Hyperkinetic disorder

Hyperkinetic disorder was a psychiatric neuro-developmental condition that was thought to emerge in early childhood. Its features included an enduring pattern of severe, developmentally inappropriate symptoms of inattention, hyperactivity, and impulsivity across different settings (e.g., home and school) that significantly impair academic, social and work performance. It was classified in the World Health Organization's ICD-10 and was roughly similar to the "combined presentation" of attention deficit hyperactivity disorder in the American Psychiatric Association's DSM-5. However, in the ICD-11 the entry for hyperkinetic disorder no longer exists and is replaced by attention deficit hyperactivity disorder.

Symptoms
Hyperkinetic people displayed disorganized, poorly controlled, and excessive activity; they lacked perseverance in tasks involving thought and attention and tended to move from one activity to the next without completing any. They were frequently accident-prone, reckless, and impulsive and might thoughtlessly (rather than defiantly) break rules. Cognitive impairment and delayed language and motor development were more common in this group than in the general population, and they might have experienced low self-esteem and engaged in dis-social behavior as a consequence of the disorder.

While hyperkinetic children were commonly incautious and unreserved with adults, they might have been isolated and unpopular with other children.

Diagnosis
Though the American Psychiatric Association's criteria for Attention Deficit Hyperactivity Disorder (ADHD), and the World Health Organization's criteria for hyperkinetic disorder each list a very similar set of 18 symptoms, the differing rules governing diagnosis meant that hyperkinetic disorder featured greater impairment and more impulse-control difficulties than typical ADHD, and it most resembled a severe case of ADHD combined type.

Unlike ADHD, a diagnosis of hyperkinetic disorder required that the clinician directly observed the symptoms (rather than relying only on parent and teacher reports), that onset must have been by age 6 not 7; and that at least six inattention, three hyperactivity and one impulsivity symptom be present in two or more settings. While ADHD may exist comorbid with (in the presence of) mania or a depressive or anxiety disorder, the presence of one of these rules out a diagnosis of hyperkinetic disorder. Most cases of hyperkinetic disorder appear to have met the broader criteria of ADHD.

Hyperkinetic disorder was also sometimes comorbid with conduct disorder, in which case the diagnosis was hyperkinetic conduct disorder.

Epidemiology
The rate in school age children was thought to be about 1.5%, compared with an estimated 5.3% for ADHD.

Treatment
Once the patient and family had been educated about the nature, management and treatment of the disorder and a decision has been made to treat, the European ADHD Guidelines group recommended medication rather than behavioral training as the first treatment approach; and the UK's National Institute for Health and Clinical Excellence recommended medication as first line treatment for those with hyperkinesis/severe ADHD, and the provision of group parent-training in all cases of ADHD.