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ICD-10 Learning Lab Exit Presentation Mode

Category: F90 F91 F92 F93 F94 F95 F98

F90 — Hyperkinetic disorders: facilitator sheet

Teaching objective

F90 requires inattention (failing to sustain attention on tasks or play, not following through on instructions, being easily distracted) together with overactivity and impulsiveness (excessive running or climbing in situations where it is inappropriate, difficulty waiting turns, blurting out answers), evident before age 6, and — decisively — evident in more than one situation (for example, both at home and at school), not confined to one setting alone.

Choose material

Worked example · Case: Restless everywhere he goes · Case: Impulsive rule-breaking, or a conduct pattern? · Case: Restless in one classroom only

Worked example

Show scenario

An 8-year-old boy's teacher reports he is constantly out of his seat, cannot wait his turn, and rarely finishes assigned work. His parents, when asked, say he is 'a bit of a handful' at home but manage his behaviour without much difficulty, and no comparable pattern has been reported by his grandparents, who care for him most weekends.

(or reveal one step at a time below)
  1. Reveal step 1

    Step 1 — Check the core features: out-of-seat behaviour, difficulty waiting turns, and not finishing work are consistent with overactivity, impulsiveness, and inattention.

  2. Reveal step 2

    Step 2 — Check cross-situational pervasiveness specifically: the pattern is clearly documented at school, but at home it is described only as 'a bit of a handful,' and it is absent during weekends with grandparents.

  3. Reveal step 3

    Step 3 — Weigh what this means: F90 requires the pattern to be evident in more than one situation; here, only one setting (school) shows a clear, impairing pattern.

  4. Reveal step 4

    Conclusion — Before F90 can be confirmed, a more detailed history from home and other settings is needed; on the information given so far, cross-situational pervasiveness is not yet established.

Comparison points

F90 is distinguished from F91 (conduct disorders) by which feature is primary: attention/activity regulation difficulty in F90, versus a persistent pattern of rule-violating, aggressive, or defiant conduct in F91 — though the two frequently co-occur (F90.1). It is distinguished from ordinary high-energy childhood behaviour by degree, cross-situational pervasiveness, and functional impairment, and from an anxiety-driven restlessness (F93) by the absence of a specific fear or worry driving the activity.

Misconception prompt

Believing hyperkinetic disorder is caused by poor parenting or diet: "If the parents just disciplined him more consistently (or cut out sugar), this wouldn't be happening."

Ask the class why this reasoning fails before revealing the explanation below.

Reveal why it fails

F90 is defined by a specific pattern of inattention, overactivity, and impulsiveness that is early-onset and pervasive across settings — it is a description of that pattern, not a claim about what caused it. Popular beliefs blaming diet, screen time, or parenting style for hyperkinetic presentations are not part of ICD-10's diagnostic criteria and can lead to unfairly blaming families instead of focusing on the actual diagnostic question: is the pattern present, early-onset, and pervasive across more than one setting?

Discussion prompts

(or reveal one at a time below)
  1. Prompt 1

    Name the three core feature domains of F90.

  2. Prompt 2

    Explain why evidence from only one setting is not enough to confirm F90.

  3. Prompt 3

    Explain the difference between F90.0 and F90.1.

Summary

Inattention, overactivity, and impulsiveness, evident before age 6 and pervasive across more than one setting — not a single-classroom pattern.