Younger ones are likely to be failing in school work.
Usually there is:
severe difficulty in maintaining attention (short attention
span, frequent changes of activity)
abnormal physical restlessness (most evident in classroom
or at mealtimes)
impulsiveness (the patient cannot wait his or her turn,
or acts without thinking).
Sometimes there may be discipline problems, underachievement in
school, proneness to accidents.
This pattern occurs in all situations (home, school, play).
Avoid premature diagnosis. High levels of physical activity are
not necessarily abnormal.
Also consider presence of:
a specific physical disorder (e.g., epilepsy, fetal alcohol
syndrome, thyroid disease)
general emotional disorders (patient exhibits anxiety depression)
autism (social/language impairment and sterotyped behaviours
conduct disorder (patient exhibits disruptive behaviour
without inattentiveness, see Conduct disorder - F91)
mild mental retardation or learning disability.
Hyperkinetic behaviour can either cause or result from parent-child
problems. Assessment of family relationships may be important. Hyperkinetic
(attention deficit) disorder - management guidelines Essential information
for patient and family
Hyperkinetic behaviour is not the child's fault, it is caused
by an impairment of attention and self-control that is often
The outcome is better if parents can be calm and accepting.
Hyperactive children need extra help to remain calm and
attentive at home and school.
Some hyperactive children continue to have difficulties
into adulthood, but most make a satisfactory adjustment.
Counselling of patient and family
Encourage parents to give positive feedback or recognition
when the child is able to pay attention.
Avoid punishment. Disciplinary control must be immediate
(within seconds) to be effective.
Advise parents to discuss the problem with the child's schoolteacher
(to explain that learning will be in short bursts, immediate
rewards will encourage attention, and periods of individual
attention in class may be beneficial).
Stress the need to minimise distractions (e.g., have child
sit at front of class).
Sport or other physical activity may help release excess
Encourage parents to meet with the school psychologist or
counsellor (if available).
For more severe cases, stimulant medication may improve attention
and reduce overactivity (e.g., methylphenidate 15-45mg a day or
dextroamphetamine 10-30mg a day). Pemoline 6-120mg a day is preferred
if substance abuse is possible (adolescents) and clonidine 25-50mg
a day is preferred if motor tics are also present.
If available, consider consultation before starting drug treatment
or if the above measures are unsuccessful.
Referral for behavioural treatment, if available, can improve attention