Medical Specialties Commons^™

Relation Of Neurovascular Structures Of The Elbow To An Accessory Anterolateral Approach To The Capitellum: A Cadaveric Study, Michael Okoli, Ryan Tantone, Chidi Okolo, Samantha Muhlrad, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Purpose: The purpose of this study is to describe an anterolateral portal technique to the capitellum and to investigate its anatomic relationship nearby neurovascular structures in the elbow.

Methods: The study included 6 arm-to-fingertip adult cadavers. The demographic information of the cadavers was recorded. We initially dissected the elbows using a lateral approach to the capitellum. Next, a 1.5-cm anterolateral portal to the radiocapitellar joint was made and tagged with heavy suture and passed through the lateral elbow wound, with the elbow and forearm in an extended, supinated position. We then dissected out neurovascular structures around the elbow and measuring …

Non-Weightbearing In Cam Boots After Foot/Ankle Fracture Fixation: Are Patients Compliant?, Amos Z. Dai, Michelle Regan, Megan Paulus

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: The controlled ankle motion (CAM) boot has become an integral part of the management of both operative and nonoperative foot and ankle conditions. Similar to casts, CAM boots are used to immobilize the foot and ankle after injury or surgery. However, unlike casts, CAM boots can be readily removed for showering and range of motion (ROM) exercises. While CAM boots are well-designed for ambulation and are frequently utilized in early weightbearing (WB) and early ROM protocols, their usage in non-weightbearing (NWB) protocols is less clear.

Purpose: The purpose of the current study is to determine the patient compliance rate …

Comparison Of Early Active Range Of Motion In Primary Reverse Shoulder Arthroplasty Based On Indication: A Single Center Retrospective Review, Michael E. Doany, Kenny Ling, Rosen Jeong, Alireza K. Nazemi, David E. Komatsu, Edward D. Wang

Stony Brook Orthopaedic and Musculoskeletal Journal

Background: Reverse shoulder arthroplasty (RSA) is commonly used in the treatment of rotator cuff arthropathy.  Indications for RSA have expanded to include complex proximal humerus fractures. Studies directly comparing outcomes between traumatic and traditional elective indications are limited. The purpose of this study was to compare early active range of motion (aROM) within the first two years postoperatively between traumatic and non-traumatic primary RSA, as well as compare ASES scores, and patient satisfaction at final follow-up.

Methods: A retrospective analysis was conducted of all RSA performed by a single surgeon between January 2000 and December 2018. Patients were grouped by …

Psychometric Characteristics And Validity Of The Promis Cancer Function Brief 3d Profile, Sean R. Smith, Mary Vargo, David S Zucker, Samman Shahpar, Lynn Gerber, Maryanne Henderson, Gina Jay, Minji Lee, Andrea Cheville

All Podium Presentations

Purpose: To develop an item response theory (IRT)-calibrated patient-reported outcome measure (PRO) that assesses cancer patient physical function, fatigue and social participation.

Problem Statement: The subspecialty of cancer rehabilitation medicine (CRM) has to date lacked a psychometrically validated patient-reported outcome measure that assesses patients’ physical function, fatigue, and social participation. A significant proportion of the 16.9 million US cancer survivors will experience, or have already experienced, impairments that compromise function, a predictable consequence of their disease and treatment. While each disease site and line of treatment may be associated with unique impairments, there are some that cut across several cancers …

Hypertension Pharmacological Treatment In Adults: A World Health Organization Guideline Executive Summary, Akram Al-Makki, Donald Dipette, Paul K. Whelton, M Hassan Murad, Reem A. Mustaf, Shrish Acharya, Hind Mamoun Beheiry, Beatriz Champagne, Kenneth Connell, Unab I. Khan

Department of Family Medicine

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Multidirectional Instability In Female Athletes, Meghan E. Bishop, Heli Patel, Brandon J. Erickson, Christopher C. Dodson

