A simplified pediatric school entry screening examination for the syndrome of deficits in attention, motor control and perception (DAMP) is suggested from the Goteborg University, Sweden. A population-based cohort of 113 children, 6-7 years of age (62 with and 51 without DAMP), were compared on measures of attention, motor function, language, and cognition. Attention deficits were identified by both parents and pediatrician. Four of nine motor function tests and visual reaction times discriminated between the DAMP and control groups. Design copying for diagnosing perceptual disorders was better than block design and object assembly WISC subtests. Full-scale WISC IQs were lower in the DAMP group, and children with DAMP had greater phonological processing difficulties. [1]

COMMENT. A simplified school entry examination involving four motor tests (standing on one foot, Fog test for associated movements, design copying and diadochokinesis), combined with clinical observation and parent interview, identified 80% of children with DAMP. In Scandinavia, DAMP replaced MBD in the 1980s, and overlaps with ADHD. One third of children with DAMP meet criteria for ADHD, and the remainder have ADD. Diagnosis of DAMP requires the presence of both attentional and motor/perceptual difficulties and a normal IQ Testing by a neuropsychologist is recommended in suspected cases. The inclusion of neuromotor and perceptual criteria in the diagnosis of ADHD would add some objective data to the subjective behavioral criteria of the DSM-IV diagnosis.

DAMP and MBD versus AD/HD and hyperkinetic disorders is discussed in an invited commentary from the Children’s Hospital, Karolinska Hospital, Stockholm, Sweden [2]. The author refers to Rutter’s publications (1970, 1994), stating that “brain disease with localizing neurologic signs is uncommon in children with ADDH....by contrast, the more severe hyperkinetic disorder is disproportionately common in children with damaged brains.” In Sweden, “the concept of DAMP is in need of revision,” as are the diagnostic criteria for ADHD in the USA.