No abstract

The distinction between hyperactivity and conduct disorder was explored in a mixed group of 64 children referred to psychiatric clinics because of antisocial or disruptive behaviour. A semi-structured interview measure (the Parental Account of Children's Symptoms, PACS) proved to have adequate inter-rater reliability, internal consistency and factorial validity. The PACS scales of defiance and hyperactivity, and similar subscales from Conners' Teacher Rating Scale, were tested against laboratory and clinical measures of activity, attention, cognitive performance, psychosocial background and family relationships. The hyperactivity (but not the defiance) scales were associated with greater activity, younger age, poorer cognitive performance and abnormalities on a developmental neurological examination. The defiance (but not the hyperactivity) scales were associated with impairment of family relationships and adverse social factors. It was concluded that a dimension of inattentive, restless activity should be separated from one of antisocial, defiant conduct in children with psychiatric disorder.

SUMMARY An epidemiological survey designed to investigate the possible causal influence of biological and psychological factors on hyperactivity and conduct disturbance among 226 primary school boys is provided. The background variables investigated were: adverse perinatal events, neurodevelopmental abnormalities, minor physical anomalies and a combination of psychosocial disadvantage factors. Hyperactivity and conduct disturbance were measured by parent and teacher questionnaires, the disturbed groups being taken as the top 10 per cent. Teachers and parents largely identified separate children as disturbed. The teacher questionnaires failed to distinguish between the two conditions but disturbance was significantly related to high social disadvantage. The parent questionnaire distinguished the two groups better and disturbance of either kind was markedly associated with maternal mental distress, and this far outweighed the contribution of any other background variable.

Sixty boys, aged from 6 to 10 years, were studied after their referral to psychiatric clinics for antisocial or disruptive behaviour. Their scores on reliable measures of hyperactivity, defiant behaviour, emotional disorder and attention deficit were taken for the home, school and clinic settings; and subjected to two techniques of cluster analysis. Both gave a similar set of clusters, one of which had high scores on all measures of hyperactivity and attention deficit. Membership of this cluster was associated with a lower IQ, a younger age of problem onset and referral, an abnormal neurological examination, a history of developmental delay, smaller family size, poor peer relationships and a high rate of accidental injuries; and it predicted a good response to stimulant medication in a controlled trial. Other research on the classification of hyperactivity is discussed, and proposals are made for the criteria of a rather narrow definition of 'hyperkinetic conduct disorder'.

In a survey of training in child psychiatry in Great Britain, all senior registrars were sent questionnaires; the response rate was 69 per cent. We describe background factors of the trainees, details of the clinical and academic experience available to them, and their attitudes towards their training. Most trainees had had extensive previous experience in adult psychiatry and the predominant orientation was psychoanalytic. In general, they approved of the guidelines for training issued by the Joint Committee for Higher Psychiatric Training. Family therapy was the most popular treatment method. We comment on their training experience where the interest expressed was not matched by adequate availability of the training facilities.