Hyperkinetic disorder

This article is about the childhood-onset psychiatric syndrome. For disorders featuring pathologically increased muscle activity, see Hyperkinesia.

Hyperkinetic disorder
Classification and external resources
Specialty
ICD-10	F90
ICD-9-CM	314.00, 314.01
OMIM	143465
Patient UK	Hyperkinetic disorder

Hyperkinetic disorder is a psychiatric syndrome emerging in early childhood that features an enduring pattern of severe, developmentally inappropriate inattention, hyperactivity and impulsivity across different settings (e.g., home and school) that significantly impair academic, social and work performance.

Hyperkinetic children display disorganized, poorly controlled and excessive activity; they lack perseverance in tasks involving thought and attention, and tend to move from one activity to the next without completing any. They are frequently accident-prone, reckless and impulsive, and may thoughtlessly (rather than defiantly) break rules. While they are commonly incautious and unreserved with adults, they may be isolated and unpopular with other children. Cognitive impairment and delayed language and motor development are more common in this group than in the general population; and they may experience low self-esteem and engage in dissocial behavior as a consequence of the disorder.

Diagnosis

Though the American Psychiatric Association's criteria for attention deficit hyperactivity disorder (ADHD), and the World Health Organization's criteria for hyperkinetic disorder each list a very similar set of 18 symptoms, the differing rules governing diagnosis mean that hyperkinetic disorder features greater impairment and more impulse-control difficulties than typical ADHD, and it most resembles a severe case of ADHD combined type.

Unlike ADHD, a diagnosis of hyperkinetic disorder requires that the clinician directly observes the symptoms (rather than relying only on parent and teacher reports); that onset must be by age 6 not 7; and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings. While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder. Most cases of hyperkinetic disorder appear to meet the broader criteria of ADHD.

Hyperkinetic disorder may exist comorbid with conduct disorder, in which case the diagnosis is hyperkinetic conduct disorder.

Epidemiology

The rate in school age children is thought to be about 1.5%, compared with an estimated 5.3% for ADHD.

Treatment

Main article: Attention deficit hyperactivity disorder management

Once the patient and family have been educated about the nature, management and treatment of the disorder and a decision has been made to treat, the European ADHD Guidelines group recommends medication rather than behavioral training as the first treatment approach; and the UK's National Institute for Health and Clinical Excellence recommends medication as first line treatment for those with severe ADHD, and the provision of group parent-training in all cases of ADHD.