From the Guidelines
Hyperkinetic disorders, including those associated with attention-deficit/hyperactivity disorder (ADHD), should be managed with a comprehensive approach that includes behavioral therapies, lifestyle modifications, and, when necessary, medication, with stimulants like methylphenidate being a common first-line treatment for ADHD at doses starting from 5-10mg, tailored to the individual's response and needs, as evidenced by recent clinical guidelines 1.
When considering the management of hyperkinetic disorders, it's crucial to differentiate between various conditions that could present with similar symptoms, such as chorea, dystonia, myoclonus, tics, tremors, and ADHD. For ADHD, particularly the hyperactive-impulsive type, the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, should be followed, which includes symptoms like frequent fidgeting, difficulty sitting still, feelings of inner restlessness, and being often loud and disruptive, among others 1.
Key points to consider in the management of hyperkinetic disorders include:
- Accurate diagnosis based on clinical presentation and diagnostic criteria
- Individualized treatment plans that may include medication, behavioral therapy, and lifestyle changes
- For ADHD, the use of stimulant medications like methylphenidate, with careful dose adjustment to minimize side effects and maximize efficacy
- Regular follow-up to assess treatment response and adjust the treatment plan as necessary
In the context of ADHD, the Adult ADHD Self-Report Scale (ASRS-V1.1) can be a useful tool for initial screening, with a positive screen indicated by symptoms occurring often or very often for 4 or more of the 6 questions 1. Treatment should aim to reduce symptoms, improve quality of life, and enhance functional outcomes, with a focus on the safest and most effective interventions available, as supported by the most recent and highest quality evidence 1.
From the FDA Drug Label
The symptoms must not be better accounted for by another mental disorder. For the Hyperactive-Impulsive Type, at least 6 of the following symptoms must have persisted for at least 6 months: fidgeting/squirming, leaving seat, inappropriate running/climbing, difficulty with quiet activities, “on the go,” excessive talking, blurting answers, can’t wait turn, intrusive. Atomoxetine capsules are indicated for the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD)
Hyperkinetic symptoms are associated with the Hyperactive-Impulsive Type of ADHD, which includes symptoms such as:
- Fidgeting/squirming
- Leaving seat
- Inappropriate running/climbing
- Difficulty with quiet activities
- “On the go”
- Excessive talking
- Blurring answers
- Can’t wait turn
- Intrusive behavior Atomoxetine is indicated for the treatment of ADHD, which includes hyperkinetic symptoms 2.
From the Research
Definition and Diagnosis of Hyperkinetic Disorder
- Hyperkinetic disorder is a condition characterized by excessive restlessness, inattention, and impulsivity [ 3 ].
- The diagnosis of hyperkinetic disorder is based on the presence of symptoms such as tremor, dystonia, tics, myoclonus, and drug-induced dyskinesia [ 3 ].
Treatment Options for Hyperkinetic Disorder
- Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) includes stimulant and non-stimulant medications [ 4 ].
- Combined methylphenidate and atomoxetine pharmacotherapy has been shown to be effective in reducing symptoms of ADHD [ 4 ].
- Non-stimulant therapies, such as atomoxetine, bupropion, and alpha-2 agonists, can be used to treat ADHD [ 5 ].
Assessment Scales for Hyperkinetic Disorders
- Several scales have been proposed to assess the severity of hyperkinetic disorders, including the Movement Disorder Society (MDS) task force for rating scales in Parkinson's disease [ 3 ].
- The European clinical guidelines for hyperkinetic disorder provide recommendations for the conceptualization and management of hyperkinetic disorder and attention deficit/hyperactivity disorder (ADHD) [ 6 ].