Journal of Learning Disabilities

Psychostimulant drugs have been used for the past 30 years in the treatment of children with behavior disorders, hyperactivity, and learning problems. Difficulties with operational definitions and complicated methodology which haw hampered the determination of efficacy of such medication are discussed. Research on the site and mechanism of action of psychostimulant drugs is reviewed. The decision to initiate drug therapy for children with minimal cerebral dysfunction is now complicated by the climate the times - the social revolution, particularly among the young, and above ail, the present drug culture. A discussion of the therapeutic regimen is included.

A brief overview is given of recent controlled studies of the effects of stimulent drugs on general behavior, motor organizaition, cognition and learning, physiololigical responsiveness and attentions in hyperkinetic children. Emphasis is placed on objective methods of assessment of drug effects which have began to allow standing clinical lore to become documented and to contribute to the understanding of basic psychological and physioloicial process involed in the heterogenous disorders lumped under the label of “hyperkinetics syndrome.”

Inadequate newspaper reporting of medication usage in Omaha school children, scare headlines, adroitly misleading editorials, and overemphasis on hyperactivity prompted this reporting of two careful studies of the effects of cerebral stimulants on M.B.D. children. Forty children were rated twice weekly by their classroom teacher on the Fels Rating Scale for six weeks. A double blind placebo method proved that dextro-amphetamine significantly (P < .001) improved their classroom behavior. Using a questionnaire, parents of 197 children taking cerebral stimulants reported details of symptom and trait changes brought about by cerebral stimulants. This work plus subsequent clinical experience suggests that with certain precautions, it is safe to employ these chemical aids for a year or more, if necessary. No habituation to cerebral stimulants has been encountered in any school-aged child by the author in 25 years of clinical experience. These drugs may ameliorate listening ability, over-excitability, forgetfulness, and peer relationships as much as “overactivity.” As such, psychcpharmaceuticals are not chemical strait-jackets and may be compared with eyeglasses or other necessary prosthetic devices which enable more normal functioning.

Utillizing objective scales for rating characteristics in the hyperkinetic syndrome, teachers' rating revealed favorable effects of dextroamphetamine in 27 of a group of 42 children with hyperkinetic impulse disorder and learning difficulties. Statistical comparisons of ratings received under prestest, placebo, and drug conditions showed significant differences on the scales measuring hyperactivity, short attentions span, and impulsivity. Teachers can preselect hyperkinetic children who will respond to medication with the questionnaire-rating scale technique. Other objective mesaures have been discussed which can be incorporated into the evaluative procedure.

The background, development, and preliminary appraisal of rating scales for assessing characteristics of the hyperkinetic syndrome are presented. The main purpose of this report is to make the instrument available to other investigators who are conducting studies on the diagnosis and treatment of hyperkinesis.

Classroom teachers have two tasks to perform in assisting the proper use of drug therapy on hyperactive children. The first is to supply objective observations on the effectiveness of the medication in controlling classroom behavior. The second is to develop teaching strategies for the children who are unable to benefit from medication. Proper teacher training in behavior control techniques will make it possible for many children to learn with a minimum of medication to effect behavior change.

The present study had two primary objectives: (1) to evaluate the relatively long-term (4-6 months) effects of dextroamphetamine on the behavior, achievement, and perceptual-cognitive functioning of hyperkinetic children; (2) to compare the effects of dextroamphetamine and prescriptive perceptual-cognitive tutoring. Sixty-eight children matched for intelligence and degree of hyperactivity were assigned to the following groups: placebolno tutoring; placebo/tutoring; dextroamphetamine/no tutoring; and dextroamphetamine /tutoring. Double-blind procedures were used in the administration of medication. Results indicate that dextroamphetamine contributed to a reduction of hyperkinetic behavioral symptoms and to improvement in performance on various measures of perceptual motor and cognitive development. Twice-a-week tutoring for an average of 20 weeks resulted in gains on some WISC subtests but was clearly not as effective as medication. Neither experimental condition significantly influenced academic achievement as measured by the Wide Range Achievement Test. Implications for the management and instruction of hyperkinetic children are discussed.

This paper on the symptom picture called “hyperkinetic impluse disorder” and its effect upon learning and behavior in childern and adolescents. Clinical experience hasd indicated that there may be a specific, beneficial, controlling effect from the use of psychic energinzers and cereberal stimulants, all characterized by causing an increase in available norepinephrine at cell surfaces in the central nervous system. it has also been found that the symptom picture may be worsened by medications which reduce the the level of available norepinphrine at cell surfaces. The medications in use of are quite potent ones and concerns as to how they may best be administered are discussed. Possible side effects and long term outcomes of their use are described. A method is given for determining proper dosage, lisiting and controlling side effects. other concurrent necessary kinds of help are described. Means of recongnizing the eventual outgrwoing of the hyperkinetic impluse disorder are indicated. Last, results of a follow-up study are presented: a group of private patients were followed up for varying periods after medication had been terminated. The study show the current levels of functioning and presence or absence of persistinig toxix effect from long-term use of these medications.