Psychiatric hospitalization of preschool children: A follow-up study

This paper reviews the five year follow-up status of 18 patients initially studied while psychiatrically hospitalized during their preschool years. Only four are currently doing well. Outcome is correlated with patient, family and treatment variables. Possible clinical and research approaches are discussed.     

A self-control classroom for hyperactive children

In this study we investigated the effectiveness of a package of self-control procedures in a classroom with six hyperactive boys ages 7 to 10. A within-subjects reversal design was used. Measures of on-task behavior and class misbehavior, as well as measures of activity level, were recorded. Results indicated that the self-control package was effective in improving misbehavior and attention to tasks during the individual seat work but not during group instruction. Activity level was not affected by the treatment. Changes in the schedule of self-monitoring for the boys in the class produced an increase in variability and some deterioration in their behavior. Those boys of lower mental age seemed most affected by the schedule shift. This project was supported by funds provided by the Crippled Children's Division, University of Oregon Health Sciences Center, Portland, Oregon. During the completion of this project, the first two authors were supported by Mental Retardation Training Grant 920, Maternal and Child Health Service, Department of Health, Education and Welfare, Washington, D.C. The authors would like to thank the children who participated in this project and their mothers for their cooperation. Appreciation is also extended to Lief Terdal and Gerald Smith for their supervision of the program, and to Lisa Buckmaster, Grant Godby, Robert McClellarn, Lou-Ann McCoy, and Nancy Thistlethwaite for their assistance in the data collection. We are also indebted to Randy Wolfe and Timothy Carmody for serving as teacher's aides in the classroom.     

Predictive validity in a prospective follow-up of PTSD in preschool children

OBJECTIVE: To examine the predictive validity of an alternative to the DSM-IV for diagnosing posttraumatic stress disorder (PTSD) in preschool children and prospectively explore the course of PTSD symptomatology. METHOD: Sixty-two traumatized children, ages 20 months through 6 years, were assessed three times in 2 years with caregiver diagnostic interviews. RESULTS: PTSD diagnosis at visit 1 significantly predicted degree of functional impairment 1 and 2 years later and predicted PTSD diagnosis 2 years later but not 1 year later. The lack of 1-year diagnostic continuity may be explained by children with new traumas. Unexpectedly, overall PTSD symptoms did not remit over time, regardless of community treatment; however, reexperiencing symptoms decreased and avoidance/numbing symptoms increased with time, with avoidance/numbing symptoms increasing at a faster rate in children with PTSD at visit 1. The previous finding that arousal may cause emotional numbing was not replicated. Significantly more children were functionally impaired at visits 2 (48.9%) and 3 (74.3%) than were diagnosed with PTSD (23.4% and 22.9%, respectively). CONCLUSIONS: This study demonstrates predictive validity for the alternative method of diagnosing PTSD in preschool children. The unremitting course of PTSD symptomatology in preschool children and rates of impairment that are higher than rates of diagnosis indicate the need for efficacious treatment.     

Multimodality treatment. A one-year follow-up of 84 hyperactive boys.

This study reports findings at the end of the first year of a three-year prospective study of 84 hyperactive boys. A multidimensional approach to evaluation and an individualized multimodality treatment plan commensurate with each child's disabilities was used. Treatment plans were implemented by members of the research staff working together as a coordinated therapeutic team. Measures of the child's behavior at home and at school, academic performance, delinquent behavior, and emotional adjustment were obtained initially and at one year. Results suggest that the combination of a clinically useful medication with appropriate psychological treatments simultaneously directed to each of the child's many disabilities is associated with an unexpectedly good outcome. Whether this will continue to be true when these children are followed up over a longer period of time awaits further investigation.     

Long-term outcome of hyperactive children

A review of outcome studies of hyperactive children suggests that they experience significant academic, social, and conduct difficulties during adolescence, and that social, emotional, and impulse problems persist into young adulthood for the majority. While some hyperactive children were found to be functioning normally as adults, a troublesome minority were experiencing severe psychiatric or antisocial problems.     