Rothman Institute Papers

Multidirectional instability (MDI) of the shoulder is characterized by generalized shoulder capsular laxity and symptomatic shoulder instability in more than one direction with one direction of instability as inferior. Generalized ligamentous laxity and specifically shoulder laxity, has been associated with female athletes. While males are at a higher risk of shoulder instability due to a number of extrinsic risk factors including participation in higher risk contact/collision activities, females are particularly susceptible to MDI due to their association with increased joint laxity. Patients with MDI often have a loose patulous capsule and display altered glenohumeral and scapulothoracic mechanics. The mainstay of …

Perceived Instability, Pain, And Psychological Factors Predict Function And Disability In Individuals With Chronic Ankle Instability, Ashley M.B. Suttmiller, Julie M. Cavallario, Shelby E. Baez, Jessica C. Martinez, Ryan S. Mccann

Rehabilitation Sciences Faculty Publications

Context:

Chronic ankle instability (CAI) is associated with residual instability, pain, decreased function, and increased disablement. Injury-related fear has been associated with CAI, although its relationship to other impairments is unclear. The Fear-Avoidance Model is a theoretical framework hypothesizing a relationship between injury-related fear, chronic pain, pain catastrophizing, and disability. It has been useful in understanding fear's influence in other musculoskeletal conditions but has yet to be studied in those with CAI.

Objective:

To explore relationships between instability, pain catastrophizing, injury-related fear, pain, ankle function, and global disability in individuals with CAI.

Design:

Cross-Sectional Study

Setting:

Anonymous online survey

Patients …

Preventive Training Program Feedback Complexity, Movement Control, And Performance In Youth Athletes, Hayley J. Root, Eleanor M. Beltz, Julie P. Burland, Jessica C. Martinez, R. Curt Bay, Lindsay J. Distefano

Rehabilitation Sciences Faculty Publications

Context: Preventive training programs (PTPs) reduce injury risk by improving movement control. Corrective feedback is important; however, many cues at once may be too complicated for athletes.

Objective: To compare movement control and long-jump (LJ) changes in youth athletes participating in a season-long PTP, with simplified feedback, traditional feedback, or a warmup of the coaches' choosing.

Design: Cluster-randomized controlled trial.

Setting: Soccer fields.

Patients or Other Participants: A total of 420 athletes (simplified feedback = 173, traditional feedback = 118, and control = 129; age = 11 ± 3 years).

Intervention(s): Teams were randomized into the simplified PTP, traditional PTP, …

A Plague Of Their Own: Injury Incidence Remains Elevated In The 2021 Major League Baseball Season Compared To Pre-Covid-19 Seasons, Brooks N. Platt, Breanna Sullivan, Shawn Dripchak, Timothy L. Uhl, Aaron Sciascia, William B. Kibler, Austin V. Stone

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background Significant increases in injuries were observed in the 2020 Major League Baseball (MLB) season; these were attributed to an increased acute to chronic workload due to the interrupted preseason and compressed season during the coronavirus disease of 2019 (COVID-19) pandemic. In 2021, the MLB resumed its regular schedule.

Hypothesis/Purpose The purpose of this study was to determine the injury incidence and epidemiology of the 2021 MLB season compared to the injury incidence in the 2020 season and pre-COVID-19 seasons. The hypothesis was that, with the return to normal preseason training, injury incidence in 2021 would return to pre-COVID-19 rates. …

Exploiting Modulation Of The Blood-Brain And Blood-Tumor Barrier Permeability By Translational Focused Ultrasound For Therapeutic Delivery To Cns Metastases, Tasneem A. Arsiwala

Graduate Theses, Dissertations, and Problem Reports (ETD)

Transcranial low-intensity focused ultrasound is a unique technology to modulate the integrity of tight endothelial junctions and transiently increase BBB/BTB permeability to enhance therapeutic delivery. Despite promising early studies, present literature lacks agreement on key experimental conditions, which restricts our knowledge and the technique's widespread translation. This dissertation first provides a critical review of the current gaps in knowledge regarding the universal use of LiFUS in preclinical and clinical use. We then identify key parameters for translational and predictable opening of the BBB using a 3T MRI coupled with a clinical device. Our investigation highlights that passive permeability of the …

Vitamin D Level In Relation To Depression Symptoms During Adolescence, Reem Al-Sabah, Abdullah Al-Taiar, Lemia Shaban, Ahmed N. Albatineh, Reem Sharaf Alddin, Praveen K. Durgampudi

Community & Environmental Health Faculty Publications

BACKGROUND: This study aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D) and depression symptoms among adolescents in Kuwait, a country with a high prevalence of vitamin D deficiency.

