Summary
Emma, a 7-year-old girl, is referred to a psychiatrist by her teacher due to concerns about her ability to focus and complete tasks in the classroom. She presents with:

• Displaying inattention, distractibility, and poor concentration
• Poor academic performance resulting in problems with her grades
• Parents describing difficulty in following directions, disorganization, and forgetfulness
• No symptoms of depression, psychosis, blank stare episodes, or developmental problems

Most Likely Diagnosis: Attention-deficit/hyperactivity disorder (ADHD), predominantly inattentive presentation

Diagnostic Steps:
The diagnosis of ADHD requires evidence of persistent inattention that interferes with academic or social functioning. A clinical interview with parents and teachers, along with validated ADHD rating scales (such as the Vanderbilt Assessment Scales or Conners Rating Scales), should be used to assess symptoms across different settings. A comprehensive neuropsychological evaluation may be beneficial to rule out learning disabilities or other cognitive impairments. Additional assessments should include ruling out environmental or emotional factors contributing to inattentiveness.

Role of the Psychiatrist in the Care of This Patient:

The psychiatrist plays a crucial role in confirming the diagnosis, educating the family about ADHD, and discussing evidence-based treatment options. Treatment recommendations include:

• Pharmacological interventions – A psychostimulant (e.g., methylphenidate or amphetamine-based medication) or atomoxetine (a non-stimulant alternative) may be prescribed to improve focus and impulse control.
• Behavioral interventions – Parent training in behavior management (PTBM) can help caregivers implement structured routines and positive reinforcement strategies at home.
• Classroom accommodations – Behavioral classroom management programs, preferential seating, and individualized education plan (IEP) or 504 plan modifications may be necessary to support her academic progress.
• Regular follow-ups – Ongoing psychiatric and medical monitoring is essential to assess treatment efficacy, address side effects, and provide continued guidance for the family and school.