Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T13:32:42.343Z Has data issue: false hasContentIssue false

Which boys respond to stimulant medication? A controlled trial of methylphenidate in boys with disruptive behaviour

Published online by Cambridge University Press:  09 July 2009

E. Taylor*
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
R. Schachar
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
G. Thorley
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
H. M. Wieselberg
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
B. Everitt
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
M. Rutter
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London
*
1Address for correspondence: Dr E. Taylor, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF.

Synopsis

Thirty-eight boys, referred for psychiatric treatment because of serious problems of behaviour, underwent a double-blind, placebo-controlled, crossover trial of methylphenidate and placebo. Methylphenidate was an effective treatment over a 3-week period. A good response to methylphenidate was predicted by higher levels of inattentive and restless behaviour, impaired performance on tests of attention, clumsiness, younger age and by the absence of symptoms of overt emotional disorder. DSM-III and ICD-9 diagnoses of ‘hyperactivity’ were not good predictors. The results support the validity of a construct of hyperactivity in describing childhood psychopathology, but emphasize the need for a refinement of diagnostic criteria.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1987

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1980), Diagnostic and Statistical Manual of Mental Disorders (3rd edn). APA: Washington, D.C.Google Scholar
Barkley, R. (1976). Predicting the response of hyperkinetic children to stimulant drugs: a review. Journal of Abnormal Child Psychology 4, 327348.CrossRefGoogle ScholarPubMed
Bender, L. & Cottington, F. (1942). The use of amphetamine sulfate (benzedrine) in child psychiatry. American Journal of Psychiatry 99, 116121.CrossRefGoogle Scholar
Blouin, A., Bornstein, R. & Trites, R. (1978). Teenage alcohol use among hyperactive children: a 5-year follow-up study. Journal of Pediatric Psychology 3, 188194.CrossRefGoogle Scholar
Bosco, J. J. & Robin, S. S. (1980). Hyperkinesis: prevalence and treatment. In Hyperactive Children: The Social Ecology of Identification and Treatment (ed. Whalen, C. K. and Henker, B.), pp. 173190. Academic Press: New York.Google Scholar
Bradley, C. (1937). The behavior of children receiving benzedrine. American Journal of Psychiatry 94, 577585.CrossRefGoogle Scholar
Broadbent, D. E. (1971). Decision and Stress. Academic Press: London.Google Scholar
Campbell, M., Cohen, I. L. & Small, A. M. (1982). Drugs in aggressive behaviour. Journal of the American Academy of Child Psychiatry 21, 107117.CrossRefGoogle Scholar
Cantwell, D. & Carlson, G. A. (1978). Stimulants. In Pediatric Psychopharmacology: The Use of Behavior Modifying Drugs in Children (ed. Werry, J. S.), pp. 171207. Brunner/Mazel: New York.Google Scholar
Conners, C. K. (1969). A teacher rating scale for use in drug studies with children. American Journal of Psychiatry 126, 884888.CrossRefGoogle ScholarPubMed
Conners, C. K. (1973). Rating scales for use in drug studies with children. Psychopharmacology Bulletin Special Issue: Pharmacotherapy of Children 2484.Google Scholar
Egger, J., Carter, C. M., Graham, P. J., Gumley, D. & Soothill, J. F. (1985). Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet i, 540545.CrossRefGoogle Scholar
Eisenberg, L., Lachman, R., Molling, P., Lockner, A., Mizelle, J. & Conners, C. (1963). A psychopharmacologic experiment in a training school for delinquent boys. American Journal of Orthopsychiatry 33, 431447.CrossRefGoogle Scholar
