Attention Deficit and Hyperkinetic Disorders in Children and Young People

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• Attention Deficit and Hyperkinetic Disorders in
  Children and Young People

Dr. Derek Godfrey (GPR)
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ADHD/HKD What are they?

• Heterogeneous behavioural syndrome
• Symptoms of inattention, hyperactivity and
  impulsivity
• HKD (ICD-10) more severe disturbance with
  significant hyperactivity component
• Commonly diagnosed disorder with MF ratio (ADHD
  prevalence) of 41

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Why is it important?

• Common!
• Affected children/young people often unpopular
  with adults and peers
• Often fail to achieve potential
• Comorbid difficulties often present

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Diagnostic Criteria (1)

• Core symptoms
• Inattention
• Hyperactivity
• Impulsive behaviour
• DSM-IV and ICD-10 criteria are similar but DSM
  identifies 3 subtypes
• Predominately inattentive, predominately
  hyperactive/impulse AND combined

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Diagnostic Criteria (2)

• To meet diagnostic criteria
• Onset before age 7 (ADHD) or 6 (HKD)
• At least 6 months
• Pervasive
• Caused significant functional impairment
• Not better accounted for by other mental
  disorders
• Beware failure to meet above ? sig.difficulties

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Outcomes

• No good quality data for ADHD in Scotland
• Rate diminishes in adolescence/can persist
• Predictors include maternal depression, marital
  discord, -ve parent-child interaction, family
  disadvantage and FHx.
• Current service provision for adults is limited
  (See NICE guidance)

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Treatment/Therapy

• Dietary modification
• Psychological
• Behavioural parent training
• School-based interventions
• Pharmacological therapy
• Only initiated by specialists
• Shared care once started (Annex 2)
• No evidence of benefit from alternative therapies

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Mephylphenidate
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Atomoxetine
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