Hyperkinetic is just another word for Hyperactive. Hyperactivity
describes children who show numerous amounts of inappropriate behaviors in
situations that require sustained attention and orderly responding to fairly
structured tasks. Humans who are hyperactive tend to be easily distracted,
impulsive, inattentive, and easily excited or upset. Hyperactivity in children
is manifested by gross motor activity, such as excessive running or climbing.

The child is often described as being on the go or “running like a motor”, and
having difficulty sitting still. Older children and adolescents may be
extremely restless or fidgety. They may also demonstrate aggressive and very
negative behavior. Other features include obstinacy, stubbornness, bossiness,
bullying, increased mood lability, low frustration tolerance, temper outbursts,
low self-esteem, and lack of response to discipline. Very rarely would a child
be considered hyperactive in every situation, just because restraint and
sustained attentiveness are not necessary for acceptable performance in many
low-structure situations. Many parents rate the onset of abnormal activity in
their child when it is and infant or toddler. Abnormal sleep patterns are
frequently mentioned, the child objects to taking naps, he also seems to need
less sleep, and becomes very stubborn at bedtime. Then, when the child is
seemingly exhausted, hyperactive behavior may increase. Family history studies
show that hyperactivity, which is more common in boys than in girls, may be a
hereditary trait, as are some other traits (reading disabilities or enuresis-bed
wetting). Certain predisposing factors affect the mother, and therefore the
child, at the time of conception or gestation or during delivery. Included are
radiation, infection, hemorrhage, jaundice, toxemia, trauma, medications,
alcohol, tobacco, and caffeine. The course of the syndrome typically spans the
6-year to 12-year age range. In many classrooms, children who display
inappropriate overactivity (restlessness, moving around without permission) ,
attention deficits (distractible by task-irrelevant events, inability to sustain
attention to the task) , and impulsivity (making decisions and responses hastily
and inaccurately, interrupting and interfering with classmates and the teachers)
are likely to be identified as hyperactive. The diagnosis of hyperactivity is
usually suggested when parents and teachers complains that a child is
excessively active, behaves poorly, or has learning difficulties. However,
there is no specific definition or precise test to confirm that a child is
hyperactive. This syndrome is most frequently recognized when the child cannot
behave appropriately in the classroom. There are three characteristic courses.

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In the first, all of the symptoms persist into adolescence or adult life. In
the second, the disorder is self-limited and all of the symptoms disappear
completely at puberty. In the third, the hyperactivity disappears, but the
attentional difficulties and impulsivity persist into adolescence or adult life.

The relative frequency of the courses is unknown. The individual, accordingly,
does not grow out of the disorder. As the child passes through puberty,
aggression and restlessness may decrease, but most symptoms persist and may lead
the adolescent to develop a low self-esteem and a tendency to withdraw. The
adolescent may also manifest anti-social tendencies, for instance, lieing,
stealing, and violence, which frequently lead to delinquency. Similarly,
symptoms persist into adult life and account for social maladjustment (behavior
that violates laws or unwritten standards of the school or community, yet
conforms to the standards of some social subgroup). Attention-deficit
Hyperactivity Disorder (ADHD), also called attention deficit disorder (ADD), is
presently the most common condition diagnosed in hyperactive children. This
specific syndrome focuses on the child’s inability to pay attention. This
syndrome occurs early in life (in infancy or by the age of 2 or 3 years ) is
more common in boys and may occur as many as 3 percent of prepubertal children.