METHODS: A school based cross-sectional study was conducted on randomly selected 704 adolescents in middle schools. Data on depression symptoms were collected using the Children's Depression Inventory (CDI). Data on covariates were collected from the parents by self-administered questionnaire and from adolescents by face-to-face interview. Blood samples were analyzed in an accredited laboratory; and 25(OH)D was measured using liquid chromatography-tandem mass spectrometry.

RESULTS: Of 704 adolescents, 94 (13.35%; 95%CI:10.35-17.06%) had depression …

Profiles And Correlates Of Language And Social Communication Differences Among Young Autistic Children, Rachel Reetzke, Vini Singh, Ji Su Hong, Calliope B. Holingue, Luther G. Kalb, Natasha N. Ludwig, Deepa Menon, Danika L. Pfeiffer, Rebecca J. Landa

Communication Disorders & Special Education Faculty Publications

Delays in early language development are characteristic of young autistic children, and one of the most recognizable first concerns that motivate parents to seek a diagnostic evaluation for their child. Although early language abilities are one of the strongest predictors of long-term outcomes, there is still much to be understood about the role of language impairment in the heterogeneous phenotypic presentation of autism. Using a personcentered, Latent Profile Analysis, we first aimed to identify distinct patterns of language and social communication ability in a clinic-based sample of 498 autistic children, ranging in age from 18 to 60 months (M = …

Analysis Of Race And Sex Bias In The Autism Diagnostic Observation Schedule (Ados-2), Luther G. Kalb, Vini Singh, Ji Su Hong, Calliope Holingue, Natasha N. Ludwig, Danika Pfeiffer, Rachel Reetzke, Alden L. Gross, Rebecca Landa

Communication Disorders & Special Education Faculty Publications

Importance: There are long-standing disparities in the prevalence of autism spectrum disorder (ASD) across race and sex. Surprisingly, few studies have examined whether these disparities arise partially out of systematic biases in the Autism Diagnostic Observation Schedule, Second Edition (ADOS-2), the reference standard measure of ASD.

Objective: To examine differential item functioning (DIF) of ADOS-2 items across sex and race.

Design, Setting, and Participants: This is a cross-sectional study of children who were evaluated for ASD between 2014 and 2020 at a specialty outpatient clinic located in the Mid-Atlantic region of the US. Data were analyzed from July 2021 to …

Patient And Provider Perspectives On Medication Non-Adherence Among Patients With Depression And/Or Diabetes In Diverse Community Settings – A Qualitative Analysis, Jane E Hamilton, Eduardo Blanco, Salih Selek, Kelly L Wirfel, Elmer V Bernstam, Dawn Velligan, Meghana Gudala, Kirk Roberts

Faculty, Staff and Student Publications

BACKGROUND: Diabetes and depression affect a significant percentage of the world's total population, and the management of these conditions is critical for reducing the global burden of disease. Medication adherence is crucial for improving diabetes and depression outcomes, and research is needed to elucidate barriers to medication adherence, including the intentionality of non-adherence, to intervene effectively. The purpose of this study was to explore the perspectives of patients and health care providers on intentional and unintentional medication adherence among patients with depression and diabetes through a series of focus groups conducted across clinical settings in a large urban area.

