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Ritalin effects in children with learning disability
ABSTRACT
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Ritalin effects in children with learning disability DONALD F. KLEIN and RACHEL GITTELMAN-KLEIN Long Island Jewish-Hillside Medical Center, Glen Oaks, New York, U.S.A. Stimulants have been reported to ameliorate both the behavior of children with “emotional problems”, as well as their performance on various measures of intellectual functioning and learning. As a result there is a growing trend in the U.S.A. to view stimulants as useful for learning disability. However, so far all studies have been conducted with children selected because of behavior disorders. Therefore, it is not known whether stimulants are a relevant intervention among children who are poor achievers, but who have no significant psychopathology. This study tested the effects of methylphenidate on the intellectual functioning of children free of behavioral deviance, but with learning lags. Fifty children, 7-12, not hyperactive, with an I.Q. of at least 85,2 yr below their expected grade level in reading, and free of moderate to severe psychopathology, were randomly assianed to methvluhenidate or ulacebo for 12 weeks. A battery of achievement and cognitive tests was adn&istered befor; treatment, ripeated 4 and 12 weeks after treatment. The child was &en weekly by a psychiatrist, blind to the treatment. Results. On the Wide Range Achievement Test, both reading and arithmetic scores were significantly improved by methylphenidate after 4 weeks. Over the first month of methylphenidate treatment, the children gained 4 months in’ reading, 7 months in arithmetic, whereas the placebo treated group gained only 14 months in readine and showed no chance in arithmetic CD < 0.005). After 12 weekzof treatment the pi&e was considegably different. The methylphenidate and placebo groups were no longer significantlj different either on the reading or arithmet~cc‘scores of the WRAT. The Grav Oral Reading Test was not sensitive to drue effect at anv noint. Children’s uerformance on the Porteus Maze test showsd marked gain in favor of the &g-treated @up after 4 and 12tveeks of treatment. Comment. The above results indicate that methylphenidate does have a positive effect on cognitive function, independent of its clinical action in behavior disorders. However it may be unjustified to generalize about stimulant effects on learning from short-term studies. The current practice in American pediatric psychopharmacology of long-term treatment on the basis of short-term investigations should be reviewed by appropriate long-term studies.
The validation of specific diagnostic criteria for primary affective disorder by means of a blind five year follow-up ROBERT A. WOODRUFF and MARIJAN HERJANIC of Psychiatry, Washington University, School of Medicine, St. Louis, Missouri, U.S.A.
GEORGE E. MURPHY, Department
One hundred fifteen patients admitted to Renard Hospital in 1962 and 1963 with depressive symptoms were interviewed systematically with a structured research protocol containing approximately 500 items of information. Each interview lasted l&4 hr. Clinical diagnoses were made on the basis of these interviews. Follow-up interviews were sought with these same patients 5 yr later, to test the validity (stability over time) of the original diagnoses. Each patient was interviewed blindly bv interviewers who had not narticipated in the original colikction of data and who had no knowledge of the patient’s index diagnosis.& Fifty-two patients met specific inclusion and exclusion criteria (no other psychiatric illness or atypical symptoms) for primary affective disorder at the initial interview and were so diagnosed. Of these, follow-up was obtained with 43 (83 per cent). Thirty-seven of the 43 patients (86 per cent) were diagnosed blindly at follow-up as having primary affective disorder. They had unequivocal primary affective disorder during the follow-up interval and no other psychiatric illness, or were well throughout the entire interval. Each of these circumstances satisfies the basic requirement for a legitimate diagnostic entity: that it remain the same or disappear, but that it not turn into something else. Six patients receiving an index diagnosis of primary affective disorder were given another diagnosis at follow-up. Four had developed interval conditions not ordinarily considered incompatible with primary affective disorder (alcoholism, organic brain syndrome,
321
Ritalin effects in children with learning disability DONALD F. KLEIN and RACHEL GITTELMAN-KLEIN Long Island Jewish-Hillside Medical Center, Glen Oaks, New York, U.S.A. Stimulants have been reported to ameliorate both the behavior of children with “emotional problems”, as well as their performance on various measures of intellectual functioning and learning. As a result there is a growing trend in the U.S.A. to view stimulants as useful for learning disability. However, so far all studies have been conducted with children selected because of behavior disorders. Therefore, it is not known whether stimulants are a relevant intervention among children who are poor achievers, but who have no significant psychopathology. This study tested the effects of methylphenidate on the intellectual functioning of children free of behavioral deviance, but with learning lags. Fifty children, 7-12, not hyperactive, with an I.Q. of at least 85,2 yr below their expected grade level in reading, and free of moderate to severe psychopathology, were randomly assianed to methvluhenidate or ulacebo for 12 weeks. A battery of achievement and cognitive tests was adn&istered befor; treatment, ripeated 4 and 12 weeks after treatment. The child was &en weekly by a psychiatrist, blind to the treatment. Results. On the Wide Range Achievement Test, both reading and arithmetic scores were significantly improved by methylphenidate after 4 weeks. Over the first month of methylphenidate treatment, the children gained 4 months in’ reading, 7 months in arithmetic, whereas the placebo treated group gained only 14 months in readine and showed no chance in arithmetic CD < 0.005). After 12 weekzof treatment the pi&e was considegably different. The methylphenidate and placebo groups were no longer significantlj different either on the reading or arithmet~cc‘scores of the WRAT. The Grav Oral Reading Test was not sensitive to drue effect at anv noint. Children’s uerformance on the Porteus Maze test showsd marked gain in favor of the &g-treated @up after 4 and 12tveeks of treatment. Comment. The above results indicate that methylphenidate does have a positive effect on cognitive function, independent of its clinical action in behavior disorders. However it may be unjustified to generalize about stimulant effects on learning from short-term studies. The current practice in American pediatric psychopharmacology of long-term treatment on the basis of short-term investigations should be reviewed by appropriate long-term studies.
The validation of specific diagnostic criteria for primary affective disorder by means of a blind five year follow-up ROBERT A. WOODRUFF and MARIJAN HERJANIC of Psychiatry, Washington University, School of Medicine, St. Louis, Missouri, U.S.A.
GEORGE E. MURPHY, Department
One hundred fifteen patients admitted to Renard Hospital in 1962 and 1963 with depressive symptoms were interviewed systematically with a structured research protocol containing approximately 500 items of information. Each interview lasted l&4 hr. Clinical diagnoses were made on the basis of these interviews. Follow-up interviews were sought with these same patients 5 yr later, to test the validity (stability over time) of the original diagnoses. Each patient was interviewed blindly bv interviewers who had not narticipated in the original colikction of data and who had no knowledge of the patient’s index diagnosis.& Fifty-two patients met specific inclusion and exclusion criteria (no other psychiatric illness or atypical symptoms) for primary affective disorder at the initial interview and were so diagnosed. Of these, follow-up was obtained with 43 (83 per cent). Thirty-seven of the 43 patients (86 per cent) were diagnosed blindly at follow-up as having primary affective disorder. They had unequivocal primary affective disorder during the follow-up interval and no other psychiatric illness, or were well throughout the entire interval. Each of these circumstances satisfies the basic requirement for a legitimate diagnostic entity: that it remain the same or disappear, but that it not turn into something else. Six patients receiving an index diagnosis of primary affective disorder were given another diagnosis at follow-up. Four had developed interval conditions not ordinarily considered incompatible with primary affective disorder (alcoholism, organic brain syndrome,