The conclusions of the paper by Foreman and colleagues¹ will not come as a surprise to any parent or paediatrician. Children who behave badly stress their parents. The normal methods of discipline work less well in the face of pervasive hyperactivity, impulsivity, and inattention. After some years of failure, combined with feelings of inadequacy, most parents give up and take the line of least resistance. Paediatricians can do the same. Faced with the chaos of a wrecked surgery and conscious of a very full waiting room, the line of least resistance can suddenly become very attractive. Seeing what appears to be a textbook presentation of a lack of parental discipline, it is all too easy to blame the parents and refer the child on quickly to someone who “does behaviour”.

Hyperkinesis is a major risk factor for parenting breakdown, increasing the risk that a child will be excluded from the family by a factor of three. The risk appears to be independent of any other psychosocial difficulties affecting the family. Logically therefore, early detection and treatment might prevent the distress of family breakdown. However, to achieve this laudable aim will not be easy. Hyperkinesis challenges not only our professional tolerance but also the way paediatric services for all community based childhood disorders are currently structured.

“Hyperkinetic disorder”, the World Health Organisation term, is the description of choice in Europe. “ADHD; attention deficit, hyperactivity disorder” is the preferred term in America, Australia, and many other parts of the world. Hyperkinetic disorder has stricter diagnostic criteria and therefore applies to fewer children than ADHD. Nevertheless, the figures are striking. One per cent of school aged children in the UK and 3–4% of school aged children in the USA could …