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ARTICLE |

Drugs in Management of Hyperkinetic and Perceptually Handicapped Children FREE

J. Gordon Millichap, MD
[+] Author Affiliations

This communication was invited by the Drug Utilization Section of the Council on Drugs.

Reprint requests to Secretary, Council on Drugs, American Medical Association, 535 N Dearborn St, Chicago 60610.


JAMA. 1968;206(7):1527-1530. doi:10.1001/jama.1968.03150070065010
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Drugs are useful in the symptomatic treatment of hyperkinetic and perceptually handicapped children, but their administration should be preceded by a careful clinical evaluation. On the basis of present evidence, short-term trials of drugs are justified as an adjunct to remedial methods of education. Central nervous system stimulants are the agents of choice. Chlordiazepoxide and chlorpromazine are recommended as alternative agents in patients who fail to respond to methylphenidate or dextroamphetamine. Diphenylhydantoin sodium or primidone, alone or in combination with a stimulant or antianxiety or antipsychotic agent, is indicated when signs and symptoms of minimal brain dysfunction include seizures or electroencephalographic evidence of epilepsy. Phenobarbital usually exacerbates hyperactivity and is contraindicated. The use of central nervous system stimulants and mood-modifying agents for prolonged periods should await further evaluation by long-term controlled studies.

REFERENCES

Stewart, M.:  Hyperactive Child Syndrome Recognized 100 Years Ago , JAMA 202:28-29 ( (Dec 25) ) 1967;.
Stevens, J.R.; Sachdev, K.; and Milstein, V.:  Behavior Disorders of Childhood and the Electroencephalogram , Arch Neurol 18:160-177 ( (Feb) ) 1968;.
Birch, H.G.: " The Problem of 'Brain Damage ' in Children," in Birch, H.G. (ed.): Brain Damage in Children , Baltimore: Williams & Wilkins Co., 1964;, pp 3-12.
Conners, C.K.:  The Syndrome of Minimal Brain Dysfunction: Psychological Aspects , Ped Clin N Amer 14:749-766 ( (Nov) ) 1967;.
Millichap, J.G., and Fowler, G.W.:  Treatment of "Minimal Brain Dysfunction" Syndromes: Selection of Drugs for Children With Hyperactivity and Learning Disabilities , Ped Clin N Amer 14:767-777 ( (Nov) ) 1967;.
Eisenberg, L.: " Behavioral Manifestations of Cerebral Damage in Childhood ," in Birch, H.G. (ed.): Brain Damage in Children , Baltimore: Williams & Wilkins Co., 1964;, pp 61-73.
Schulman, J.L.; Kasper, J.C.; and Throne, F.M.: Brain Damage and Behavior: A Clinical-Experimental Study , Springfield, Ill: Charles C Thomas, 1965;.
Millichap, J.G., and Boldrey, E.E.:  Studies in Hyperkinetic Behavior: II. Laboratory and Clinical Evaluations of Drug Treatments , Neurology 17:467-471 ( (May) ) 1967;.
Millichap, J.G., et al:  Hyperkinetic Behavior and Learning Disorders: III. Battery of Neuropsychological Tests in Controlled Trial of Methylphenidate , Amer J Dis Child , 116:235-244 ( (Sept) ) 1968;.
Bradley, C.:  The Behavior of Children Receiving Benzedrine , Amer J Psychiat 94:577-584 ( (Nov) ) 1937;.
Conrad, W.G., and Insel, J.:  Anticipating the Response to Amphetamine Therapy in the Treatment of Hyperkinetic Children , Pediatrics 40:96-99 ( (July) ) 1967;.
Conners, C.K., and Eisenberg, L.:  The Effects of Methylphenidate on Symptomatology and Learning in Disturbed Children , Amer J Psychiat 120:458-464 ( (Nov) ) 1963;.
Nichamin, S.J., and Comly, H.M.:  The Hyperkinetic or Lethargic Child With Cerebral Dysfunction , Mich Med 63:790-791 ( (Nov) ) 1964;.
Eisenberg. L., et al:  A Psychopharmacologic Experiment in a Training School for Delinquent Boys: Methods, Problems, Findings , Amer J Orthopsychiat 33:431-446 ( (April) ) 1963;.
Zrull, J.P., et al:  A Comparison of Chlordiazepoxide. D-Amphetamine, and Placebo in the Treatment of the Hyperkinetic Syndrome in Children , Amer J Psychiat 120:590-591 ( (Dec) ) 1963;.
Kugel, R.B., and Alexander, T.:  The Effect of a Central Nervous System Stimulant (Deanol) on Behavior , Pediatrics 31:651-655 ( (April) ) 1963;.
Werry, J.S., et al:  Studies on the Hyperactive Child: III. The Effect of Chlorpromazine Upon Behavior and Learning Ability , J Amer Acad Child Psychiat 5:292-312 ( (April) ) 1966;.
Schulman, J.L.. and Clarinda, M.:  The Effect of Promazine on the Activity Level of Retarded Children , Pediatrics 33:271-275 ( (Feb) ) 1964;.

