Nature and Nurture

A 9 year old boy is referred to you by his 3rd grade teacher because she's worried he has absence seizures. "I had a child last year with absence seizures and this boy is displaying the same thing. I talked to his 1st and 2nd grade teachers and they agree. He's often daydreaming and forgetful in daily things. He can't sustain his attention in tasks or even when playing. And his grades are suffering; he makes careless mistakes and doesn't pay attention to details. I'm worried about him. When we have a test, he forgets his pencil. When we're reading, he forgets his book. He's just so unorganized."

The mother protests. "They expect too much of my son. He's always been like this, but he means well. Sure, he never finishes his chores and I have to sit with him for him to do his homework, but he's smart enough; he understands everything. His strengths are elsewhere. He's always so curious; whenever he sees something interesting he'll just drop what he's doing and go investigate. The one thing that frustrates me is that he sometimes doesn't listen even when I'm talking to him directly."

You ask about seizure-like activity and no one has noticed anything. His problems seem to be more chronic rather than episodic. A full physical exam including neuro exam is normal.

Challenge: What's your most likely diagnosis?