Studies on the hyperactive child. V. The effects of dextroamphetamine and chlorpromazine on behaviour and intellectual functioning

Typical neuroleptics in child and adolescent psychiatry

This paper reviews the use of typical ("old") neuroleptics in the treatment of child and adolescent psychiatric disorders. Very few methodologically sound papers have been published in the field. It is concluded that typical neuroleptics should be used sparingly and only in severe and incapacitating disorders such as some psychotic conditions and handicaping tic disorders. Side effects have to be very carefully monitored.

Clinical effects of methylphenidate and thioridazine in intellectually subaverage children

Thirty children with subaverage IQs and psychiatric diagnoses of attention deficit disorder and/or or conduct disorder took part in a double-blind study of placebo, methylphenidate, and thioridazine, which were given for 3 weeks each. The results showed a consistent and highly significant effect of methylphenidate in reducing teacher ratings of problem behavior. Parent ratings showed no behavioral effects for the group as a whole. An attentional model of stimulant drug response was used to divide subjects according to a cognitive maturity domain presumed to reflect selective attention. When divided according to breadth of attention, mental age, and IQ level, higher functioning subjects were found to show a generally favorable response to methylphenidate on both teacher and parent rating scales, whereas children of low functional level typically showed an adverse or indifferent response. The present data suggest that mental age and IQ may be important determinants of drug response; below a given level, there was a greatly reduced likelihood of responding positively. Clinical response to thioridazine was substantially less than the response to methylphenidate, with significant improvements confined to conduct and hyperactivity problems on teacher ratings.

Controlled prospective fifteen year follow-up of hyperactives as adults: non-medical drug and alcohol use and anti-social behaviour

This is a fifteen year prospective controlled study of the non-medical drug and alcohol use and antisocial behaviour of 61 hyperactives, and 41 matched control subjects, (mean age 25 years). The data was collected from detailed interviews with the subjects as well as computerized court records to verify subjects reports. Generally hyperactives did not differ significantly from controls on current drug and alcohol use and antisocial behaviour. However one sees trends of greater drug alcohol and antisocial involvement in the hyperactive group. All the subjects who have antisocial behaviour at 15 year follow-up (mean age 25) had early and persistent histories of antisocial behaviour beginning at initial assessment (mean age 8) or at 5 year follow-up (mean age 13). However many hyperactives do not continue their antisocial behaviour into adulthood (mean age 25). There thus appears to be a small subgroup of hyperactive subjects who have more negative outcomes with significantly greater social, emotional and psychological difficulties. It is this subgroup which we need to identify early and treat vigorously.

Hyperactives as young adults: past and current substance abuse and antisocial behavior

In a ten-year prospective follow-up study, young adults who had been diagnosed as hyperactive in childhood were found to have had greater involvement with alcohol and drug use and with courts and police than did matched controls during the five years preceding evaluation. However, differences between groups were generally not significant in the year prior to evaluation, and tests indicate that they had attained similar levels of moral development. Results suggest a more encouraging adult outcome than has previously been expected for hyperactive children.

Hyperactives as young adults: self-esteem and social skills

Eighteen pairs of young adult hyperactives and controls, matched for age, sex, IQ and socioeconomic class and education completed, were assessed on tests of social skills and self-esteem. Hyperactive subjects had significantly more difficulty than matched controls in social skills tests which involved direct oral responses than those involving written responses. This would suggest that the hyperactive young adults cognitively know what the most appropriate response would be from a number of possibilities, but have problems spontaneously producing such a response. Situations dealing with heterosocial and assertion situations were more difficult for hyperactives than job interview situations. Hyperactive young adults also scored significantly worse than matched controls on a number of self-esteem tests, thus supporting the findings of previous psychiatric assessments and the California Psychological Inventory. Finally, no significant correlations were found between the self-esteem and social skills tests. Possible explanations for the findings are discussed.

The hyperactive child syndrome

The behavioral characteristics of the hyperactive child are described at different stages of development. Recent and sometimes controversial research findings are discussed with respect to prevalence, etiology, treatment, and outcome. It is concluded that this syndrome can best be understood in terms of interactions between social, psychological, and biological variables.

