The hyperactive child and the body: a clinical study on the origin of hyperactivity in children

Abstract

-A group of 22 hyperactive children from 7 to 12 years of age was selected among 38 out-patients registered at Hospital do Servidor Público de São Paulo (Civil Servant Hospital of the State of São Paulo). Their psychiatric evaluation was negative, the neurological examination showed "psychomotor syndrome", and psychological evaluation revealed disorders related with Ego maturation in all cases. Although all children were referred to psychotherapy, only thirteen underwent individual sessions once a week for an uninterrupted period of up to one year. Neither diets nor medicines were prescribed. After six months and one year of treatment, the children were reevaluated. They showed improved school performance, reduced hyperactivity, and better internal psychic organization. These results are considered as undeniable evidence of the psychodynamic origin of hyperactivity syndrome in children, when no definite neurologic or psychiatric diseases are demonstrated.KEY WORDS: children hyperactivity, psycopathogenesis, diagnosis, therapy, clinical approach.A criança hiperativa e seu corpo: estudo clínico sobre a gênese da hiperatividade em crianças RESUMO -Vinte e duas crianças hiperativas, de 7 a 12 anos de idade foram selecionadas dentre 38 matriculadas no Ambulatório de Psiquiatria do Hospital do Servidor Público do Estado de São Paulo. A avaliação psiquiátrica foi negativa, o exame neurológico revelou síndrome psicomotora, a avaliação psicológica evidenciou transtornos relacionados com maturação do Ego em todos os casos. Encaminhadas à psicoterapia, apenas 13 crianças puderam atender a sessões individuais e semanais, por um período ininterrupto de seis meses a um ano. Nem dietas nem medicamentos foram prescritos. Reavaliação feita após seis meses e um ano, revelou redução da hiperatividade, aumento do rendimento escolar e melhor organização psíquica interna. Estes resultados são considerados forte evidência da origem psicodinâmica da síndrome hiperativa em crianças neurologicamente normais.PALAVRAS-CHAVE: hiperatividade na infância, fisiopatogenia, clínica, diagnótico, tratamento.Hyperactive behavior in children, often associated with learning disabilities, is one of the most common parents' complaints that lead them to seek medical and psychological care in children's outpatient clinics. Hyperactivity has attracted a growing interest of study in the last decades.The term hyperactivity in childhoodhas been widely used as synonymous to other terms such as "minimal cerebral dysfunction", "hyperkinetic syndrome", "hyperkinetic reaction", "learning disabilities", "behavior disorders", "psychomotor instability", and "attention deficit syndrome". The use of so many synonymous terms is a clear sign of the conceptual inaccuracy and divergence among

Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base

“…Quasi-experimental studies: three studies employed quasi-randomised methods of assignment to each treatment arm: -Psychoanalytic child psychotherapy (alongside in-patient medical care) vs in-patient medical care only for children with dangerously uncontrolled diabetes (Moran and Fonagy, 1987;Fonagy and Moran, 1990;Moran et al, 1991) -Brief, focused psychodynamic psychotherapy vs assessment only for children with emotional disorders (Muratori et al, 2002(Muratori et al, , 2003(Muratori et al, , 2005) -Short-term psychodynamic psychotherapy vs waiting list control for children and adolescents with a range of disorders Kronmu¨ller et al, 2010) Level 3. Controlled observational studies: eight controlled observational studies were identified, using a range of control groups, including no-treatment control groups, non-matched control groups or the matching of the comparison group on the basis of clinical and demographic characteristics: -Intensive (four times weekly) psychoanalytic child psychotherapy vs once weekly psychoanalytic child psychotherapy for children with learning difficulties and emotional disturbance (Heinicke, 1965;Heinicke and Ramsay-Klee, 1986) -Psychodynamically orientated therapy vs supportive educational therapy for adolescents with OCD (Apter et al, 1984) -Psychoanalytic child psychotherapy vs no treatment control group for adopted children with 'severe difficulties' (Lush et al, 1991;Boston and Lush, 1994;Lush et al, 1998;Boston et al, 2009) -Individual psychotherapy vs untreated control group attending hospital for children with 'hyperactivity and attention deficit' (Jordy and Gorodscy, 1996) -Long-term follow-up of psychoanalytic child psychotherapy vs no treatment control group (Midgley and Target, 2005;Midgley et al, 2006;Schachter and Target, 2009) -Long-term psychodynamic psychotherapy for adolescents with a range of disorders vs It should be kept in mind that a study's position in this 'hierarchy of evidence' does not necessarily reflect the quality of the study. There is a great deal of debate about the assumptions built into the idea of a 'hierarchy of evidence' and especially the emphasis placed on randomised controlled trials (RCTs) as the 'gold standard' for psychotherapy research (see, for example, Leichsenring, 2004;Wachtel, 2010).…”

The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis

“…One study focused on children and young people specifically diagnosed with CD (Edginton et al, 2018), and one focused on children diagnosed with ODD (Prout et al, 2019). One study of hyperactive children was too poorly designed to draw conclusions (Jordy and Gorodscy, 1996). In addition to these studies, two papers have reported secondary analyses of larger studies of mixed populations, with the secondary analyses focusing on outcomes for those children with a range of externalizing disorders (Fonagy and Target, 1994;Winkelmann et al, 2000).…”