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Not a medical provider, but I see lots of student with ADHD.
When I see it, it usually in three or more of these situations…
1 – When the student has no positive response to the typical ADHD meds.
2 – When the impulsivity tends to manifest itself in anger management or safety problems.
3 – In my foster children when the ADHD is suspected to have been caused by prenatal drug exposure, which is a much different and stubborn version of ADHD than the pure genetic one.
This is in the US for school-age children.