Hyperkinetic Children



	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.  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.