Attention Deficit and Attention Deficit and Hyperkinetic Disorders Hyperkinetic Disorders in Children and Young in Children and Young

PeoplePeople

Dr. Derek Godfrey (GPR)Dr. Derek Godfrey (GPR)

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

ADHD/HKD – What are they?ADHD/HKD – What are they?

Common!

Affected children/young people often unpopular with adults and peers

Often fail to achieve potential

Comorbid difficulties often present

Why is it important?Why is it important?

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

Diagnostic Criteria (1)Diagnostic Criteria (1)

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

Diagnostic Criteria (2)Diagnostic Criteria (2)

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)

OutcomesOutcomes

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

Treatment/TherapyTreatment/Therapy

MephylphenidateMephylphenidate

AtomoxetineAtomoxetine