DAMP and MBD versus AD/HD and hyperkinetic disorders.

" Deficits in attention, motor control and perception (DAMP): a simplified school entry examination " , a paper presented by Landgren, Kjellman and Gillberg (1) in this issue of Acta Paediatrica, sets in focus the need to discuss the Swedish concept of DAMP and how it relates to the concepts of minimal brain dysfunction (MBD), AD/HD (according to the DSM-IV) and the hyperkinetic disorders (according to the ICD-10). DAMP was introduced by Gillberg and Rasmussen in the early 1980s in studies on 6 and 7-year-old children in Gothenburg, Sweden. In the original theses, Gillberg (2) and Rasmussen (3) both addressed similar questions, and used the same sample of Gothenburg children and the same screening methods in a cooperation between paediatrics/child neurology and child and adolescent psychiatry. The main aims of Gillberg's study were to construct a screening instrument for detecting MBD in Swedish public pre-schools and to analyse and evaluate different aspects of the concept of MBD from a psychiatric point of view. Rasmussen's aims were similar, namely to analyse the prevalence of attention deficit, motor control and perception/conceptualization in 6-year-old children in public pre-schools and to analyse and discuss MBD in relation to the neurological findings. Both Gillberg and Rasmussen used the concepts of MBD, MPD (motor perception dysfunction) and ADD (attentional deficit disorder) similarly. According to Gillberg (2) " MBD is in this context regarded as an operational diagnosis, requiring the presence of both attentional deficit signs and signs of either fine motor, gross motor or perception/conceptualization dysfunc-tion. It is applied only in cases without cerebral palsy and mental retardation ". Rasmussen (3) applied the term MBD " to children showing concomitant signs of marked attention deficit and marked gross motor, fine motor or perception/conceptualisation dysfunction. ADD was diagnosed in children having marked attention deficit without signs of marked motor or percep-tion/conceptualisation dysfunction. In cases showing marked perception/conceptualisation or motor dysfunc-tion but no marked attention deficit, a diagnosis of MPD was applied. These diagnostic categories were not used in children with cerebral palsy or MR ". The definition of MBD was based on the Scandina-vian concept used at the time and as formulated by Clements et al. in the 1960s (4). When discussing MBD and the concept of ADD as described above, the third edition of the American DSM system was referred to briefly. Gillberg wrote: " The vagueness of the definition of MBD in the international literature …