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.

Multimodality treatment. A two-year evaluation of 61 hyperactive boys.

This study reports findings at the end of the second year of a three-year prospective study of 61 hyperactive boys. Individualized multimodality treatment plans commensurate with each child's disabilities were implemented by the research staff. Measures of the child's behavior at home and at school, academic performance, delinquent behavior, and emotional adjustment were obtained initially and at the end of each treatment year. The combination of a clinically useful medication in appropriate dosage schedules with relevant psychological treatments simultaneously directed to each of the child's many disabilities were associated with an unexpectedly good outcome at the end of one and two years. Whether this improvement will be maintained over a longer period of time and whether young adult outcome will be affected await further investigation.

Growth of hyperactive children treated with methylphenidate.

This is a study of the growth of 72 hyperactive boys treated continuously with methylphenidate hydrochloride. Major findings were that methylphenidate produces an adverse effect on growth in height and in weight in the first year of treatment, but not in the second year; the first year height deficit is offset in the second year by a greater-than-expected growth rate. No clinical predictors of growth deficits were found; growth in height deficits are not related to total dosage or summer drug holidays, but weight deficits may be related to these factors. Side effects did not correlate with dosage. The temporary growth deficits of the first year are of such minor magnitude as to have little clinical significance.

Ontogeny of selective attention effects on event-related potentials in attention-deficit hyperactivity disorder and normal boys.

A longitudinal study of young attention-deficit hyperactivity disorder (ADHD) boys has found clear evidence for developmental abnormalities in event-related potential (ERP) waves that reflect cognitive processes associated with selective attentional tasks. Boys alternated attention to auditory or visual modalities in a train of stimuli, in an attempt to detect target stimuli in the attended modality. Results suggest that ADHD boys' attentional difficulties are due to insufficient facilitation of responses to the attended stimuli and not to an inability to block ignored stimuli. Abnormalities in ERPs reflecting cognitive processes associated with both interchannel selection mechanisms (processing negativity) and intrachannel selection mechanisms (P3b) were found. The degree of abnormality in the P3b responses to target stimuli in ADHD boys (lower than normal boys) was found to increase with age. It is suggested that the abnormally low P36 response to attended target stimuli found in ADHD boys may be due in part to insufficient LC noradrenergic activity normally triggered by attended task-relevant or novel stimuli.

A cross-sectional and longitudinal study of age effects of electrophysiological measures in hyperactive and normal children.

Longitudinal and cross-sectional event-related potential, EEG power spectral, and skin conductance level data were obtained from 138 hyperactive and 60 normal boys. A age-by-diagnosis interaction was found for several measures in the cross-sectional data and for all three types of measures in the longitudinal data. These findings emphasize the importance of age in electrophysiological studies of young children and strongly suggest an abnormal maturational process in hyperactive children.

A prospective study of delinquency in 110 adolescent boys with attention deficit disorder and 88 normal adolescent boys.

The authors studied official arrests from childhood through adolescence in two groups of boys; one group (N = 110) was diagnosed in childhood as suffering from attention deficit disorder (ADD), and the second group (N = 88) consisted of normal control adolescents. Rates of single and multiple serious offenses and of institutionalization for delinquency were significantly higher in the ADD subjects. These findings suggest a strong relationship between childhood ADD and later arrests for delinquent behavior.

A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality.

OBJECTIVE: To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. METHOD: In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. RESULTS: Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. CONCLUSIONS: Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.

Potential risk of prolonged administration of stimulant medication for hyperactive children.

A battery of clinical laboratory evaluations was obtained biannually in hyperactive boys treated continuously with methylphenidate hydrochloride for 1 to 4 years. Blood pressure and heart rate were evaluated annually. Pretreatment baseline studies did not implicate low blood glucose or calcium levels, or anemia, as factors contributing to hyperactivity. Prolonged administration of methylphenidate hydrochloride was not associated with disturbances in the hemopoietic, endocrine, hepatic or cardiovascular functions analyzed.

Evoked potentials and brain maturation in hyperactive and normal children.

Auditory evoked cortical potentials in 39 hyperactive children in the age range of 72--144 months and 39 age sex matched normal control children were studied. The importance of careful control of age when studying evoked cortical potentials in hyperactive children is illustrated. Evidence is presented for two independent evoked potential components (P1--N1 and P2--N2) both of which show abnormal changes with maturation in hyperactive children. It is suggested that changes in these two evoked potential components may reflect abnormal development of two quasi-independent neural substrates in the hyperactive child. The 77% successful classification by means of discriminant function analyses (utilizing two evoked potential components) suggests potential usefulness of this objective laboratory measure as an aid to the diagnostic classification of hyperactive children.

