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
The effect of stimulants on the hyperactive behavior of MBD children has been studied extensively of the last decade. A review of this research will be published in an upcoming issue of the Journal. In assessing the effects of stimulant drugs, studies frequently used visual-motor performance because of the importance of visual-motor functioning in the early school years and the availability of appropriate measurement devices. This study examines the role of amphetamine optical isomers in Bender Gestalt performance. -G.M.S. As part of a double-blind Latin-square crossover comparison of placebo, dextroamphetamine and levoamphetamine in SI hyperkinetic minimally brain dysfunctioned children, Bender Gestalt tests were administered.On mean Koppitz error scores, dextroamphetamine showed significant benefit over predrug, placebo, and levoamphetamine. Predrug, placebo, and levoamphetamine Koppitz scores were not significantly different from one another, though all three were significantly worse than dextroamphetamine. Dosages of the two isomers were not significantly different, and behavioral effects were comparable.
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