Hyperkinetic disorder, also known as attention deficit hyperactivity disorder (ADHD), is characterized by inattentive, restless and impulsive behavior. It is caused by both genetic and environmental factors and affects 5-10% of school-aged children. The three main subtypes are inattentive, hyperactive-impulsive, and combined type. Diagnosis involves evaluating symptoms such as inattention, hyperactivity and impulsivity, which must be present before age 7 and impair functioning. Treatment includes behavioral therapy, psychosocial interventions, and medications like stimulants and antidepressants. Comorbid conditions are common and outcomes vary depending on the individual and treatments.

1. Jomanah A.Hmood

2. Hyperkinetic disorder is a persistent and
severe impairment of psychological
development resulting from a high level of
inattentive, restless and impulsive behavior.

3.  No single factor determines the expression of ADHD
1. birth complications, such as toxemia, long labor, and
complicated delivery.
2. Maternal drug use, smoking and alcohol use during
pregnancy .
3. Genetic causes .
4. Abnormal brain structures (delayed in frontal and
temporal lobe ).
5. Lower dopamine levels .
6. Psychosocial family stressors .

4.  difficult to diagnose in preschoolers because
distractibility and inattention are often
considered developmentally normal during
this period.
 5-10% of school-aged children are affected .
 The prevalence rate in adolescent samples is
2-6%.
 Approximately 2% of adults have ADHD.

6. 1) Fails to give close attention to details
2) difficulty sustaining attention in tasks or play activities
3) does not seem to listen when spoken to directly
4) does not follow through on instructions
5) has difficulty organizing tasks and activities
6) Avoids and dislikes to engage in tasks that require
sustained mental effort .
7) loses things necessary for tasks or activities
8) easily distracted by extraneous stimuli
9) forgetful in daily activities
 6 or more for 6 months

7.  6 or more for 6 months
 Hyperactivity:
1) fidgets with hands or feet or squirms in seat
2) leaves seat in classroom or in other situations in which
remaining seated is expected
3) runs about or climbs excessively in situations in which it
is inappropriate (in adolescents or adults, may be limited
to subjective feelings of restlessness)
4) difficulty playing or engaging in leisure activities quietly
5) Is often "on the go" or often acts as if "driven by a motor"
6) talks excessively

8.  Impulsivity:
7) blurts out answers before questions have been
completed
8) difficulty awaiting turn
9) interrupts or intrudes on others

9. I. must begin before age 7 yr, must be present for at
least 6 mo,
II. must be present in 2 or more settings –at school ,at
home- , and
III. Must not be secondary to another disorder.
IV. There must be clear evidence of clinically significant
impairment in social, academic, or occupational
functioning

10.  Three main subtypes:
1. Inattentive Type (more in female , cognitive
Impairment)
2. Hyperactive-Impulsive Type
3. Combined Type (more in males)

11. Impulsiveness
Inattention
Combined
type
Hyperactive-
Impulsive type
Inattentive
type
Hyperactivity
61%30%
9%

13.  The diagnosis of ADHD is made by history.
 The physical examination is essential to rule out
possible underlying medical or developmental
problems.
 The examination should include the observation of
the child and the parents and their relationship.
 It is a mistake to interpret absence of hyperactivity in
the office as a sign that the child does not have ADHD.
 It is common for children with ADHD to focus
without hyperactivity in an environment that has low
stimulation and little distraction.

14.  thyroid function studies,
 blood lead levels,
 genetic karyotyping,
 and brain imaging studies
 These studies do not confirm ADHD, but are useful in
excluding other conditions.

15. Behaviorally Oriented
Treatments
Psychosocial Treatments
Medications

16.  Parents and teachers also can give positive or negative
feedback for certain behaviors.
 Schedule. Keep the same routine every day,
 Organize everyday items. Have a place for
everything, and keep everything in its place. This
includes clothing, backpacks, and toys.
 Use homework and notebook organizers.
 Be clear and consistent. Children with ADHD need
consistent rules they can understand and follow.
 Give praise or rewards when rules are followed.
Look for good behavior, and praise it.

17.  Psychostimulant Methylphenidate
 (Recommended Amphetamine compounds
 first-line therapy) Dextroamphetamine
 Antidepressants Imipramine
 Desipramine
 Nortriptyline
 α -AGONISTS Clonidine
 Guanfacine

18.  Preschool- Disruptive behavior, aggression towards
other children, hyperactivity, conduct problems,
 Middle Childhood- Unfinished tasks trouble with
school work, criticism from parents/teachers, low self
esteem. Depression and conduct disorders can develop
here.
 Adolescence- higher rates of anxiety, depression,
oppositional behavior, social failure, substance abuse.
 Adulthood- trouble at work, relationships, difficulty
following directions, remembering, and concentrating,
emotional and social problems

19.  Personality Disorders in Adults With ADHD
 Anti-social personality (22%)
 Passive aggressive personality (19%)
 Borderline personality (14%)
 Histrionic personality disorder (11%)
 Avoidant (Anxious) (11%)

20.  Fact: ADHD is a neurobehavioural disorder , not
related to bad parenting.