METHODS: …

A Novel Framework To Estimate Cognitive Impairment Via Finger Interaction With Digital Devices, Ashley A Holmes, Shikha Tripathi, Emily Katz, Ijah Mondesire-Crump, Rahul Mahajan, Aaron Ritter, Teresa Arroyo-Gallego, Luca Giancardo

Faculty, Staff and Student Publications

Measuring cognitive function is essential for characterizing brain health and tracking cognitive decline in Alzheimer's Disease and other neurodegenerative conditions. Current tools to accurately evaluate cognitive impairment typically rely on a battery of questionnaires administered during clinical visits which is essential for the acquisition of repeated measurements in longitudinal studies. Previous studies have shown that the remote data collection of passively monitored daily interaction with personal digital devices can measure motor signs in the early stages of synucleinopathies, as well as facilitate longitudinal patient assessment in the real-world scenario with high patient compliance. This was achieved by the automatic discovery …

Quantification Of Infarct Core Signal Using Ct Imaging In Acute Ischemic Stroke, Uma Maria Lal-Trehan Estrada, Grant Meeks, Sergio Salazar-Marioni, Fabien Scalzo, Mudassir Farooqui, Juan Vivanco-Suarez, Santiago Ortega Gutierrez, Sunil A Sheth, Luca Giancardo

Faculty, Staff and Student Publications

In stroke care, the extent of irreversible brain injury, termed infarct core, plays a key role in determining eligibility for acute treatments, such as intravenous thrombolysis and endovascular reperfusion therapies. Many of the pivotal randomized clinical trials testing those therapies used MRI Diffusion-Weighted Imaging (DWI) or CT Perfusion (CTP) to define infarct core. Unfortunately, these modalities are not available 24/7 outside of large stroke centers. As such, there is a need for accurate infarct core determination using faster and more widely available imaging modalities including Non-Contrast CT (NCCT) and CT Angiography (CTA). Prior studies have suggested that CTA provides improved …

Brain Antigens Stimulate Proliferation Of T Lymphocytes With A Pathogenic Phenotype In Multiple Sclerosis Patients, Assaf Gottlieb, Hoai Phuong T Pham, John William Lindsey

Faculty, Staff and Student Publications

A method to stimulate T lymphocytes with a broad range of brain antigens would facilitate identification of the autoantigens for multiple sclerosis and enable definition of the pathogenic mechanisms important for multiple sclerosis. In a previous work, we found that the obvious approach of culturing leukocytes with homogenized brain tissue does not work because the brain homogenate suppresses antigen-specific lymphocyte proliferation. We now report a method that substantially reduces the suppressive activity. We used this non-suppressive brain homogenate to stimulate leukocytes from multiple sclerosis patients and controls. We also stimulated with common viruses for comparison. We measured proliferation, selected the …

A Multimodal Clinical Data Resource For Personalized Risk Assessment Of Sudden Unexpected Death In Epilepsy, Xiaojin Li, Shiqiang Tao, Samden D Lhatoo, Licong Cui, Yan Huang, Johnson P Hampson, Guo-Qiang Zhang

Faculty, Staff and Student Publications

Epilepsy affects ~2–3 million individuals in the United States, a third of whom have uncontrolled seizures. Sudden unexpected death in epilepsy (SUDEP) is a catastrophic and fatal complication of poorly controlled epilepsy and is the primary cause of mortality in such patients. Despite its huge public health impact, with a ~1/1,000 incidence rate in persons with epilepsy, it is an uncommon enough phenomenon to require multi-center efforts for well-powered studies. We developed the Multimodal SUDEP Data Resource (MSDR), a comprehensive system for sharing multimodal epilepsy data in the NIH funded Center for SUDEP Research. The MSDR aims at accelerating research …

Radiomic Texture Feature Descriptor To Distinguish Recurrent Brain Tumor From Radiation Necrosis Using Multimodal Mri, M. S. Sadique, A. Temtam, E. Lappinen, K. M. Iftekharuddin

Electrical & Computer Engineering Faculty Publications

Despite multimodal aggressive treatment with chemo-radiation-therapy, and surgical resection, Glioblastoma Multiforme (GBM) may recur which is known as recurrent brain tumor (rBT), There are several instances where benign and malignant pathologies might appear very similar on radiographic imaging. One such illustration is radiation necrosis (RN) (a moderately benign impact of radiation treatment) which are visually almost indistinguishable from rBT on structural magnetic resonance imaging (MRI). There is hence a need for identification of reliable non-invasive quantitative measurements on routinely acquired brain MRI scans: pre-contrast T1-weighted (T1), post-contrast T1-weighted (T1Gd), T2-weighted (T2), and T2 Fluid Attenuated Inversion Recovery (FLAIR) that can …