Treatment of hyperactive children with D-phenylalanine

Eleven hyperactive boys were treated for 2 weeks with D-phenylalanine (20 mg/kg per day) and for 2 weeks with placebo in a double-blind crossover study. Tests included parent and teacher behavior ratings, cognitive measures, and blood and urine measures of norepinephrine, amino acids, and trace amines. No significant improvement or deterioration in behavior and no side effects were noted, and only serum phenylalanine was increased by the active treatment phase. This provides reassurance about the toxicity of aspartame, a food additive that contains phenylalanine, but argues against precursor loading treatment of hyperactivity.     

Neuroleptic-induced tics in two hyperactive children

Two hyperactive boys who had developed motor and phonic tics during stimulant treatment reacted similarly to low doses of haloperidol and thioridazine. Neuroleptic-induced tics may be a consequence of presynaptic dopamine blockade.     

Behavioral relaxation training with hyperactive children

Three boys meeting multiple criteria of hyperactivity were trained to emit ten specific relaxed behaviors by means of Behavioral Relaxation Training (BRT). Dependent measures included the Behavioral Relaxation Scale (BRS), frontalis electromyogram (EMG), the Conners Parent Symptom Questionnaire, and self-report. A multiple-probe design across subjects was employed, plus a reversal between recliner and beanbag chair for each subject. BRT was effective in producing high levels of relaxed behaviors and low EMG levels in the office setting, particularly in conjunction with the beanbag chair, with some reduction of hyperactivity scores on the Conners. Subsequent training in each child's home by his mother was accompanied by further reductions in parent-reported symptoms and low EMG levels, which were maintained at a 1-month follow-up.     

A neuropathic substrate for stimulant drug effects in hyperactive children

Behavioral, physiological, and cognitive data are presented from a sample of 55 hyperactive children undergoing methylphenidate treatment. Consistent with previous research, considerable variability exists on these measures in this clinical population with little evidence for a consistent profile on any of these dimensions. A theoretical discussion is offered reflecting these findings with reference to a proposed pathophysiologic basis for the disorder. The proposed model postulates a particular emphasis on the functional responsibilities of the frontal-striatal system. A neural substrate for the abnormal oscillations that characterize hyperactive children, the correction of which is germane to therapeutic stimulant effects, is presented in terms of the regulatory functions of the frontal lobe.     

A symptom self-report measure for preschool children

The Preschool Symptom Self-Report (PRESS) is a pictorial instrument designed to facilitate the self-report of depressive symptoms by preschool children. It was tested with a sample of 84 Head Start children and their parents and teachers. A parent-teacher version of the instrument correlated with other measures designed for adult rating of children's depression about as well as those measures correlate with one another. It showed high reliability upon retesting by a different examiner within 24 hours. The instrument also showed high internal consistency, which implies that the children responded to items based upon their meaning rather than upon irrelevant characteristics. The retest reliability of the instrument did not depend upon the child's mental age. The children's self-reports showed no relation to adults' ratings of the children's symptoms; this result is consistent with some findings with older children.     

Group counseling for parents of hyperactive children

A procedure is described in which parents of hyperactive children learned how to make and enforce rules, and to influence their children's behavior by using the principles of learning theory. This procedure, with combined group counseling and discussion, may be an effective alternative or adjunct to drug treatment when specific advice and support are also given to the children's teachers.     

Methylphenidate and growth in hyperactive children. A controlled withdrawal study

The effect of stimulants on growth has been controversial. Among hyperactive children receiving long-term methylphenidate hydrochloride treatment, we examined the effects of methylphenidate withdrawal on the growth of hyperactive children randomly assigned to be taken off, or remain on, the medication regimen over two consecutive summers. After one summer, no group difference in height was found, but weight was higher in the group that had been taken off methylphenidate therapy. In contrast, two summers of being off methylphenidate treatment had a significant positive effect on height but not on weight. The results document a linkage between exposure to methylphenidate and reduction in growth velocity. However, they do not address whether the medication has long-term effects on height.