Structure: Hyperkinetic Disorder

Script: Hyperkinetic Disorder

• “Hello, my name is Dr.X and I have been asked to speak to

you about your son as I understand you have been extremely
concerned about his behavior”

• “Could you share with me what the problems have been?”

• “When did you first notice this?”

• “Feedback - so it’s been going on for 2 years”

• “Is he like this wherever he is?” > “Is he like this whomever
he’s with?”
 Script: Hyperkinetic Disorder

• “I see and how has is school described his behavior?” >

• “Could you take me through a typical day with him?” > “What sort of
things does he get up to when he comes back home?”> “How is he
at mealtimes?” > “Is he fidgety?”

• “How have you managed these problems so far?”

• “How would you describe his ability to focus?” > “Can he enjoy one
activity at a time?” > “Do you know if that is also the school’s
impression of him?” >

• “Does he ever make decisions without thinking about them?

 Script: Hyperkinetic Disorder

• “Does he have any brothers and sisters?” > “How does he get on with them?” > “How about
other friends?”

• “Has his behavior ever put himself in danger?” > “Has he ever been overly aggressive
towards anyone?” > “Has he ever vandalised property?” > “Do you know if he has ever
been cruel to animals?” >“Outside of this behaviour, have they ever raised concerns about
his academic ability for his age?”

• “Have his grades been effected?” > “How do you think your husband and you are coping at
the moment?” >”Has your relationship been affected at all?”

• “It sounds as if things have been difficult for you”

• “I just needed to ask a question which may be a little upsetting” > “Does he ever seem
more unhappy than usual?” > “Has he ever mentioned any thoughts about wanting to harm
himself?”
 Script: Hyperkinetic Disorder

• “Does he have any medical problems at the

moment?” > “Are you aware of any other problems
you may have had with him during your
pregnancy?” > “How about during his early
development?” > “Has he ever had a head injury?”
> “Has he had a hearing test?” > “Does he have
any other unusual movements that worry you?”

• “Has anyone in the family ever had to see a

psychiatrist before?”

• “Is there anything you would like to ask me?”

 Script: Hyperkinetic Disorder

• “From what you have told me so far it is possible that (NAME) is displaying symptoms of
hyperkinetic disorder”

• “It is a disorder that affects 1-2% in children and is characterized by 3 main symptoms of
impulsivity, hyperactivity and inattention in a no of different settings”

• “It can run in families however there is no one cause for it. There is some evidence to
suggest that it is genetic, smoking and alcohol in pregnancy have a strong association with
it”

• “There are no specific cures however we can do manage his behavior and use medication
to help if necessary”

• “In order for us to confirm the diagnosis I’d like you to complete a questionnaire called the
Connors. I’ll also be asking your school to complete one. It will give us an accurate idea of
his behavior and enable us to confirm the diagnosis”
 Script: Hyperkinetic Disorder

• “Initially his treatment would look at involve rewarding good behaviors for example with star
charts” > “However we may also require medications like Ritalin – have you heard of that
before?”

• “The main side effects are changes to appetite. However it can also affect his blood
pressure and can also affect growth” > “We can minimize these by monitoring him
physically as well as having periods in the year where he doesn’t take the medication”

• “There is no evidence to suggest that diet causes hyperkinetic disorder, however ongoing
use of high sugar diet and caffeinated drinks will exacerbate his behavior”

• “It is difficult to predict, however some evidence to suggest that children grow out of the
disorder by 18 others suggest in their early 30s. Their impulsivity and hyperactivity do
improve however their ability to focus still remains problematic.”

• “Their behavior can have effects on their own self-esteem in the future.”

• “I can provide some leaflets for you – thank you very much
 Epidemiology

• Affects 1 in 50 in the United Kingdom

• Onset before the age of 7 years
• > 6 months
• Males > Females
 Causes

• Multifactorial - genetics and environment

e.g. alcohol, smoking in pregnancy

• Dietary roles unclear

 Signs and symptoms

• Impaired attention
• Over-activity
• Impulsivity
 Co-morbidity

• Conduct disorder
• Anxiety/Depression
• Learning disorders
 Differentials

• Epilepsy
• Hearing difficulties
• Autism
• Conduct disorder/ODD
• Tourette’s
 Investigations

• Get a good history!

• Connor’s Rating scale (2 locations)
• Home hyperactivity scale
• Strength and Difficulty questionnaire
• Keep a food diary
• IQ test
 Management

• Psychological: Behavioural techniques – e.g

star chart, social skills training, teacher
training and family therapy

• Biological:
– Methylphenidate
– Atomoxetine

• Social: Support services

 Prognosis

• Can live a normal life

• 20% do develop dissocial personality traits
and/or substance misuse/ depression/
anxiety
• 20% persists into adulthood
 Alternative Scenarios

LINKED:
• Speak to father
• Consultant or GP presentation and
management

• Adult ADHD
 Thank You!

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