Long-term use and discontinuation of methylphenidate with hyperactive children

Absence of tolerance to the behavioral effects of methylphenidate in hyperactive and inattentive children

To determine whether the behavioral benefits of methylphenidate in hyperactive and inattentive children decline during long-term treatment, we analyzed data from 108 hyperactive students who responded well to methylphenidate therapy for 3 to 10 years. Responders were identified by their consistent improvement from baseline on standard teacher rating scales. The therapeutically effective drug doses were corrected for body size and evaluated in relation to increasing age and treatment duration. Body size corrections included milligrams per kilogram, milligrams per kilogram to the 0.7th power, and milligrams per square meter of estimated body surface area. The major findings were that (1) the dose of methylphenidate, when adjusted for growth, did not change significantly during the 3 to 10 years of treatment; (2) the loss of a previously satisfactory response to methylphenidate treatment was uncommon (6%) and when present was related to middle school enrollment, male gender, noncompliance with medication, and lower than customary dosage; (3) the dose calculations that minimized the effects of growth with age were milligrams per kilogram to the 0.7th power and milligrams per square meter of estimated body surface area; and (4) the commonly used milligrams per kilogram dose consistently overcorrected for growth with advancing age.

Additive effects of dexedrine and self-control training. A multiple assessment

The present study reports the use of a single-case experimental design in examining the additive effects of psychostimulant medication (Dexedrine) and self-control training with a 9-year-old psychiatric inpatient diagnosed as hyperactive. Over a 10-week period, Dexedrine was systematically applied and withdrawn during the absence and presence of self-control procedures. Dependent measures included direct behavioral observation, teacher ratings of hyperactivity, laboratory tests of cognitive performance, and academic achievement measures. Results demonstrated that a combination of Dexedrine and self-control training was more effective than either Dexedrine alone or self-control training plus placebo in (1) increasing on-task behavior in the classroom (as measured by direct classroom observations) and (2) decreasing the teacher's reports of hyperactivity and distractability. Results also demonstrated that Dexedrine, but not self-control training, was effective in increasing attention and decreasing impulsive responding as measured by the Continuous Performance Test. However, only direct reinforcement for correct responses was found to improve (1) performance on measures of spelling and math performance and (2) performance on the Matching Familiar Figures Test. Implications for treatment of children with attention deficit disorders are discussed.

Physiotherapy in the treatment of hyperkinetic children

The hyperkinetic syndrome is a feature of present times. This paper gives a brief survey of literature concerning the problem together with some details about causes, treatments, and methods of assessing the quantity and quality of the excessive movement. Although physiotherapists cannot treat the basic causes, they may give assistance by assessing the nature of the excessive movement and explaining this to teachers and parents, as well as helping with any co-existing clumsiness.

A four-year follow-up study of the effects of methylphenidate on the behavior and academic achievement of hyperactive children

Sixty-two children were evaluated 4 years after their initial referral for symptoms of hyperactivity. Behavioral measures included parent and teacher judgments of behavior and social adjustment. Academic achievement was assessed by teachers' reports, number of failed grades, special education services, and two individually administered achievement tests. Data were analyzed for the total group to determine both the extent to which presenting problems diminished over time and the major problems still present. The effects of stimulant drug therapy on outcome were assessed by dividing the children into groups according to the duration of time they had taken stimulants. Total duration of time on stimulants ranged from less than 6 months (group 1) to 4 years (group 5). Results indicated that the symptoms of hyperactivity significantly lessened, but remained higher in these children than in normal peers. Behavioral and social problems were less pervasive than academic underachievement. There were no group differences, indicating that the duration of stimulant intervention did not have a significant effect on outcome. The clinical implication of this study is that the beneficial effects of stimulant drug intervention occur within the first months after initiation of therapy. Long-term treatment does not appear to be of value in producing better outcome.