A small proportion of hyperactive children have a definite history of injury to,
or disease of, the brain that preceded a change to abnormal behavior. These
children show relatively minor disabilities of coordination, reflexes,
perception, problem solving, and other behaviors often referred to as
“softsigns” of neurological disorder (brain-injured). It has not been
established, however, that brain damage or malfunction is a factor in most cases
of hyperactivity. Studies of many children who had difficulties at birth show
no connection between such difficulties and later hyperactivity. In these other
wise, normal children, hyperactivity, impulsivity, and distractibility are
variable. The syndrome has been described for many years, and these children
were previously said to have minimal brain dysfunction (MBD). In the MBD
syndrome, the behaviors of ADHD (attention deficit disorder with hyperactivity)
were combined with poor coordination, emotional instability, immature
development, perceptual difficulties, learning disabilities, language disorders,
and minor neurological abnormalities observed through medical examinations. In
most cases it is not possible to find a specific cause for hyperactivity and may
not be appropriate to try. Since hyperactivity behavior is common, starts early
and persists at least into adolescence, has hereditary determinants, and also is
relatively hard to change by psychological means, it may represent a type of
temperament rather than a psychological or medical disorder. Most authorities
feel that factors that interfere with the normal development of a child’s brain
during pregnancy, labor, delivery, and early infancy are most significant.

These include infections, injuries, prematurity, and difficult births. Other
possible causes include environmental conditions such as maternal drug addiction,
lead poisoning, malnutrition, and emotional deprivation. In some, hyperactivity
seems to be an inherited trait. Only in rare circumstances is there a precise
history of previous injury or disease of the brain, or an ongoing neurological
or psychiatric disorder that can be diagnosed. Although, it’s usually
associated with normal intelligence, it may accompany mental retardation or
emotional disturbances. Target-behavior recording is commonly used to measure
hyperactivity, especially the inappropriate overactivity component, but also
inattention and impulsivity. Behavior-rating scales often include hyperactivity
items; some such as the Conners Parent-teacher Questionnaire, are especially
designed for measuring hyperactivity. Other behavior patterns indicative of
hyperactivity may be measured with objective tests, such as “selective
attention” (ability to concentrate on task-relevant aspects of a situation
rather than in cendental, task-irrelevant features) and “impulsive cognitive
tempo” (tendency to decide and act hastily without fully considering alternative
responses, which often leads to mistakes in problem solving and decision making).

These measures of actual functioning in an artificial situation do resemble
important learning situations for students, and are useful and are useful
research tools, but are not yet well developed enough for educational
applications. Because, it is not possible in most cases to find a specific
cause for hyperactivity, there is little agreement as to how much medical or
psychological investigation is needed for every child. Most parents begin by
discussing their child’s problem with their family doctor or pediatrician.

Based upon that evaluation, referral is sometimes made for neurological,
psychological, psychiatric, and educational evaluations for consideration of
possible related disorders and to place the child in the most appropriate school
environment. Researchers must understand a disorder before they can attempt to
treat it. There are a variety of theories on the etiology of ADHD, but most
researchers now believe that there are multiple factors that influence it’s
development. It appears that many children may have a greater likelihood of
developing ADHD as a result of genetic factors. This predisposition is
exacerbated by a variety of factors. Although a very popular belief is that
food additives or sugar can cause ADHD, there has been almost no scientific
support for these claims. Since so many factors have been found to be
associated with the development of ADHD, it is not surprising that numerous
treatments have been developed for the amelioration of ADHD symptoms. Although,
numerous treatment methods have been developed and studied, ADHD remains a
difficult disorder to treat effectively.

Treatments of hyperactivity can be broken down into roughly two
categories: medication, and behavioral or cognitive-behavioral treatment with
the individual ADHD child, parents, or teachers. Stimulant medications have
been used in the treatment of ADHD since 1937. The most commonly prescribed
stimulant medications are methylphenidate (Ritalin), premoline (Cylert) and
dextroamphetamine (Dexedrine). Ritalin corrects the neurochemical imbalances in
the brain, and it is the most widely used stimulant drug. Until the 1960’s
hyperactive children were thought to be suffering from anxiety resulting from
conflict between their parents, and together with their families they were
treated by psychotherapy. Since then, stimulant drugs have come into wide use
to calm hyperactive children. Drug therapy, however, is only temporary in
effect and presents the danger that, if prolonged, the children may become
psychologically dependent on the drugs. Behavioral improvements caused by
stimulant medications include impulse control and improved attending behavior.

