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INTERNATIONAL CLASSIFICATION OF DISEASES

10th Edition - World Health Organization, 1990 (ICD-10)

CRITERIA FOR HYPERKINETIC DISORDER

A. Demonstrate abnormality of attention and activity at HOME, for the age and developmental level of the child, as evidenced by at least three of the following attention problems:

1. short duration to spontaneous activities
2. often leaving play activities unfinished
3. over-frequent changes between activities
4. undue lack of persistence at tasks set by adults
5. unduly high distractibility during study, e.g. homework or reading assignment
6. and by at least two of the following activity problems: continuous motor restlessness (running, jumping etc.)
7. markedly excessive fidgeting or wriggling during spontaneous activities
8. markedly excessive activity in situations expecting relative stillness, e.g. mealtimes, travel, visiting, church
9. difficulty in remaining seated when required

B. Demonstrate abnormality of attention and activity at SCHOOL or NURSERY (if applicable), for the age and developmental level of the child, as evidenced by at least two of the following attention problems:

1. undue lack of persistence at tasks
2. unduly high distractibility, i.e. often orientating towards extrinsic stimuli
3. over frequent changes between activities when choice is allowed
4. excessively short duration of play activities
5. and by at least two of the following activity problems: continuous and excessive motor restlessness (running, jumping etc.) in school
6. markedly excessive fidgeting and wriggling in structured situation
7. excessive levels of off-task activity during tasks
8. unduly often out of seat when required to be sitting

C. Directly observed abnormality of attention or activity. This must be excessive for the child's age and developmental level. The evidence may be any of the following:

1. direct observation of the criteria in A or B above, i.e. not solely the report of parent and/or teacher
2. observation of abnormal levels of motor activity, or off-task behaviour, or lack of persistence in activities, in a setting outside home or school (e.g., clinic or laboratory)
3. significant impairment of performance on psychometric test of attention

D. Does not meet criteria for pervasive developmental disorder, mania, depressive or anxiety disorder.

E. Onset before the AGE OF 6 YEARS.

F. Duration of AT LEAST 6 MONTHS.

G. IQ above 50.

Note: The research diagnosis of Hyperkinetic disorder requires the definite presence of abnormal levels of inattention and restlessness that are pervasive across situations and persistent over time, that can be demonstrated by direct observation, and that are not caused by other disorders such as autism or affective disorders.

Eventually, assessment instruments should develop to the point where it is possible to take a quantitative cut-off score on reliable, valid and standardised measures of hyperactive behaviour in the home and classroom, corresponding to the 95th percentile on both measures. Such criteria would then replace A and B above.

*From the International Classification of Diseases (10th Ed.). World Health Organization, Geneva, 1990 © WHO