There is little question but that the problem of children who are hyperactive is both widespread and of serious concern. Moreover, there appears to be little question that the treatment, though satisfactory in some ways, raises more questions for the critical observer and physician than it answers.The research dealing with the use of drugs to benefit children who are hyperactive has now accumulated data for more than a third of a century. Like all pioneer research, it must be interpreted with considerable caution. With the exception of a few of the latest studies reported by a very limited number of the more sophisticated researchers, the conclusions and recommendations for the most part have been made uncritically, even optimistically, due possibly to confidence in the clinical acuity of an experienced professional, even though critical interpretation of a study does not warrant definitive conclusions.Although some studies dealing with the use of psychoactive drugs to modify behavior were less loosely con¬ trolled than others, no study was found that dealt rigorously with all the variables known to be involved in determining the effects of such drug therapy. A very few dealt vigorously with many of the variables for which concern was expressed.
VariablesThese seven characteristics are con¬ sidered minimal in a study designed so effectively as to meet the criteria of either researcher or physician.Placebo Control.-The administra¬ tion of medication often has a pro¬ found psychological effect on those involved. "The placebo effect has long been recognized."1 Freed2 pointed out that about one third of a population of children experience placebo effect; Beecher3 reported them to be be¬ tween 30% and 35%. Some in¬ vestigators have attributed as much as 70% of improvement to placebo ef¬ fect. Freeman1 has pointed out that placebo effect can sometimes exceed drug responses. Davis'4 data verify this conclusion.Blind Procedures.-Although the use of a placebo is essential to effective drug research, it is not sufficient. It is obvious that if the patient knows a placebo is being used, it would not have the same effect as it would if he believed it were the active drug. It is less obvious that when the dispenser of the drug believes a placebo is being administered it will result in lower improvement in the patient. HeatonWard5 changed the numbers identi¬ fying placebo and active drug and the behavioral ratings changed, even though there was no exchange of drug and placebo. Studies in which neither patient nor dispenser can dis¬ tinguish between active drug and pla¬ cebo are termed double blind.Cole6 has pointed out that "patients receiving the active agent in a set¬ ting of a drug-positive physician be¬ havior remain in treatment to a much greater extent than patients on pla¬ cebo or patients receiving the active drug in a neutral setting." To be com¬ pletely certain that what the re¬ searcher does will not contaminate the results, a triple blind procedure can be used. In this procedure even the researcher cannot distingui...
The arithmetic test1 shown in Figure 1 was given to thirty-five mathematics teachers representing various geographic areas of the United States.2 These teachers had been awarded National Science Foundation Scholarships on the basis of training and demonstrated competence. They were asked to imagine themselves to be Billy Brown's teacher and to grade Billy's arithmetic test, adding any comments they considered appropriate.
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