Overall, approximately 75 percent of ADHD children on stimulant medication show
behavioral improvement, and 25 percent show either no improvement or decreased
behavioral functioning. It appears that stimulant medications can help the ADHD
child with school productivity and accuracy, but not with overall academic
achievement. Although ADHD children tend to show improvement while they are on
stimulant medication, there are rarely any long-term benefits to the use of
stimulant medications. In general, stimulant medication can be seen as only a
short-term management tool. Antidepressant medications (such as imipramine and
desipramine ) have also been used with ADHD children. These medications are
sometimes used when stimulant medication is not appropriate. Antidepressant
medication, however, like stimulant medications, appear to provide only short-
term improvement in ADHD symptoms. The treatment program for hyperactive
children must be individualized to meet their particular needs. Medication,
used alone or in combination with educational and psychological interventions,
are most commonly utilized. Overall, the use or nonuse of medications in the
treatment of ADHD should be carefully evaluated by a qualified physician. If a
child is put on medication for ADHD, the safety and appropriateness of the
medication must be monitored continuously throughout it’s use. Behavioral and
cognitive-behavioral treatments have been used with ADHD children themselves,
with parents, and with teachers. Most of these techniques attempt to provide
the child with a consistent environment in which on-task behavior is rewarded
(for example, the teacher praises the child for raising his or her hand and not
shouting out an answer) , and in which off-task behavior is either ignored or
punished (for example, the parent had the child sit alone in a chair near an
empty wall, a “time-out chair” , after the child impulsively does something
wrong) . In addition, cognitive-behavioral treatments try to teach ADHD
children to internalize their own self-control by learning to “stop and think”
before they act. One example of a cognitive-behavioral treatment, which was
developed by Philip Kendall and Lauren Braswell, is intended to teach the child
to learn five “steps” that can be applied to academic tasks as well as social
interactions. The five problem-solving steps that children are to repeat to
themselves each time they incounter a new situation are the following: Ask :What
am I supposed to do?” , “What are my choices?” ; concentrate and focus in ; make
a choice ; ask “How did I do?” (If I did well, I can congratulate myself ; If I
did poorly, I should try to go more slowly next time.) In each therapy session,
the child is given twenty plastic strips at the beginning. The child looses a
strip every time he or she does not use one of the steps, does too fast, or
gives an incorrect answer. At the end of the session, the child can use the
chips to purchase a small prize. This treatment alone combines the use of
cognitive strategies ( the child learns self-instructional steps) and behavioral
techniques ( the child looses a desired object, a chip, for impulsive behavior).

Overall, behavioral and cognitive-behavioral treatments have been found to be
relatively effective in the settings in which they are used and at the time,
they are being instituted. There is some evidence to suggest that the
combination of medication and behavior therapy can increase the effectiveness of
the treatment. Like the effects of medications, however, the effects of
behavioral and cognitive-behavioral therapies tend not to be long-lasting. A
promising trend in treatment is to help the hyperactive child by teaching his
parents and teachers how to cope with his individual behavior. Hyperactive
children need to have a relatively set routine that includes a maximum of
regularity and a minimum of surprises and interruptions. The school setting may
need to be altered in such a way as to make additional help and provisions
available. The children frequently need praise, encouragement, and special
attention so that experiences that previously only lead to failure may now
become successful and enjoyable. Unfortunately, some children may never make a
complete recovery from hyperactivity, and have a greater chance of developing
alcoholism or mental health problems as adults.

While the diagnostic definition and specific terminology of ADHD will
undoubtedly change throughout the years, the interest in and commitment to this
disorder will likely continue. Children and adults with ADHD, as well as the
people around them, have difficult lives to lead. The research community is
committed to finding better explanations of the etiology and treatment of this
common disorder.


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