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Stewart, M.:  Hyperactive Child Syndrome Recognized 100 Years Ago , JAMA 202:28-29 ( (Dec 25) ) 1967;.
Stevens, J.R.; Sachdev, K.; and Milstein, V.:  Behavior Disorders of Childhood and the Electroencephalogram , Arch Neurol 18:160-177 ( (Feb) ) 1968;.
Birch, H.G.: " The Problem of 'Brain Damage ' in Children," in Birch, H.G. (ed.): Brain Damage in Children , Baltimore: Williams & Wilkins Co., 1964;, pp 3-12.
Conners, C.K.:  The Syndrome of Minimal Brain Dysfunction: Psychological Aspects , Ped Clin N Amer 14:749-766 ( (Nov) ) 1967;.
Millichap, J.G., and Fowler, G.W.:  Treatment of "Minimal Brain Dysfunction" Syndromes: Selection of Drugs for Children With Hyperactivity and Learning Disabilities , Ped Clin N Amer 14:767-777 ( (Nov) ) 1967;.
Eisenberg, L.: " Behavioral Manifestations of Cerebral Damage in Childhood ," in Birch, H.G. (ed.): Brain Damage in Children , Baltimore: Williams & Wilkins Co., 1964;, pp 61-73.
Schulman, J.L.; Kasper, J.C.; and Throne, F.M.: Brain Damage and Behavior: A Clinical-Experimental Study , Springfield, Ill: Charles C Thomas, 1965;.
Millichap, J.G., and Boldrey, E.E.:  Studies in Hyperkinetic Behavior: II. Laboratory and Clinical Evaluations of Drug Treatments , Neurology 17:467-471 ( (May) ) 1967;.
Millichap, J.G., et al:  Hyperkinetic Behavior and Learning Disorders: III. Battery of Neuropsychological Tests in Controlled Trial of Methylphenidate , Amer J Dis Child , 116:235-244 ( (Sept) ) 1968;.
Bradley, C.:  The Behavior of Children Receiving Benzedrine , Amer J Psychiat 94:577-584 ( (Nov) ) 1937;.
Conrad, W.G., and Insel, J.:  Anticipating the Response to Amphetamine Therapy in the Treatment of Hyperkinetic Children , Pediatrics 40:96-99 ( (July) ) 1967;.
Conners, C.K., and Eisenberg, L.:  The Effects of Methylphenidate on Symptomatology and Learning in Disturbed Children , Amer J Psychiat 120:458-464 ( (Nov) ) 1963;.
Nichamin, S.J., and Comly, H.M.:  The Hyperkinetic or Lethargic Child With Cerebral Dysfunction , Mich Med 63:790-791 ( (Nov) ) 1964;.
Eisenberg. L., et al:  A Psychopharmacologic Experiment in a Training School for Delinquent Boys: Methods, Problems, Findings , Amer J Orthopsychiat 33:431-446 ( (April) ) 1963;.
Zrull, J.P., et al:  A Comparison of Chlordiazepoxide. D-Amphetamine, and Placebo in the Treatment of the Hyperkinetic Syndrome in Children , Amer J Psychiat 120:590-591 ( (Dec) ) 1963;.
Kugel, R.B., and Alexander, T.:  The Effect of a Central Nervous System Stimulant (Deanol) on Behavior , Pediatrics 31:651-655 ( (April) ) 1963;.
Werry, J.S., et al:  Studies on the Hyperactive Child: III. The Effect of Chlorpromazine Upon Behavior and Learning Ability , J Amer Acad Child Psychiat 5:292-312 ( (April) ) 1966;.
Schulman, J.L.. and Clarinda, M.:  The Effect of Promazine on the Activity Level of Retarded Children , Pediatrics 33:271-275 ( (Feb) ) 1964;.
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