Methylphenidate in Aggressive Hyperactive Boys: II. Indirect Effects of Medication Treatment on Peer Behavior

Abstract

The present study examines the indirect "spillover" effects of methylphenidate on the behavior of the classmates of drug-treated children in public school settings, and it measures the extent to which medication normalizes hyperactive and noncompliant-aggressive behaviors. Eleven aggressive hyperactive boys, who met DSM-III diagnostic criteria for attention deficit disorder, received placebo and methylphenidate in a double-blind crossover design. Medication effects were assessed by conducting observations of the drug-treated boy and his peers in the classroom and lunchroom settings. In most classrooms, a spillover effect did not occur for most of the behaviors assessed, but there was a decrease in the rate of nonphysical aggression exhibited by peers as a function of the hyperactive child's methylphenidate dose. Peers were generally less aggressive when the hyperactive boys were receiving methylphenidate than when they received placebo. In the lunchroom, in contrast, peers appeared slightly more noncompliant and aggressive when the aggressive hyperactive boys were receiving medication compared with placebo, but these differences did not attain statistical significance. Methylphenidate effectively normalized the negativistic behaviors of the aggressive hyperactive boys in the classroom. In some cases, the frequency of occurrence of certain behaviors dropped significantly below the level of the hyperactive child's peers. This "supranormalization" may reflect behavioral toxicity of the psychostimulant.

An Exploration and Critical Examination of How “Intelligent Classroom Technologies” Can Improve Specific Uses of Direct Student Behavior Observation Methods

“…The ADHD‐SOC has accrued less evidence pointing to consistent use of the tool across coders, as test–retest reliability within a 2‐week period found variable coder agreement. However, like the COC, evidence supports that the ADHD‐SOC also allows coders to discriminate between a child's behavior indicative of ADHD from another same‐aged child's typical in‐class behavior (Gadow et al., 1992).…”

Clinical issues in child and adolescent psychopharmacology.

“…Care providers respond to these improvements in the child’s demeanor by being less negative and less directive (e.g., Barkley & Cunningham, 1979). Peers also appear to be less controlling (giving commands, negative responses) and in some cases less disruptive when the ADHD child is receiving methylphenidate compared with placebo (e.g., Cunningham, Siegel, & Offord, 1985, 1991; Gadow et al, 1991). Subjectively, parents and teachers may report that on medication the child is happier and less frustrated.…”

“…For example, a major complaint of teachers about disruptive hyperactive children is that they lower the overall level of classroom performance by increasing the rate of negativistic behaviors in classmates. Although there is some evidence that this may be true in specific cases (Campbell, Endman, & Bernfeld, 1977), the effect that pharmacotherapy has on this phenomenon is relatively unstudied (e.g., Gadow et al, 1991). In other words, researchers generally do an excellent job of describing symptom suppression, but they are less successful when it comes to demonstrating the link between symptom suppression and the reason for prescribing medication.…”