Prenatal And Pediatric Oral Health Education Among Dental Hygiene Programs In The United States, Denise M. Claiborne, Shillpa Naavaal

Dental Hygiene Faculty Publications

Purpose: Health care and dental providers must be prepared to address the oral health needs of mothers and children in order to reduce the burden of dental disease in these populations. The purpose of this study was to describe the curriculum and clinical experiences related to prenatal and pediatric oral health in the university and community college dental hygiene programs in the United States (US).

Methods: Dental hygiene program directors (PDs) from across the US were invited to participate in a cross-sectional electronic survey regarding the prenatal and pediatric oral health curriculum at their institution. In addition to program characteristics, …

The Effect Of Concussion History On Lower Extremity Injury Risk In College Athletes: A Systematic Review And Meta Analysis, Vanessa Ramirez, Ryan Mccann, Eric Schussler, Jessica Martinez

Rehabilitation Sciences Faculty Publications

INTRODUCTION: Collegiate athletes who suffer a concussion may possess prolonged impairments even after clearance for return-to-participation, which may place them at an increased risk of lower extremity injury.

OBJECTIVE: To conduct a systematic review and meta-analysis of studies examining risk of lower extremity musculoskeletal injury following a concussion in collegiate athletes.

METHODS: A literature search was performed using the following databases: PubMed, CINAHL, SPORTDiscus. The following search terms were used to identify relevant articles, ["concussion" OR "brain injury" OR "mild traumatic brain injury" OR "mTBI"] AND ["lower extremity injury" OR "musculoskeletal injury"]. Articles were included if they were published between …

Observations Of Delayed Changes In Respiratory Function Among Allergy Clinic Patients Exposed To Wildfire Smoke, James Blando, Michael Allen, Hadiza Galadima, Timothy Tolson, Muge Akpinar-Elci, Mariana Szklo-Coxe

Community & Environmental Health Faculty Publications

Wildfires have increased in frequency and magnitude and pose a significant public health challenge. The principal objective of this study was to assess the impact of wildfire smoke on respiratory peak flow performance of patients exposed to two different wildfire events. This longitudinal study utilized an observational approach and a cohort study design with a patient-level clinical dataset from a local outpatient allergy clinic (n = 842). Meteorological data from a local weather station served as a proxy for smoke exposure because air quality measurements were not available. This study found that there were decreases in respiratory peak flow among …

Initial Antihyperglycemic Options For Populations With Type 2 Diabetes Who Cannot Take Metformin, Rena Ogino

Capstone Showcase

Type 2 diabetes is a common disease in the United States that can result in life-threatening cardiac, vascular, and/or renal complications. The treatment of type 2 diabetes includes but is not limited to exercise, diet, multi-disciplinary approaches, and pharmaceuticals. Metformin is the first line pharmaceutical for newly diagnosed type 2 diabetes, however patients may be unable to tolerate metformin. With more than seven different antihyperglycemic drug classes and over twenty antihyperglycemic drugs, clinicians may have difficulty choosing the best agent for patients when metformin is not tolerated. This article compares common anti-hyperglycemic pharmaceutical agents and their drug classes, focusing on …

A Case Of Irritable Bowel Syndrome In The Setting Of Generalized Anxiety Disorder, Stephen Driscoll

Capstone Showcase

Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder characterized by a relapsing-remitting course of abdominal discomfort and change in stool form and/or frequency in the absence of any structural or biochemical abnormalities. Currently there is debate on its pathogenesis but there is no definitive conclusion. Treatment consists of primarily playing symptomalogic catch-up with anti-spasmodics, anti-diarrheals, stool softeners, or laxatives depending on which symptoms the patient is currently experiencing. Patients with IBS typically struggle to control their symptoms long term, like the patient described in this case study. This case study explores a possible link between IBS and its’ most …

