The authors compared the efficacy of caffeine, methylphenidate, and d-amphetamine in children with minimal brain dysfunction using a double-blind crossover design. The slight improvement with caffeine was not significantly better than placebo. Both prescription drugs resulted in significant improvement and were significantly superior to caffeine. The authors suggest that the discrepancy between these results and an earlier, more optimistic report may stem from the use in this study of pure caffeine rather than whole coffee.In recent years a growing public and professional concern about the use of Schedule II stimulants to treat hyperkinetic children has sparked a desire to find a "safer" medication that has equal efficacy. Caffeine has been one of the drugs proposed as an alternative. Schnackenberg's initial report of a pilot study was promising (1); however, he cautioned that controlled studies were necessary. We thought it would be particularly useful to compare caffeine with the two most widely accepted and prescribed agents, d-amphetamine and methylphenidate. Although our study is not complete, the results seem so clinically relevant that we are reporting a preliminary analysis of the first half of the sample.
Method and DesignAfter an initial two-week placebo washout, caffeine, d-amphetamine, and methylphenidate were compared in a double-blind randomized Latin square crossover design. The subjects were 18 children consecutively admitted to the Ohio State University Child Psychiatry Clinic (12 boys and 6 girls, mean age = 8.5 years) who met the following criteria:1. Diagnosable minimal brain dysfunction with such symptoms as hyperactivity, distractibility, short attention span, incorrigibility, labile explosiveness, uncoordination, and perceptuomotor problems.2. A total score of 24 or more on the first six items of Davids' Hyperkinetic Rating Scale (2). 3. Age between 5 and 12 years. 4. Enrollment in some sort of school setting in order to obtain teachers' ratings. 5. No psychoactive medications in the preceding month. 6. Failure to respond to a two-week placebo washout period.In the initial two-week period, 10 children received "true" placebo and 8 received a combination of vitamins. Because comparison of these two groups revealed no significant differences between the true placebo and the vitamin group, results for these patients were pooled and reported as placebo scores for the whole sample. Only 2 subjects, both of whom had received the true placebo, were placebo responders.All medications were dispensed by a pharmacist who randomized the order of drug
To test the hypothesis that overlapping items of Minnesota Multiphasic Personality Inventory scales measure factors common to the criterion groups associated with the scales, three scales were constructed. The neurotic overlap scale contained items shared by more than one neurotic scale. The psychotic overlap scale contained items shared by more than one psychotic scale. The maladjustment overlap scale contained items shared by both a neurotic and a psychotic scale. These scales were validated against clinical psychotic and neurotic groups and two normal control groups. The results support the hypothesis and the validity of the three new scales.
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