Hyperkinetic disorder: assessment and treatment

Hyperkinetic disorder is the generic ICD-10 (WHO, 1992)term used to describe one of the most common childhood psychiatric disorders. It is a severe form of a syndrome which is referred to in DSM-IV (APA, 1994)and the American literature as attention deficit hyperactivity disorder (ADHD). Hyperactivity or hyperkinesis can be defined as "an enduring disposition to behave in a restless, inattentive, distractible and disorganised fashion" (Taylor, 1994). It is thus more than motor overactivity.Diagnostically there are three main groups of symptomatology: overactivity, inattentiveness and impulsiveness. Overactivity is either a general increase in the tempo and therefore amount of purposeful activity; an increase in the number of purposeless minor movements which are irrelevant to the task at hand (fidgeting); or an increase in the number of purposeless whole body movements (restlessness). It includes excessive talkativeness and noisiness. Inattentiveness refers to difficulties in focusing and sustaining attention. This results in careless mistakes, failure to sustain or follow through on set tasks, particularly if these contain cognitive demands. Typically tasks are left unfinished. In addition, the affected individual may be demonstrably distractible and often poorly organised. Impulsiveness is common but not necessary for the clinical diagnosis (although it is included in the research criteria). It is characterised by interrupting others, blurting out answers, failure to wait for ones turn and excessive talk beyond normal social cons traints. It commonly has a quality of impatient socialdisinhibition. In some individuals it is mainly evident in reckless behaviour; things are done suddenly without heed for danger or adverse consequences. To make the clinical diagnosis, there must be abnormalities in both attention and overactivity which (a) are excessive compared with the norm for a child of that age or developmental ability; (b) have been present from an early age (< 6 years), and (c)are pervasive, i.e. present in more than one type of social situation. They are most obvious in situations which demand a measure of self-control