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Attention fixed on the hyperactive

Matthew Beard reports on attempts to help ADHD sufferers often dismissed as nuisance children.

Once known as hyperactivity, the condition which now goes by the more wordy title of attention deficit hyperactivity disorder, has long sparked controversy.

It has been associated with the glib diagnosis of nuisance children, and subsequently, liberal prescription of the drug Ritalin.

In an attempt to sift the muddle of opinion and identify genuine sufferers the British Psychological Society has published an extensive digest of research into ADHD.

Although ADHD children are relatively few (current estimates put the figure between 1 and 8 per cent of the child population), they can wreak havoc in the classroom.

According to Dr Geoff Thorley, child clinical psychologist who has contributed to the report, the key to successful treatment of ADHD is in picking it out among the diverse causes of bad behaviour.

As research advances, psychologists make the distinction between a child's problems that can be linked to family stress or other upset (around one in five of all children) and those caused by ADHD.

The analysis of the latest research suggests the symptoms of ADHD - impulsive, over-active and inattentive behaviour - could be underpinned by "an inability to maintain effort over time to meet task demands".

Experts in Europe and the United States are beginning to reach a consensus on what constitutes ADHD.

In the past, methods of diagnosis in the US have been criticised for being too loose, resulting in up to 20 per cent of children being diagnosed and treated with Ritalin, a non-sedative drug which in small doses helps control behaviour.

Researchers believe that the condition is under-diagnosed in Europe. The latest analysis is partly intended to foster an understanding of ADHD among parents, child psychologists and special needs co-ordinators.

The causes of ADHD remain contentious, as indicated by the report's title, A psychological response to an evolving concept. In the US, ADHD has been seen as a neurological and inherited disorder. In the UK it has been viewed as a psycho-social syndrome.

The report identifies key stages in treating ADHD. Dr Rea Reason, who chaired the working party, said: "Successful help varies from child to child. Whether ADHD is implicated or not, a consideration of environmental circumstances becomes the essential first step in helping children at home and school. Programmes which include behavioural and cognitive management may be effective. "

The report emphasises the importance of psychotherapy and "educational interventions" as a means of improving social adjustment and academic achievement.

Dr Thorley said: "ADHD children will always be wanting things to do. They have a constant need for stimulus which is a problem in the classroom. If nothing is happening then they can cause chaos."

Modern treatment of ADHD focuses on early intervention. Dr Thorley says special educational needs techniques can be successfully applied to assess the extent of the problem and tailor curriculum and other aspects of schooling.

Dr Thorley said: "ADHD eases with age because children learn to curb impulsive and overactive behaviour. But if is not recognised and treated, the effects of ADHD can be long-lasting."

Attention Deficit Hyperactivity Disorder: A psychological response to an evolving concept. Report of a working party of the British Psychological Society, Pounds 4 members, Pounds 10 non-members

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