A rare presentation of attention deficit/hyperactivity disorder: A recommendation to be more alert!

Marwan Al-Sharbati*, Rashid Al-Zaidi, Rahma Al-Naamani, Amna Al-Futaisi, Rajeev Jain

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


We report the case of a 7 year-old Omani girl with tuberous sclerosis (TS), attention deficit hyperactivity disorder (ADHD) and bipolar disorder (BD), at Sultan Qaboos University Hospital (SQUH), Oman. For a year she had been suffering from hyperactivity, aggression, over talkativeness, insomnia, risk-taking behaviour, distractibility, poor attention and seizures. This clinical picture evolved slowly, but was progressive in nature. Before the consultation at her local health centre, she was given four drugs without being properly investigated; she continued to deteriorate. In SQUH, she showed hyperactive-impulsive behaviour, elation, flight of ideas, preoccupation with self and high self-confidence. The physical examination revealed multiple hypomelanotic patches all over the body and a shagreen patch at the sacral area. The electroencephalogram showed generalised epileptic discharges, while brain imaging showed multiple parenchymal calcified foci in both cerebral hemispheres. Other investigations were normal. She was given valproate, and then a psychostimulant, methylphenidate, that controlled her state. Our aim in reporting this case is not only because it is unique, given its rare comorbidity (ADHD, TS and BD), but also to remind our junior colleagues to be alert to the possibility of an underlying neuropathology when performing clinical examinations and investigations of children presenting with neuropsychiatric symptoms.

Original languageEnglish
Pages (from-to)84-88
Number of pages5
JournalSultan Qaboos University Medical Journal
Issue number1
Publication statusPublished - Apr 2010


  • Attention deficit hyperactivity disorder
  • Bipolar disorder
  • Case report
  • Children
  • Investigation
  • Mania
  • Oman
  • Physical examination
  • Tuberous sclerosis

ASJC Scopus subject areas

  • Medicine(all)


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