Childhood brain function differences in delinquent and non-delinquent hyperactive boys.

Childhood electrophysiological and clinical measures were obtained in 110 hyperactive (HA) and 76 normal children, who were later followed up as adolescents. Official arrest data were obtained on all subjects and used to measure outcome. The usual interpretation, that the presence of a brain function abnormality suggests a poor prognosis, does not apply to the clinical EEG, EEG spectral and ERP measures obtained on these HA boys. In fact, the converse was found to be true, that is EEG and ERP abnormalities were associated with a good outcome, while normal values of these measures were associated with a poor outcome. Data were presented that suggest that there may be two distinct subgroups of HA boys. The first group was characterized by abnormalities in childhood brain function, abnormal changes in brain function with age, less antisocial and hyperactive behavior in childhood, and absence of delinquency in adolescence. The second group was characterized by normal childhood brain function, normal changes in brain function with age, more antisocial and hyperactive behavior in childhood, and teenage delinquency. Childhood EEG and ERP measures were found to be significantly different in these delinquent and non-delinquent HA groups, while social, familial and cognitive attributes were not. The N2 amplitude of the AERP in delinquent hyperactive (DHA) boys was found to be significantly larger than in the non-delinquent hyperactive (NDHA) boys. This N2 amplitude may prove clinically useful in selecting HA boys for delinquency prevention programs.

Longitudinal study of AERPs in hyperactive and normal children: relationship to antisocial behavior.

Changes in AERP measures from childhood to adolescence were studied in 2 subgroups of hyperactive children (25 non-delinquent and 9 delinquent) and 1 group of 34 non-delinquent normal children. The 3 groups were selected on the basis of official delinquency measures obtained 8 years after their initial evaluations. All subjects were studied using the same AERP paradigm at both points in time. The major finding was that the non-delinquent hyperactive subjects were found to have abnormal maturational changes as reflected by AERP measures while the delinquent hyperactive subjects were found to have normal maturational changes in these same measures. This suggests that these 2 hyperactive groups are on a different developmental course and that they may represent different clinical entities. Results of the comparison of cross-sectional data in childhood and again in adolescence were consistent with the concept of 2 distinct subgroups.

Preferential neural processing of attended stimuli in attention-deficit hyperactivity disorder and normal boys.

Event-related auditory and visual potentials were recorded from 36 attention-deficit hyperactivity disorder (ADHD) and 35 normal 6-year-old subjects engaged in a two-choice discrimination task. When normal subjects attended to stimuli in a given modality, enhanced negative (N2) and positive (P3b) responses (as compared with responses to nonattended stimuli) were found for auditory and visual target stimuli. In contrast, when ADHD subjects attended, little or no enhanced negative responses were found in either modality, and enhanced positive P3b responses were found only in response to visual target stimuli. Auditory N1, N2, and P3b and visual N2 amplitudes to attended target stimuli were significantly reduced in ADHD subjects as compared with normal subjects. No between-group differences were found for responses to nonattended stimuli. Both amplitude and latency abnormalities indicate that ADHD boys suffer from deficient preferential processing of attended stimuli. P3b and N2 abnormalities found here suggest deficiencies in two independent cognitive processes thought to be crucial to what we perceive, learn, and remember.

Three-year multimodality treatment study of 100 hyperactive boys.

We conducted a prospective study of 100 hyperactive boys admitted to a multimodality treatment program. After a comprehensive evaluation, an individualized psychotherapy plan commensurate with the child's disabilities was developed. In addition to medication, each child was enrolled in one or more indicated psychotherapeutic modalities. Since approximately 50% of our patients dropped out of treatment, groups receiving less and more treatment were compared on outcome measures. At three-year follow-up the group receiving more treatment was found to be further ahead educationally, to demonstrate less antisocial behavior, to be more attentive (as rated by their teachers), to have better adjustment at school and at home (as reported by their parents), and to be more globally improved (as rated by psychiatrists and by parents) than children in the group receiving less treatment. Outcome for the group receiving more treatment was found also to be unusually good as compared to that in other studies of hyperactive children treated for varying lengths of time and evaluated after one to five years.