Social impairment in Hyperkinetic Disorder - relationship to psychopathology and environmental stressors.

Background: There is paucity of information concerning social impairment in children and adolescents referred to mental health services.

Aims: The aim of this study was to assess the association of social impairment, psychopathology and environmental stressors in Hyperkinetic Disorder (HKD) and to determine the frequency of pervasive developmental disorder (PDD) symptoms in HKD.

Method: 'Item sheets' about children and adolescents seen in child and adolescent mental health between 1992 and 2001 (n = 3644) were used to extract nine psychopathology domains, two social impairment subtypes and nine environmental stressors. The two social impairment subtypes were relationship difficulty (RD) and social communication difficulty (SCD) (i. e. autistic-like social impairment). The association of SCD/RD, psychopathology domains and environmental stressors was investigated in HKD cases and compared to a psychiatric control group.

Results: In children and adolescents with HKD, SCD was associated with speech and language difficulties, repetitive behaviour, developmental difficulties (all symptoms of PDD), affective symptoms, conduct problems and ADHD symptoms. Relationship difficulty was linked to conduct problems, affective symptoms and environmental stressors. Unlike SCD, RD was associated with all of the environmental stressors studied. There were significantly more children with PDD symptoms in the HKD group than in the control group.

Conclusion: This study highlights the importance of subtyping social impairment in HKD and its association with psychopathology and environmental stressors. In HKD, SCD reflecting autistic social impairment is associated with other autistic symptoms, such as speech and language problems and repetitive behaviour. A small subgroup of HKD cases may have a milder form of autistic spectrum disorder.