Attention deficit disorder

Attention deficit disorder (hyperkinetic syndrome) is characterized by restlessness, impulsiveness, inability to concentrate, and short attention span. It is more common in boys. There is often a history of birth trauma or other cerebral insult in early life. Aggressive behaviour, low intelligence, epilepsy, minor motor abnormalities, and minor EEG changes are sometimes present. Food additives, as in coloured sweets or drinks, may exacerbate the symptoms.

This is a real syndrome but it has tended to be over-diagnosed, especially in the USA, the term 'minimal brain dysfunction' being applied to cases with no demonstrable abnormalities on examination or investigation. Differential diagnosis includes mania.

A behavioural-modification programme combined with special teaching methods at school is the treatment of choice. Avoiding food additives may be helpful. The most effective short-term drug treatment is, paradoxically, with a cerebral stimulant such as dextroamphetamine, methylphenidate, or pemoline. These drugs have many adverse effects, including stunting growth, and they may be addictive, so are best reserved for occasional or short-term use. They are only lisensed for use as part of a multidisciplinary care package. Spontaneous improvement by adolescence is usual. Problems arise when children leave CAMHS for adult services and request continued prescription of stimulants, as they are not licensed in adults.

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