Adrian D. Sandler

Conditioned placebo dose reduction: a new treatment in attention-deficit hyperactivity disorder?

Objective: This study examined if pairing a placebo with stimulant medication produces a placebo response that allows children with attention-deficit hyperactivity disorder (ADHD) to be maintained on a lower dose of stimulant medication. The primary aim was to determine the efficacy, side effects, and acceptability of a novel conditioned placebo dose reduction procedure. Method: Participants included 99 children ages 6 to 12 years with ADHD. After an initial double-blind dose finding to identify optimal dose of mixed amphetamine salts, subjects were randomly assigned to 1 of 3 treatments of 8-week duration: (a) conditioned placebo dose reduction condition (50% reduced dose/placebo [RD/P]) or (b) a dose reduction only condition (RD) or (c) a no reduction condition (full dose). The innovative conditioned placebo dose reduction procedure involved daily pairing of mixed amphetamine salts dose with a visually distinctive placebo capsule administered in open label, with full disclosure of placebo use to subjects and parents. Results: Seventy children completed the study. There were no differences in subject retention among the 3 groups. Most subjects in the RD/P group remained stable during the treatment phase, whereas most in the RD group deteriorated. There was no difference in control of ADHD symptoms between the RD/P group and the full dose group, and both RD/P and full dose groups showed better ADHD control than the RD group. Treatment emergent side effects were lowest in the RD/P group. Conclusion: Pairing placebos with stimulant medication elicits a placebo response that allows children with ADHD to be effectively treated on 50% of their optimal stimulant dose.

Neurodevelopmental study of writing disorders in middle childhood.

This study investigated patterns of neurodevelopmental dysfunction in children with writing disorders (WD). Records of children, ages 9 to 15 years, referred to a school problems clinic were examined. Using teacher questionnaire information, including ratings of writing legibility, mechanics, rate, linguistic sophistication, and spelling, 99 cases of WD were found. Sixty-three children without WD served as clinic controls. A cluster analysis revealed four discrete subtypes of WD and two non-WD control clusters. The four WD clusters were found to have different patterns of writing and reading characteristics. Neurodevelopmental tests discriminated among the clusters (F = 2.8, p < .0001), and an examination of neurodevelopmental performance characteristics among the clusters showed different patterns of strengths and weaknesses. An empirically derived subtyping of WD is proposed: WD with fine motor and linguistic deficits, WD with visualspatial deficits, WD with attention and memory deficits, and WD with sequencing deficits. This subtyping, if confirmed in a population study, may have important diagnostic and therapeutic implications. J Dev Behav Pediatr 13:17–23, 1992. Index terms: learning disorders, written language, dysgraphia, spelling, subtypes.

Children with Spina Bifida: Key Clinical Issues

Spina bifida is the most common of the neural tube defects, which include myelomeningocele, encephalocele, and anencephaly. Spina bifida is a complex and multisystem birth defect, in which one or more vertebral arches may be incomplete. This article discusses the sensory and motor impairments, neurologic disorders, orthopedic and cognitive impairments, and skin and other problems associated with spina bifida. This article also summarizes some of the key clinical issues in the care of children with this complex birth defect.

Adolescents Talking About Thinking: Preliminary Findings of a Self-Report Instrument for the Assessment of Cognition and Learning

The Survey of Teenage Readiness and Neurodevelopmental Status (STRANDS) is a new multidimensional measure designed to obtain a profile of abilities directly reported by the respondent. It is intended for use in clinical settings and schools to assist in the assessment of potential learning problems in high school students ages 15-19 years. It consists of a Questionnaire and Structured Interview, and takes 1 hour to administer. This study provides preliminary findings with respect to reliability and validity of the STRANDS. Subjects included 54 older adolescents who were divided into two groups: Learning Disability (n = 24) and Normal Achieving (n = 30). The two groups did not differ in terms of chronological age, race, gender, socioeconomic status, or Full Scale IQ. The STRANDS Questionnaire and Interview, and a number of benchmark measures were administered. Internal consistency measures for all scales on the STRANDS ranged from.66 to.91. Test-retest reliability of the Interview ranged from.72 to 97. Construct validity was examined for the scales of attention, memory, language, and visual-perceptual function using multi-trait/multi-method correlational analysis. Construct validity was supported by moderate, significant correlations between the latter three scales and a priori related measures. The construct validity for the attention scale was not well supported. Several scales on the Questionnaire and on the Interview significantly discriminated between the groups, with the Learning Disability group reporting significantly greater concerns than the Normal Achieving group. These results suggest the potential utility of such an assessment approach with adolescents, particularly those experiencing learning problems.

Youth Views on Communication About ADHD and Medication Adherence

The purpose of this study was to examine youth perceptions of attention deficit hyperactivity disorder (ADHD) communication with their pediatric providers, their reported adherence to their ADHD medications, and their desired location for an ADHD educational program. Youth ages 7 through 17 with an ADHD diagnosis were recruited. A research associate interviewed the youth. Parents completed demographic questionnaires. Seventy families participated. One-third of the youth wanted more discussion about ADHD with their providers during visits. The average youth had over eight questions about ADHD and its treatment. Most youth wanted to learn about ADHD at their provider’s office. Non-white and older youth were significantly more likely to be less adherent to their ADHD medications. Youth want their providers to engage them more during visits. Providers should take advantage of this interest to engage youth more in discussions regarding ADHD and its treatment during pediatric ADHD visits.

Cognitive aspects of sexual decision making in adolescent females

A comprehensive sexuality questionnaire was administered to 37 females, ages 13 through 16 years, who attended clinics for routine health care. Subjects completed standardized scales of self-concept, locus of control, and future orientation. They also were given a short battery of standardized cognitive tests. Three groups were identified: Group 1 was sexually active and using contraception reliably, Group 2 was not using contraception reliably, and Group 3 had not been sexually active. Group 1 adolescents had higher scores on the vocabulary subtest of the WISC-R (F = 3.4, p < .05) than did Group 2 adolescents, over and above the effect of socioeconomic status (SES). Group 1 subjects had higher scores on knowledge of sex and contraception than did Group 2 (F = 3.3, p < .05). Group 1 had more internal locus of control (F = 7.0, p < .005) than did Group 2 over and above the effect of SES. Mean scores for Group 3 adolescents were intermediate and not significantly different. The findings suggest that cognitive factors may influence contraceptive behavior in adolescent females. J Dev Behav Pediatr 13:202–207, 1992. Index terms: cognition, sex, contraception, adolescence.