• Duration: ≥6 months (actually several years per parent recall).
• Character:
o Easily distracted by external stimuli (e.g., pencil tapping, hallway
noise).
o Frequently loses items (homework folder, jacket, water bottle).
o Avoids/dislikes tasks requiring sustained mental effort
(worksheets, reading comprehension).
o Makes careless mistakes in math (e.g., adds instead of multiplies).
o Does not seem to listen when spoken to directly.
o Fails to finish chores or schoolwork.
o Poor time management (takes 2 hours to do 20 minutes of math).
• Alleviating factors: One-on-one instruction, quiet environment, frequent
redirection, movement breaks.
• Radiating/related: No tics. No hyperactivity. No aggression.
• Timing: Symptoms present daily, from morning routine through bedtime.
Worse in the afternoon (mental fatigue).
• Severity: Moderate. Academic performance is 1-2 grades below expected
in math and reading fluency. Socially – has 1-2 friends but often "zones
out" during group play.
Key iHuman Interview Questions to Ask:
• "Does Avery fidget or run around excessively?" → No (rules out
combined/hyperactive type).
• "How is sleep?" → Typically adequate, but procrastination leads to late
bedtimes.
• "Any trouble with transitions?" → Yes, especially switching from a
preferred activity (art) to a non-preferred one (math).