Erlenmeyer-Kimling, L. & Cornblatt, B. (1978). Attentional measures in a study of children at high risk for schizophrenia. Journal of Psychiatric Research 14, 9398.CrossRefGoogle Scholar
Ferguson, H. B. & Rapoport, J. L. (1983). Nosological issues and biological validation. In Developmental Neuropsychiatry (ed. Rutter, M.), pp. 369384. Guilford Press: New York.Google Scholar
Gittelman, R., Manuzza, S., Shenker, R. & Bonagura, N. (1985). Hyperactive boys almost grown up: I. Psychiatric status. Archives of General Psychiatry 42, 937947.CrossRefGoogle ScholarPubMed
Gualtieri, C. T., Wargin, W. & Kanoy, R. (1981). Clinical studies of methylphenidate serum levels in children and adults. Journal of the American Academy of Child Psychiatry 21, 1926.CrossRefGoogle Scholar
Hill, D. (1947). Amphetamine in psychopathic states. British Journal of Addiction 44, 15.Google ScholarPubMed
Hills, M. & Armitage, P. (1979). The two-period cross-over clinical trial. British Journal of Clinical Pharmacology 8, 720.CrossRefGoogle ScholarPubMed
Loney, J., Kramer, J. & Milich, R. (1981). The hyperkinetic child grows up: predictors of symptoms, delinquency and achievement at follow-up. In Psychosocial Aspects of Drug Treatment for Hyperactivity (ed. Gadow, K. D. and Loney, J.), pp. 381416. Westnow: Boulder, Co.Google Scholar
McNemar, Q. (1955). Psychological Statistics (2nd edn). Wiley: New York.Google Scholar
Ounsted, C. (1955). The hyperkinetic syndrome in epileptic children. Lancet ii, 303311.CrossRefGoogle Scholar
Pastore, R. A. & Scheirer, C. J. (1974). Signal detection theory: considerations for general application. Psychological Bulletin 81, 945958.CrossRefGoogle Scholar
Porteus, S. (1947). The Porteus Maze Test Manual. Harrap: London.Google Scholar
Quinton, D., Rutter, M. & Liddle, C. (1984). Institutional rearing, parenting difficulties and marital support. Psychological Medicine 14, 197–124.CrossRefGoogle ScholarPubMed
Rapoport, J. L. (1983). The use of drugs: trends in research. In Developmental Neuropsychiatry (ed. Rutter, M.), pp. 385403. Guilford Press: New York.Google Scholar
Rapoport, J. L., Buchsbaum, M., Weingartner, H., Zahn, T., Ludlow, C. & Mikkelsen, E. (1978). Dextroamphetamine: behavioural and cognitive effects in normal prepubertal boys. Science 199, 560563.CrossRefGoogle ScholarPubMed
Robbins, T. W. & Sahakian, B. J. (1979). ‘Paradoxical’ effects of psychomotor stimulant drugs in hyperactive children from the standpoint of behavioural pharmacology. Neuropharmacology 18, 931950.CrossRefGoogle ScholarPubMed
Rutter, M. (1983). Behavioral studies: questions and findings on the concept of a distinctive syndrome. In Developmental Neuropsychiatry (ed. Rutter, M.), pp. 259279. Guilford Press: New York.Google Scholar
Rutter, M. & Garmezy, N. (1983). Developmental psychopathology. In Handbook of Child Psychiatry, Vol. 4: Socialisation, Personality and Social Development (ed. Hetherington, E. M.), pp. 775911. John Wiley & Sons: New York.Google Scholar
Rutter, M. & Graham, P. (1968). The reliability and validity of the psychiatric assessment of the child. I: Interview with the child. British Journal of Psychiatry 114, 563579.CrossRefGoogle ScholarPubMed
Rutter, M., Shaffer, D. & Sturge, C. (1975). A Guide to a Multiaxial Classtfication Scheme for Psychiatric Disorders in Childhood and Adolescence. Institute of Psychiatry: London.Google Scholar
Safer, D. J. & Allen, R. P. (1976). Hyperactive Children: Diagnosis and Management. University Park Press: Baltimore.Google Scholar
Sandberg, S., Rutter, M. & Taylor, E. (1978). Hyperkinetic disorder in psychiatric clinic attenders. Developmental Medicine and Child Neurology 20, 279299.CrossRefGoogle ScholarPubMed
