Jimmy was not seen as a "bad" child by his parents; he was not ill tempered, oppositional, or aggressive. But he was in constant motion and often wandered off, sometimes getting into dangerous situations such as running into the road without looking and putting keys in an electric socket. Jimmy frequently did not follow through on his parents requests, although this did not appear to be deliberate. Rather, it seemed that Jimmy just got sidetracked by things he found more interesting. He had constantly to be reminded to stay on task. His parents adopted an active style of dealing with him -- monitoring him, reminding him, using immediate reinforcement and punishment.

When Jimmy was enrolled in preschool, his inattention, overactivity, and impulsive behaviors led his parents to withdraw him from one programs and his being asked to leave a second program. Among the difficulties were talking out of turn, dropping out of group activities, distracting others, and engaging in too much imaginative play. Similar kinds of behaviors were reported in kindergarten, where he had problems focusing attention, being too active, and being unable to work independently. An evaluation at that time showed Jimmy to have high average intelligence but achieving at somewhat lower levels.

By first grade, Jimmy's impulsivity began to interfere with his social relationships. He was described as immature and silly. His peers complained of his bothering them, grabbing them, and pulling them, and although Jimmy was friendly, he was unable to maintain friendships. His behavior, more acceptable at early ages, was no longer accepted by peers. Teachers too had complaints. The coach of his little league baseball team noted an inability to participate in organized sports and that Jimmy was off-task and silly. In the classroom he fails to follow instructions, often does not complete his work on time, and disrupts others by his constant activity and noise making. The teacher uses behavioral interventions to help Jimmy stay on task. These have met with with minimal success.

A subsequent evaluation indicated that Jimmy was above average in intelligence with deficits in sustained attention on a continuous performance test, and with a history of chronic and pervasive inattention and hyperactivity-impulsivity. These problems have impaired his social relationships and academic work. No other psychiatric disorder is present at this time.