Academic journal article Hong Kong Journal of Psychiatry

Treatment of Hyperkinetic Children-The Experience of a Psychiatric Clinic in Hong Kong

Academic journal article Hong Kong Journal of Psychiatry

Treatment of Hyperkinetic Children-The Experience of a Psychiatric Clinic in Hong Kong

Article excerpt

SUMMARY

The syndrome of hyperkinetic disorder overlaps with conduct disorder in a substantial degree, and the children suffer from these conditions also have associated problems in academic and reading performance, non-compliance and relationship with people. The Ngau Tau Kok Day Hospital Hyperkinetic Group Treatment offers a comprehensive, multidisciplinary and multimodal approach for the assessment and treatment of this group of children and their parents. On completion of the programme, there is improvement do the parent's perception of their children's behavioural problem but only equivocal result from the teacher's perspective.

INTRODUCTION

The syndrome of hyperkinetic disorder has stirred up some controversies. The central feature of the hyperkinetic syndrome are inattention, impulsively and hyperactivity. In DSM III, the Attention Deficit Disorder with Hyperactivity (ADDH) requires the presence of all three. In DSM III R the Attention Deficit Hyperactivity Disorder (ADHD) is defined by a list of 14 behavioural criteria (8 out of the 14). It in fact broadened the concept as it is possible that only 2 of the core concept be present. In 1CD 10, only inattention and hyper-kinesis Is required. The ICD 10 definition would require :

* Early onset.

* Combination of overactive, poorly modulated behaviour with marked inattention and lack of persistent task involvement.

* Pervasiveness over situations and persistence over time.

It is also known that there is an overlap with conduct disorder. In fact, to most British psychiatrist, the American concept of ADHD corresponds more to conduct disorder. The co-occurrence of hyperkinesis and conduct disorder often point to a poorer prognosis.

These hyperkinetic children has associated problem in reading difficulties and academic underachievement. non-compliance, poor relationship with adults and peers, and conduct problems. Richman (1982) discovered that a complaint of overactivity in preschool children in fact predicts later antisocial behaviour. Local experience (LUK, 1989 & 1991) suggested that hyperkinetic behaviour in preschool children would develop aggressive and conduct behaviour in middle childhood and possibly personality/ conduct disorder later.

Against such background, it seems Imperative that some service are required for these children, preferably started at an early age. Psychostimulants had been used. (Rapoport, 1978; Taylor, 1985; Werry and Sprague, 1974). It has been demonstrated that it could reduce off-task activities, out of seat behaviour in classroom and restlessness. In fact, the Washington Post 1970 reported 5-10% of a school sample in USA has been taking the drug, and such unskeptical use of medication has created much criticism in the public. Nevertheless, the psychobehavioural effect of psychostimulants is not unique to hyperkinetic children. Similar clinical effect occurred in normal children as well (Rapoport, 1978). Against this short-term efficacy, however, the long-term value of psycho- stimulants in altering the prognosis In hyperactive children has not been established. (Taylor, 1985). In fact, from the available date, there is no difference between the treated and untreated group 5 years after referral. It appears that some conjunctive therapy are necessary in the comprehensive management of these children. Behavioural therapy (Yule, 1984; Gittelman, 1980) and cognitive behavioural therapy (Douglas, 1984) have been proposed. A combination of stimulants and behavioural therapy is regarded as the best treatment, superior to stimulant or behavioural therapy alone (Leek, 1986).

Despite absence of firm evidence from long-term follow up, it is hoped that such timely intervention with a comprehensive package of behavioural and drug treatment will have a positive effect on the child and alter developmental pathway of these children, thus reducing future psychiatric problems. …

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