CHAPTER 5
Disorders of Attention
and Activity
Whereas DSM and ICD criteria are identical or almost identical for most
disorders, they do differ significantly for disorders of attention and activ-
ity. The disorder in DSM-IV is calledattention-deficit/hyperactivity disorder
(ADHD), while the disorder in ICD-10 is calledhyperkinesis. What is the
difference between the two? To simplify slightly, hyperkinesis is a severe
subtype of ADHD – less common and more likely to respond to medica-
tion. As regards brand recognition, there is no doubt that ‘ADHD’ is the
label that is more widely used and recognised. Even fans of the ICD-10
definition often use ‘ADHD’ in preference to ‘hyperkinesis’ – and so will
we in general.
Epidemiology
Prevalence is around 2–5% for DSM-IV ADHD but only 1–3% for ICD-
10 hyperkinesis. The male:female ratio is around 3:1. It is commoner
in younger children than in adolescents. ADHD is linked with various
markers of deprivation, being commoner in inner cities, very poor rural
areas, in families of low socio-economic status and among children reared
in institutions.
Defining characteristics
Marked restlessness, inattentiveness and impulsiveness
Children and adolescents with ADHD wriggle and squirm in their seats,
fiddle with objects or clothing, repeatedly get up and wander about
when they should be seated, have difficulty persisting with any one task,
change activity frequently, and are easily distracted. The most obvious
abnormality is not in the amount but in the control of activity. In the
playground, a child with ADHD is not necessarily more active than anyone
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
56