The hyperkinetic syndrome is a symptom complex of hyperactivity, short attention span, distractibility, impulsivity, learning difficulties, other behaviour problems and 'equivocal' neurological signs. However, none of these terms has ever been objectively defined and at present diagnosis is largely a matter of clinical judgement. In the management of the disorder, drugs do have a place but the decision to use medication is a complex procedure diagnostically and therapeutically calling for the highest in clinical skill and medical supervision. The most useful medication at present is the stimulant group of drugs, particularly dextroamphetamine and methylphenidate. Antipsychotic drugs are sometimes useful but carry the risk of depressing higher CNS functions such as attention and cognition. Other drugs which have been shown to be of value include tricyclic antidepressants (although their effect is less predictable and less striking than that of the stimulants) and pemoline.