In Reply.—
Whether child psychiatry has overemphasized the role of environment as a cause of behavior disorders is surely still a matter of debate, although there appears to be much more interest in genetic links. With regard to pharmacotherapy, I asked Barry Garfinkel, MD, director of the Division of Child and Adolescent Psychiatry at the University of Minnesota, St Paul, to respond. In his view, the scientifically controlled studies support the position that the tricyclic antidepressants are drugs of second choice, preceded by the sympathomimetic medications, which include methylphenidate, amphetamine, methamphetamine, and pemoline.1,2"Dr Huessy's concern about long-acting drugs is justified," he said, "and that is why we choose methamphetamine in sustained-release tablets. Similarly, pemoline is a long-acting drug that can be given once or twice a day. The scientific literature does not support his allegation that the tricyclic antidepressants are equal in efficacy over the long term with