The Effectiveness Of Probiotics In Adults With Depressive Symptoms, Brianna Rees

Capstone Showcase

Introduction: Depression affects over 21 million adults in the United States and continues to rise, affecting more people due to the recent pandemic. Because the prevalence of this debilitating mental health disease is increasing, it is even more crucial to find additional therapeutic treatments to alleviate depressive symptoms in adults whose depression is not controlled on current anti-depressant medication or therapy. Depression has been shown to be linked to the gut-brain axis, meaning gut health is connected to our mental health. Therefore, probiotics may be effective in altering the gut microbiome, and ultimately affecting cognitive patterns in the brain.

Methods: …

Quality Of Life Before And After Cosmetic Surgery: Should Body Dysmorphic Disorder Be Considered An Absolute Or Relative Contraindication For Cosmetic Surgery?, Lindsay Conlisk

Capstone Showcase

Body Dysmorphic Disorder (BDD) has historically been regarded as a strong contraindication for cosmetic plastic surgery. New research now suggests that the contraindications to cosmetic surgery in patients with BDD may not be so absolute. This paper reviews diagnostic criteria, diagnostic challenges, and current standard of treatment of BDD. It then presents the idea of insight analysis in the BDD patient as a significant factor in determining if patients with BDD may or may not benefit from cosmetic surgery or procedures.

Treatment Of Hypothyroidism: Desiccated Thyroid Extract, Aimee Fong

Capstone Showcase

The treatment of hypothyroidism with Levothyroxine (T4) has been well studied and FDA approved. However, many patients continue to have signs and symptoms of hypothyroidism while on Levothyroxine treatment despite reaching appropriate thyroid levels. An additional thyroid treatment known as desiccated thyroid extract (DTE) is made from dried pig thyroid glands and is advertised as a “natural” alternative to Levothyroxine. Despite lack of FDA approval and studies surrounding DTE, clinicians have prescribed DTE to patients, many of whom reported relief of their symptoms. The following poster highlights the approach to the treatment of hypothyroidism with Levothyroxine and DTE and outlines …

Implementation Of Mental And Substance Misuse Screenings Into Routine Prep Therapy Encounters, Kieran Talkiewicz

Capstone Showcase

It has been well documented over the years that lesbian, gay, bisexual, transgender, queer/ questioning (LGBTQ+) populations are disproportionately affected by a higher burden of mental health illnesses, alcohol abuse, and illicit substance abuse when compared to heterosexual populations. This article will recommend utilizing routine Pre-Exposure Prophylaxis (PrEP) therapy encounters, a common point of contact for primary care for sexual minority populations, to perform screening for mental health and substance use. Due to men who have sex with men (MSM) being the highest utilizing population of this therapy, and disproportionately burdened by psychiatric and substance use disorders, this article will …

Non-Pharmacological Management Of Idiopathic/Persistent Dyspareunia, Iveshia Ford

Capstone Showcase

Painful sexual intercourse, or dyspareunia, is a condition numerous women experience. An unknown, but still important, number of those affected find no relief with medication or surgery. Yet, it can be difficult for patients to discuss concerns with their provider. In addition, many providers do not have an adequate comfort level to discuss such topics. This paper aims to equip providers with non-pharmacological treatment options which include pelvic floor physical therapy, sex therapy and lifestyle changes. With the cultural shifts and changing ideas of sexuality in today’s age, it is important that clinicians remain versed in sexual health and patient …

Conditions That Mimic Attention Deficit Hyperactivity Disorder In A Pediatric Population: A Diagnostic Guide For Primary Care Providers, Elena Schatell

Capstone Showcase

This article outlines common neurobiological, developmental, psychological, and other medical diagnoses and conditions that symptomatically mimic attention deficit hyperactivity disorder (ADHD) in the pediatric population. Many of these disorders are comorbid with ADHD, but they may also be misdiagnosed as ADHD. Due to the similarity in presentation, these conditions must be included when formulating a differential diagnosis. Accurately diagnosing a child with ADHD requires a thorough evaluation and work up to rule out diagnoses on the differential.