26 - Hyperkinetic disorders

Summary

Introduction

The terminology used to describe disorders involving attention deficit and overactivity varies, depending on the classification system used. Previously, many children with attention deficit and overactivity would have been classified as having ‘minimal cerebral dysfunction’ (MCD). Today, the most common diagnosis in use is ‘attention deficit and hyperactivity’ (ADHD) or ‘hyperkinetic conduct disorder’. The characteristics of ‘disturbance of activity and attention’ as defined in ICD-10 (WHO, 1992) are summarized in Table 26.1.

Assessment and treatment planning

In a child with hyperkinetic disorder, several difficulties become apparent. Whilst the cardinal symptoms are clear, symptoms are often heterogeneous and there is a broad spectrum of additional symptoms. Associated symptoms may be more or less severe, but should not be regarded as unimportant. Frequently, they merit just as much attention as the cardinal symptoms, and treatment may need to focus more on them than the cardinal symptoms.

A further difficulty in assessment is that symptoms may be to some degree situation specific. The behaviour of the child in the clinic, in which the child is seen alone in a structured manner may be remarkably different, resulting in diagnostic error. But, even in a familiar setting, such as the classroom, the child's behaviour may vary considerably depending on the degree of structure and the demands made on the child.

Both chronological age and developmental level must be taken into account when assessing behaviour. The degree of motor activity and associated symptomatology may vary considerably depending on the child's age and developmental status.