In Reply.—
Use of stimulant medica tion in the treatment of ADD in children should be in the context of an intervention strategy that often includes other modalities (such as parent guidance, behavior modification, special education, and psychotherapy). At present, there is no method for predicting which child will benefit from administration of stimulants, and a carefully monitored clinical "trial" may be warranted. However, stimulants are not without risk, and should not be used with all hyperactive children. For example, some severe disorders in children, such as autism, may worsen dramatically with only one or several doses, and continued use of stimulants may be catastrophic.The patients we described with Tourette's syndrome precipitated by stimulants, and others we have studied subsequently, received medication in the usual therapeutic range (eg, 15 to 60 mg/day of methylphenidate