Schachar, R., Rutter, M. & Smith, A. (1981). The characteristics of situationally and pervasively hyperactive children: implications for syndrome definition. Journal of Child Psychology and Psychiatry 22, 375392.CrossRefGoogle ScholarPubMed
Schleifer, M., Weiss, G., Cohen, N., Elman, M., Cvejic, H. & Kruger, E. (1975). Hyperactivity in preschoolers and the effect of methylphenidate. American Journal of Orthopsychiatry 45, 3850.CrossRefGoogle ScholarPubMed
Shaffer, D. & Greenhill, L. (1979). A critical note on the predictive validity of ‘the hyperkinetic syndrome’. Journal of Child Psychology and Psychiatry 20, 6172.CrossRefGoogle ScholarPubMed
Sprague, R. (1978). Principles of clinical trials and social, ethical and legal issues of drug use in children. In Pediatric Psychopharmacology: The Use of Behavior Modifying Drugs in Children (ed. Werry, J. S.), pp. 109135. Brunner/Mazel: New York.Google Scholar
Stewart, M. A., Cummings, C., Singer, S. & deBlois, C. S. (1981). The overlap between hyperactive and unsocialized aggressive children. Journal of Child Psychology and Psychiatry 22, 3546.CrossRefGoogle ScholarPubMed
Swanson, J. M. & Kinsbourne, M. (1976). Stimulant related state-dependent learning in hyperactive children. Science 192, 13541356.CrossRefGoogle ScholarPubMed
Taylor, E. (1979). The use of drugs in hyperkinetic states: clinical issues. Neuropharmacology 18, 951958.CrossRefGoogle ScholarPubMed
Taylor, E. (1980). Brain damage: evidence from measures of neurological function in children with psychiatric disorder. In Psychopathology of Children and Youth: A Cross-Cultural Perspective (ed. Purcell, E. F.), pp. 97113. Josiah Macy, Jr. Foundation: New York.Google Scholar
Taylor, E. (1983). Drug response and diagnostic validation. In Developmental Neuropsychiatry (ed. Rutter, M.), pp. 348368. Guilford Press: New York.Google Scholar
Taylor, E. (1985 a). Syndromes of overactivity and attention deficit. In Child Psychiatry: Modern Approaches (2nd edn) (ed. Rutter, M. and Hersov, L.), pp. 424443. Blackwell: Oxford.Google Scholar
Taylor, E. (1985 b). Drug treatments. In Child Psychiatry: Modern Approaches (2nd edn) (ed. Rutter, M. and Hersov, L.), pp. 780793. Blackwell: Oxford.Google Scholar
Taylor, E. & Sandberg, S. (1984). Hyperactive behavior in English schoolchildren: a questionnaire survey. Journal of Abnormal Child Psychology 12, 143156.CrossRefGoogle ScholarPubMed
Taylor, E., Schachar, R., Thorley, G. & Wieselberg, M. (1986). Hyperactivity, conduct disorder and attention deficit in child psychiatric patients. (Submitted for publication.)Google Scholar
Thorley, G. (1984). Hyperkinetic syndrome of childhood: clinical characteristics. British Journal of Psychiatry 144, 1624.CrossRefGoogle ScholarPubMed
Thorley, G., Taylor, E., Schachar, R., Wieselberg, M. & Rutter, M. (1986). Tests of attention and their association with hyperactivity and defiance in child clinic attenders. Unpublished MS.Google Scholar
Waldrop, M., Pedersen, R. & Bell, R. Q. (1968). Minor physical anomalies and behavior in preschool children. Child Development 39, 391400.CrossRefGoogle ScholarPubMed
Weiss, G. (1983). Long-term outcome: findings, concepts and practical implications. In Developmental Neuropsychiatry (ed. Rutter, M.), pp. 422436. Guilford Press: New York.Google Scholar
Weiss, G., Hechtman, L., Perlman, T., Hopkins, J. & Wener, A. (1979). Hyperactives as young adults. A controlled prospective ten-year follow-up of 75 children. Archives of General Psychiatry 36, 675681.CrossRefGoogle ScholarPubMed
Wender, P. (1971). Minimal Brain Dysfunction in Children. Wiley: New York.Google ScholarPubMed
Williams, J. I., Cram, D. M., Tausig, F. T. & Webster, E. (1978). Relative effects of drugs and diet on hyperactive behaviors: an experimental study. Pediatrics 61, 811817.CrossRefGoogle ScholarPubMed