Hyperkinetic Disorder

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Attention deficit Hyperactivity disorder

Core symptoms

Diagnosis

2 out of 3

  • Impulsivity
  • Reduced attention
  • Hyperactivity

  • Hyperactivity

    • motor overactivity

    • excessive purposeless running - pre-school

    • fidgety

    • restless

    • squirming

    • talk excessively, hoarse voice

  • Inattentiveness

    • disorganised in approach to cognitive tasks

    • appear carelessly forgetful

    • concentrate poorly

    • easily distracted

    • lack persistence with tasks

  • Impulsivity

    • impatient

    • unable to wait turn

    • reckless in situations requiring caution

  • Onset before age 6 years

  • Pervasive

  • more common in boys than girls

Aetiology

  • immaturities in motor coordination, low mental age common

  • genetic contribution

  • inability to block response while waiting for something to happen

Assessment

  • information from parents and school

  • Conner's rating scale

  • psychological and educational assessments often useful

Co-morbidity

  • conduct disorder

  • anti-social behaviour

  • learning difficulties in large minority

  • low self-esteem, depression in older children

Management

  • Information to parents and teachers

  • Attend to educational deficits and environmental factors

  • methylphenidate

    • ? increases frontal lobe activity

    • short half-life, 4 hourly dose

    • side-effects

      • rebound hyperactivity

      • GI upset

      • headaches

      • appetite suppressed

      • ? growth slowed

      • exacerbates tics

      • may worsen epilepsy

      • (no evidence psychosis)

  • diet

Prognosis

  • Major problems with self-esteem, peer rejection, aggressive behaviour

  • symptoms reduce in ~1/3 of cases in early adolescence

    • impulsivity, inattentiveness tend to persist

  • most probably settle in late teens

Differential

  • disobedience

  • aggressiveness

  • normal boisterousness

  • anxious (inc. agitated traumatised)

  • deaf inattentive

  • reactive attachment disorder

  • learning difficulties

Treatment

  • methylphenidate (ritalin)
  • clonidine
 

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