SeminarAttention-deficit hyperactivity disorder and hyperkinetic disorder
Section snippets
Diagnosis
The specific diagnostic criteria for ADHD are in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV, 1994)2 and those for HKD are in the International Classification of Diseases (ICD-10, 1992 and 1993) manual published by the World Health Organization.3
Since the 1960s when criteria for childhood psychiatric disorders were first included in diagnostic manuals (ICD-8, 1966; DSM-II, 1968), a perplexing series of changes in labels and definitions produced confusion,
Epidemiology
The differences between countries in the prevalence of ADHD and HKD have generated considerable controversy.5 A large part of the difference is due to the definitions used and not from geographical differences. Table 1 shows the frequency of broad classes of definitions used across countries and eras. A behavioural definition, based on symptoms shown at one point in time (which does not indicate actual psychiatric disorder), is found in 10–20% of the general population in several countries. A
Treatment
There are two primary modalities of treatment for ADHD and HKD: pharmacological (with stimulant medications) and behavioural (with a variety of psychosocial interventions).
In Europe, where the prescription of stimulants has been restricted by custom4, 5 and by law,15 clinical guidelines recommend an initial rigorous trial of multiple psychosocial interventions such as behaviour modification, cognitive therapy, family therapy and teacher consultation. In North America, where the prescription of
Prognosis
Follow-up studies in the USA have confirmed a poor prognosis for children with ADHD/HKD.13 Also, a 10-year follow-up study of 6 and 7 year-old boys in London community survey found that hyperactive behaviour was a strong risk factor for later psychiatric diagnosis, antisocial behaviour, and social and peer problems, even after allowing for a coexistent conduct disorder.19 This study provides a strong argument for the recognition and treatment of ADHD/HKD in childhood—even in countries with
Pathophysiology
Over the past 25 years, theories about the biological basis of ADHD/HKD have suggested that the neuroanatomical location of deficits is in the frontal-basal ganglia and neurochemical disorder involves dopamine pathways, which result in impaired neuropsychological function.20, 21 Posner and Raichle11 discuss these findings in relation to a general theory of attention and Lyon and Krasnegor10 provide several points of view about the involvement of this executive function in several disorders of
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Mechanism-based groups of children with ADHD are associated with distinct domains of impairment
2023, Psychiatry ResearchDetecting aggressive driving patterns in drivers using vehicle sensor data
2022, Transportation Research Interdisciplinary PerspectivesCitation Excerpt :The study had some overlap in the patterns they chose to detect – following too closely, erratic lane changes, and sudden change of speed without changing lanes. Attention Deficit Hyperactivity Disorder (ADHD) is a condition typically detected during the school years that may affect an individual during their entire life (Swanson et al., 1998). The primary symptoms of ADHD are hyperactivity, impulsivity, and poor sustained attention (Barkley, 1997).
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