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Attention-deficit hyperactivity disorder: a UK perspective

Nature Clinical Practice Neurology volume 4, pages 120–121 (2008)Cite this article

The acceptance of attention-deficit hyperactivity disorder (ADHD) by the medical community in the UK is a phenomenon of the last 15 years. The release of methylphenidate (Ritalin®, Novartis Corporation, Summit, NJ) to general availability in the UK in 1993 probably provided the impetus for this recognition. By the early 2000s, a number of specialist ADHD services had been established, several national conferences held and authoritative treatment guidelines published by senior clinicians and official advisory bodies.1,2 These guidelines advocated the use of stimulant medication in the context of a broad approach to treatment.

In the mid-1990s, the term used in the UK for the diagnosis of a severely hyperactive, inattentive child would have been 'hyperkinetic disorder' as defined in the ICD-10.3 This definition includes inattention and impulsivity, two of the core ADHD symptoms listed in the DSM-IV (the diagnostic system used by US clinicians).4 Compared with ADHD, hyperkinetic disorder requires more stringent criteria for its diagnosis, and its prevalence rate is about 1%.1 Only 25% of the children with ADHD in the American Multimodal Treatment Study of Children with ADHD (MTA) fulfilled the diagnostic criteria for hyperkinetic disorder.5 Although in the UK the term 'hyperkinetic disorder' began to be replaced by 'ADHD' in the late 1990s following the influence of American literature, the historical focus on the ICD system has led to the use of a concept of ADHD in the UK that is equivalent to a severe variant of the 'combined ADHD' subtype defined by the DSM-IV.1 Much UK literature, following academic leadership from the Institute of Psychiatry, conceptualizes ADHD as the handicapping combination of extreme personality traits and as a neurobehavioral syndrome with various causal risk factors. The other DSM-IV subtypes of ADHD ('predominantly hyperactive-impulsive' and 'predominantly inattentive') are not usually recognized in UK practice.

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References

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  1. 17 Wimpole St, London, W1G 8GB, UK prof@17wimpole.com

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  1. P Hill is Honorary Consultant Child and Adolescent Psychiatrist at Great Ormond Street Hospital for Children in London, UK.,

    Peter Hill

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The author is a consultant for Eli Lilly and UCB and has received speaker's honoraria from Flynn Pharma, Janssen-Cilag, Eli Lilly and UCB.

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Hill, P. Attention-deficit hyperactivity disorder: a UK perspective. Nat Rev Neurol 4, 120–121 (2008). https://doi.org/10.1038/ncpneuro0734

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