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Attention deficit and hyperkinetic disorders in childhood and adolescence

Chapter:
Attention deficit and hyperkinetic disorders in childhood and adolescence
Author(s):

Eric Taylor

DOI:
10.1093/med/9780199696758.003.0215

The concept of ADHD arose from neurological formulations, but does not entail them, and the modern definition simply describes a set of behavioural traits. The historical evolution of the concept was described by Schachar. It began with the idea that some behavioural problems in children arose, not from social and familial adversity, but from subtle changes in brain development. The term ‘minimal brain dysfunction (MBD)’ was often applied, and covered not only disorganized and disruptive behaviour but other developmental problems (such as dyspraxias and language delays) presumed to have an unknown physical cause. MBD, however, stopped being a useful description when studies of children with definite and more-than-minimal brain damage made it plain that they showed a very wide range of psychological impairment, not a characteristic pattern (see Harris, this volume); and therefore it was invalid to infer the presence of brain disorder from the nature of the psychological presentation. The successor to the concept of MBD was attention deficit and hyperactivity: defined, observable behaviour traits without assumption of cause. ‘Attention Deficit/Hyperactivity Disorder’ (ADHD) in DSM-IV, and ‘Hyperkinetic Disorder’ in ICD-10, describe a constellation of overactivity, impulsivity and inattentiveness. These core problems often coexist with other difficulties of learning, behaviour or mental life, and the coexistent problems may dominate the presentation. This coexistence, to the psychopathologist, emphasizes the multifaceted nature of the disorder; to the sociologist, a doubt about whether it should be seen as a disorder at all; to the developmentalist, the shifting and context-dependent nature of childhood traits. For clinicians, ADHD symptoms usually need to be disentangled from a complex web of problems. It is worthwhile to do so because of the strong developmental impact of ADHD and the existence of effective treatments. Public controversy continues, but professional practice in most countries makes ADHD one of the most commonly diagnosed problems of child mental health.

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