Clinical management of children with hyperactivity. A shift in diagnostic and therapeutic emphasis.

Children who have attention deficit disorder with (or without) hyperactivity are handicapped by their inability to concentrate and control their impulsivity, especially while in school. Specific performance disabilities prevent them from demonstrating, especially through written schoolwork, what they have learned. Parents and teachers are likely to mistake these children's symptoms for willful misbehavior or lack of motivation, which leads to misunderstandings and even mistreatment. The critical issue in the management of a child with hyperactivity is to effectively treat the key problems of inattention and impulsivity rather than the hyperactivity per se. A nonintensive long-term approach combining stimulant therapy and a cooperative liaison among the physician, child, family, and teachers is recommended.