Clinical features

The cardinal features of AD-HKD are excessive and impairing levels of activity, inattention, and impulsiveness. Children with AD-HKD have great difficulty remaining seated when required to in structured situations such as in the classroom or at the dinner table. They are more active than their peers in unstructured situations such as in the playground. They fail to pay attention to instructions in academic and social situations. They have serious difficulty withholding a response of any kind until the appropriate moment, interrupting an inappropriate course of action once initiated, and adjusting incorrect or maladaptive responses. These characteristics are not simply the subjective impressions of adults, but can be confirmed reliably with a range of objective measures (29 and rating scales completed by observers/2 29

AD-HKD behaviours are highly context dependent; the extent of disagreement among raters, such as mothers, fathers, and teachers, indicates that observers are influenced by their own particular perspectives on child behaviour and their opportunities for interaction with particular children. (25) Also, ratings of the severity of AD-HKD symptoms are influenced by contrast effects, which result in the exaggeration of existing differences between persons (namely, twin contrast affects), and by the presence of concurrent psychopathology. For example, the inattentiveness or irritability of the depressed person or the aggressiveness of a person with conduct disorder may result in an exaggerated perception of AD-HKD symptoms.(26,,27ยป

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