The energizer bunny meets Shirley temple: Attention deficit hyperactivity disorder, combined type

She will not sit still and be quiet! She just goes and goes nonstop. Jenna 's exasperated mother moaned during the initial clinical interview. Her voice was tinged with both frustration and guilt over her reactions to her daughter 's behavior that occasionally resulted in abrupt, sharp rebukes. In addition, Jenna herself had begun to realize that something was wrong. This previously effervescent and optimistic child began to remark that she was stupid and dumb and was being ridiculed by peers at school. Historically, Jenna was a highly energetic toddler who talked excessively. Although never significantly or consistently oppositional or argumentative, her behavior became increasingly more difficult to control as she grew older. Jenna 's mother noted that she literally played all day long and seemingly never tired. In addition, it was impossible for her to sit down appropriately for longer than a few minutes at a time. She constantly fidgeted, kicked her legs, or touched objects. Cognitively, she had extreme difficulty staying focused and on-task, and needed frequent redirection or a quiet, nonstimulating environment to complete work. She had a tendency to be impulsive, rushing through her school assignments, which resulted in careless mistakes. She had organizational problems in her day-to day-activities (e.g., frequently losing objects or articles of clothing). Academically, she had always been an average to above average student, but starting in the second grade she began to demonstrate some struggles in mathematics, spelling, and handwriting. Her mother 's perception was that Jenna 's difficulties in these academic areas were not reflective of a skill deficit but, rather, extreme problems with sustained focus and impulsivity.