What could be the diagnosis for an 11-year-old girl who has difficulty staying focused, gets easily distracted, avoids multitasking, and spends a significant amount of time on electronic devices, with these symptoms being consistent at both school and home?

Diagnosis: Attention-Deficit/Hyperactivity Disorder (ADHD), Predominantly Inattentive Type

This 11-year-old girl meets diagnostic criteria for ADHD, predominantly inattentive type, based on her inability to maintain focus, easy distractibility, avoidance of tasks requiring sustained mental effort (multitasking), and consistent symptoms across both home and school settings. 1

Diagnostic Criteria Met

The presentation aligns with DSM-5 criteria for ADHD requiring:

• At least 6 inattentive symptoms present for at least 6 months (she demonstrates difficulty concentrating, easy distractibility, difficulty completing tasks, and avoidance of sustained mental effort) 1
• Symptoms present in 2 or more settings (both school and home confirmed) 1
• Onset before age 12 years (she is currently 11 years old) 1
• Evidence of functional impairment (inability to complete homework, problems with multitasking) 1

Key Inattentive Symptoms Present

Based on the clinical presentation, she exhibits:

• Difficulty sustaining attention on tasks (cannot stay focused, loses focus during work) 1
• Easily distracted (gets distracted while doing work) 1
• Difficulty completing tasks (homework not finished, avoids multitasking) 1
• Reluctance to engage in tasks requiring sustained mental effort (her reaction to multitasking suggests avoidance) 1

Gender-Specific Considerations

Girls with ADHD frequently present with predominantly inattentive symptoms rather than hyperactivity, making the diagnosis easier to miss compared to boys who more commonly display disruptive hyperactive behaviors. 1, 2 This child's presentation is classic for how ADHD manifests in girls—less obvious externalizing behaviors but significant functional impairment. 2

Screen Time as a Red Herring

The excessive electronic device use mentioned by the relative is likely a consequence rather than a cause of her attention difficulties. 3 Children with ADHD often gravitate toward high-stimulation activities like electronics because these provide immediate feedback and novelty that temporarily compensates for their attention regulation difficulties. 3 However, rule out that screen time itself isn't exacerbating symptoms or masking other issues.

Differential Diagnoses to Exclude

Before confirming ADHD, systematically rule out:

• Depression or anxiety disorders (can mimic attention problems; look for mood changes, excessive worry, sleep disturbance, appetite changes) 4, 3
• Learning disabilities (specific academic skill deficits beyond general inattention) 5, 6
• Sleep disorders (insufficient or poor-quality sleep causing daytime inattention) 3
• Trauma or significant psychosocial stressors (recent family changes, bullying, abuse) 4

Recommended Diagnostic Approach

Obtain collateral information from multiple sources:

• Teacher rating scales documenting specific classroom behaviors and academic performance 1, 5
• Parent/guardian structured interviews about developmental history and symptom onset 4, 5
• Review of academic records looking for patterns of incomplete work, inconsistent performance, or teacher comments about attention 4, 5
• Screen for comorbid conditions particularly anxiety and depression, which co-occur frequently in girls with ADHD 2, 3

Treatment Recommendations

For an 11-year-old with confirmed ADHD, initiate stimulant medication as first-line treatment combined with behavioral interventions:

Pharmacotherapy (First-Line)

• Methylphenidate or amphetamine-based stimulants are first-line for this age group 1, 4
• Initial dosing for children >70 kg: Start atomoxetine at 40 mg daily if stimulants are contraindicated, increasing to target dose of 80 mg after minimum 3 days 7
• Initial dosing for children <70 kg: Start atomoxetine at 0.5 mg/kg daily, increasing to target of 1.2 mg/kg after minimum 3 days (maximum 1.4 mg/kg or 100 mg, whichever is less) 7
• Monitor for suicidal ideation when starting atomoxetine, as it carries a black box warning for increased suicidal thoughts in children and adolescents 7

Behavioral Interventions (Essential Adjunct)

• Parent training in behavior management focusing on organizational strategies, homework routines, and positive reinforcement 1, 3
• School accommodations including preferential seating, extended time for assignments, breaking tasks into smaller steps 1, 3
• Organizational skills training for the child directly 3

Critical Pitfalls to Avoid

• Do not rely solely on parent report—obtain teacher input and review school records to confirm cross-setting impairment 4, 5
• Do not attribute all attention problems to screen time—while excessive electronics may worsen symptoms, they rarely cause ADHD-level impairment in previously well-functioning children 3
• Do not miss comorbid anxiety or depression in girls, as internalizing symptoms are more common in females with ADHD and can complicate treatment 2, 3
• Do not delay treatment waiting for behavioral interventions alone to work—at age 11 with clear functional impairment, medication combined with behavioral therapy is most effective 1, 4