The effects of frontal EMG biofeedback and progressive relaxation upon hyperactivity and its behavioral concomitants

Hyperactive children (N = 15) and nonhyperactive children (N = 15) were compared. Hyperactive children were found to possess significantly higher (p less than .002) muscular tension levels and, in addition, presented more behavioral problems and had lower test scores. Both electromyographic (EMG) biofeedback and progressive relaxation exercises were successful in the significant reduction of muscular tension, hyperactivity, distractability, irritability, impulsivity, explosiveness, aggressivity, and emotionality in hyperactive children. The greatest improvement was seen in the area of "emotionality-aggression" (irritability, explosiveness, impulsivity, low frustration tolerance, aggresion). No differences were seen in the EMG improvement of drug and nondrug hyperactive children; both made progress under these self-control techniques. However, nondrug children made greater improvements in the behavioral area. Both EMG biofeedback and progressive relaxation resulted in improvements on the test scores of hyperactive subjects (Bender-Gestalt, Visual Sequential Memory, Digit Span, Coding). The therapy would appear to be improved by the inclusion of mental relaxation, concentration, meditation, and mind-blanking exercises for mental control.

Are the effects of psychomotor stimulant drugs on hyperactive children really paradoxical?

The improved "attention" exhibited by hyperactive children treated with amphetamine-like compounds is postulated to be related to a normal action of these drugs in producing stereotyped behavior. Such activity can be conceptualised as an increased "focusing" of attention, which would be expected to aid performance in tasks involving sustained concentration of attention, but impair performance on tasks involving reversals in cognitive strategy. These behavioural actions of the drugs can be linked to the functioning of central dopaminergic mechanisms.

Hyperactive children and the efficacy of psychoactive drugs as a treatment intervention

Characteristics of hyperactive children, including speculation in regard to etiology, are reviewed. Drug effects studies and drug treatment of hyperactive behavior are examined, and unresolved issues are discussed. Conclusions indicate that individual differences in hyperative children should form the basis for treatment planning, rather than simply treating groups of children under the rubric "hyperactivity."

Predicting the response of hyperkinetic children to stimulant drugs: a review

The present review examines 36 previous research reports involving over 1,400 hyperkinetic children in an effort to determine which variables have proven useful in predicting which hyperkinetic children will respond favorably to stimulant drugs. The research is summarized under eight types of predictor variables: (1) psychophysiological, (2) neurologist, (3) familial, (4) demographic/sociological, (5) diagnostic category, (6) parent/teacher/clinician ratings, (7) psychological, and (8) profile types. The results of this review indicate that, to date, measures of attention span or concentration and its correlates have proven to be the most useful predictors of the response of hyperactive children to drugs. The results also suggest that hyperkinetic children are heterogeneous with respect to levels of CNS arousal and that this variable may prove useful in predicting their response to stimulant drugs. Problems involved in drawing conclusions in a review of this area of research as well as directions which future research might pursue also are briefly discussed.

Increasing reading comprehension of two hyperactive children: preliminary investigation

The differential effectiveness of oral and silent reading on comprehension was evaluated for two third-grade children who were hyperactive and who displayed comprehension deficits. Oral reading resulted in significantly fewer comprehension errors than did silent reading. Time to read a story and number of comprehension errors were negatively correlated. Several possible mechanisms involved in the effect of responding orally were discussed.

Reversal-shift behavior in children with specific learning disabilities

The discrimination learning of 7- to 9-yr.-olds with specific learning disabilities was studied by using the reversal and intradimensional shift paradigms. Three groups of Ss included 20 normal controls, 20 having learning disability but receiving no drug treatment, and 10 having learning disability and receiving drug treatment. All groups given the intradimensional shift task performed significantly better than those given the reversal shift task, while the controls performed significantly better on both shift tasks than Ss with learning disabilities. The prediction of superior shift performance by the latter Ss who were receiving drug treatment, compared to that by the non-drug group, was not substantiated. Results were discussed in terms of support for the Zeaman and House attention model of discrimination learning and the effects of drug therapy on attention for children with specific learning disabilities.

Methylphenidate in children--effect of dosage

A clinical trial in two groups of hyperactive/ aggressive children showed that methylphenidate was superior to placebo for about 2/3 of the children, but that there was little difference in effectiveness between different dosage levels, especially once 0.3 mg/kg is attained. Mild side effects were common at higher dosages. Of a variety of physician, parent, teacher and psychological test and behavioral measures, teacher and physician ratings were the most sensitive to drug effects. No measures including neurological ones discriminated between responders and non-responders. It is concluded that methylphenidate is a useful treatment for hyperactive/aggressive children but that current doses may be too high and side effects more common than stated.