Hyperactive disorder of childhood. Some clinical implications of recent research.

In many European countries hyperkinesis is a relatively rare clinical diagnosis compared with the United States. Though systematic international studies comparing the diagnostic process with regard to this disorder are still lacking, it is likely that the reasons for the vast differences in the rates of the disorder do not lie in the differences of the children's behaviour but in diagnostic practice. Individual components of hyperactivity, namely overactivity, restlessness and poor concentration are common among children attending clinics as well as in randomly selected samples in the general population. Treatment for hyperactivity is largely the same as for the majority of child psychiatric disorders which predominantly involve disturbances of conduct. As the 'causes', as well as the factors maintaining the symptoms, are often complex, one form of treatment is seldom adequate. In most cases a combination of psychological and educational treatments is necessary. Stimulant drugs, though in a few instances capable of producing instant and dramatic therapeutic effects, should not be used as a treatment of first choice.