There are no systematic data on the attitudes of hyperactive children toward treatment with stimulant medication. Such knowledge would be of aid to the physician in understanding the child, structuring therapy, and improving compliance; therefore we interviewed 52 hyperactive children who had been so treated. The outstanding findings were that a large fraction of the children disliked the medication and often tried to avoid taking it. The physician interview provides valuable information with some children, but for assurance of accuracy the clinician needs to use other sources of information.'ditr~r,~' dVote---A reviewer comments: &dquo;This is a fascinating paper documenting a high level of non-compliance with stimulant medication prescribed for hyperactivity in school children. Even more interestingly, it gives a great deal of anecdotal information to the effect that the interview method is not a reliable method for obtaining accurate information from children themselves about their feelings, behavior, and attitudes. Certainly, with the amount of stimulant medication being prescribed, very little has been said about treatment failure being due to non-compliance; and, of equal note, is that there must be a great many children who are thought to be improved because of their medication but are failing to take it.&dquo; ' SOME CLINICIANS 1-4 have expressed concern that relying on medication to improve problem behavior in children may, in itself, be disadvantageous. They speculate that the child receiving medication may conclude that the problem is beyond his control and efforts are therefore that he is not responsible for his own behavior.Little is currently known about how hyperactive children feel toward stimulant drug treatment or how best to find out how they feel. Experienced investigators have recognized the questionable value of simply asking the child. 4,5 Interviews combined with pertinent information from the child's close associates would certainly enhance reliability and also permit cross-checking for accuracy of interview information. Our population of hyperactive children, prospectively followed for eight years, provided such additional source material.We interviewed the children and examined their responses in the light of information provided by parents and teachers. Our goals were to find how children feel about being given stimulants for hyperactivity and to study the reliability of interviews of children. MethodsSubject Characteristics . At 52 subjects had been diagnosed hyperactive, were 8 years of age or and had received stimulant medication for at least one year (11 had not been medicated for varying periods of time). Mean age was 11.7 years (SD 2.3); 5 were girls, 47 boys; 5 were black, and 3 of mixed race.

No abstract

A cutoff score of 15 on the Conners 10-item Abbreviated Teacher Rating Scale (ATRS), based on a study from this laboratory, has been widely used by investigators for diagnosis of the syndrome known now as Attention Deficit Disorder with or without Hyperactivity. A replication of the original research employing a larger norm sample indicates that the suggested score of 15 is too low. Comparing the norm sample with hyperactive subjects selected by cutoff of 15 on the ATRS showed that the groups differed greatly on hyperactivity but not on inattention. The abbreviated form of the Conners scale does not effectively select children with attention deficits. Numerous problems with both the 39-item teacher scale and the abbreviated form suggest strongly that they be abandoned as research tools.

Office diagnosis of hyperactivity can present a problem to the pediatrician because only about 20% of the potential patients show hyperactive behavior during office examination. Exclusion of the children who appear normal in the physician's office can eliminate from medical treatment a large number of patients for whom treatment is appropriate. Eighty percent of the children ultimately accepted into the project on the basis of home and school reports showed exemplary behavior and no sign of hyperactivity in the office. Nonetheless, at a three-year follow-up, these children were rated the same as those who were obviously hyperactive in the presence of the pediatrician. The groups appeared no different on school grade, teachers' ratings of classroom behavior, amount of stimulant medication prescribed, or duration of drug treatment. The reported outcome data indicate that the physician can have confidence in historical information from the parents combined with current teacher reports as reliable aids in the diagnostic process with hyperactive children.

Each patient with Attention Deficit Disorder (ADD), with or without hyperactivity, is unique in the variety and severity of the handicapping conditions associated with ADD. The use of a well-designed teacher rating scale can provide the clinician with a behavioral profile of each patient. The importance of knowing the child's specific problems is emphasized by the results of this research, which show that methylphenidate has a major effect in improving attention, is helpful in decreasing activity level, but often has only a minor effect on deficient social skills and oppositional (aggressive) behavior.