Transcript Attention Deficit and Hyperkinetic Disorders in Children

Attention Deficit and
Hyperkinetic Disorders
in Children and Young
People
Dr. Derek Godfrey (GPR)
ADHD/HKD – What are they?
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Heterogeneous behavioural syndrome
Symptoms of inattention, hyperactivity and
impulsivity
HKD (ICD-10) – more severe disturbance with
significant hyperactivity component
Commonly diagnosed disorder with M:F ratio
(ADHD prevalence) of 4:1
Why is it important?
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Common!
Affected children/young people often
unpopular with adults and peers
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Often fail to achieve potential
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Comorbid difficulties often present
Diagnostic Criteria (1)
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Core symptoms:
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Inattention
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Hyperactivity
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Impulsive behaviour
DSM-IV and ICD-10 criteria are similar but
DSM identifies 3 subtypes:
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Predominately inattentive, predominately
hyperactive/impulse AND combined
Diagnostic Criteria (2)
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To meet diagnostic criteria:
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Onset before age 7 (ADHD) or 6 (HKD)
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At least 6 months
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Pervasive
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Caused significant functional
impairment
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Not better accounted for by other
mental disorders
Beware failure to meet above → sig.difficulties
Outcomes
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No good quality data for ADHD in Scotland
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Rate diminishes in adolescence/can persist
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Predictors include: maternal depression,
marital discord, -ve parent-child interaction,
family disadvantage and FHx.
Current service provision for adults is limited
(See NICE guidance)
Treatment/Therapy
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Dietary modification
Psychological:
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Behavioural parent training
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School-based interventions
Pharmacological therapy:
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Only initiated by specialists
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Shared care once started (Annex 2)
No evidence of benefit from alternative therapies
Mephylphenidate
Atomoxetine