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Diagnostic validity of the hyperactive child (attention deficit disorder with hyperactivity) syndrome.

The evolution of the hyperactive child syndrome as a diagnostic category is traced through various pseudo-etiological formulations (minimal brain dysfunction) to the current descriptive DSM III category as ADDH. The review suggests that the use of inconsistent and poorly specified selection criteria in many studies has led to confusion in terminology, and controversy over the diagnostic validity of the syndrome. Probably because of diagnostic difficulties, biological and genetic studies have not so far definitively validated a syndrome distinct from conduct and learning disorders. Among the most important questions to be answered is whether response to psychostimulants depends on a unique and qualitatively different action in ADDH children. The syndrome is undoubtedly not homogeneous and recent attempts to isolate subgroups on the basis of independent hyperactivity-inattention and aggressive dimensions have shown promise in predicting natural history and therapeutic response. Thus improved methods of subclassification, coupled with improved measures of activity level and attention span are required.