James H. Satterfield

A prospective study of hyperactive boys with conduct problems and normal boys: adolescent and adult criminality.

OBJECTIVE To examine the relationship between attention deficit disorder with hyperactivity in childhood and criminality in adolescence and adulthood in 89 hyperactive and 87 normal control subjects. METHOD In this prospective study, adolescent follow-up intervals ranged from 13 to 21 years and adult follow-up ranged from 18 to 23 years. The official arrest records for all subjects were obtained. RESULTS Hyperactive subjects had significantly higher juvenile (46% versus 11%) and adult (21% versus 1%) arrest rates. Juvenile and adult incarceration rates were also significantly higher. Childhood conduct problems predicted later criminality, and serious antisocial behavior in adolescence predicted adult criminality. CONCLUSIONS Hyperactive children are at risk for both juvenile and adult criminality. The risk for becoming an adult offender is associated with conduct problems in childhood and serious antisocial behavior (repeat offending) in adolescence. Hyperactive children who do not have conduct problems are not at increased risk for later criminality.

Three-year multimodality treatment study of 100 hyperactive boys

We conducted a prospective study of 100 hyperactive boys admitted to a multimodality treatment program. After a comprehensive evaluation, an individualized psychotherapy plan commensurate with the childs disabilities was developed. In addition to medication, each child was enrolled in one or more indicated psychotherapeutic modalities. Since approximately 50% of our patients dropped out of treatment, groups receiving less and more treatment were compared on outcome measures. At three-year follow-up the group receiving more treatment was found to be further ahead educationally, to demonstrate less antisocial behavior, to be more attentive (as rated by their teachers), to have better adjustment at school and at home (as reported by their parents), and to be more globally improved (as rated by psychiatrists and by parents) than children in the group receiving less treatment. Outcome for the group receiving more treatment was found also to be unusually good as compared to that in other studies of hyperactive children treated for varying lengths of time and evaluated after one to five years.

Response to stimulant drug treatment in hyperactive children: prediction from EEG and neurological findings.

A study of neurological examinations, EEG findings, and behavioral responses to methylphenidate treatment in 57 hyperactive boys, 5 to 10 years of age, is reported and discussed. The results indicated that subjects with minor neurological abnormalities in 4 or more categories responded with significantly more improvement (p<.01) to methylphenidate treatment than subjects without abnormalities. Subjects with abnormal EEGs had significantly more improvement (p<.001) than those with normal EEGs. A significant correlation was found between the degree of evidence of brain dysfunction (obtained from EEG and neurological examinations) and the probability of response to methylphenidate treatment. It is suggested that both the neurological and the EEG examinations play a significant role in the assessment of hyperactive children.

EEG ASPECTS IN THE DIAGNOSIS AND TREATMENT OF MINIMAL BRAIN DYSFUNCTION

The relationship between abnormalities of the EEG and psychiatric disorders of childhood in general is currently unclear; the same is true for the syndrome of minimal brain dysfunction in particular.1-6 The lack of clarity results in part from differences in patient populations studied, as well as from the scarcity of blindly rated control studies. Sensory evoked cortical response studies of minimal brain dysfunction (MBD) have been reported, but the application of this technique to the study of MBD is in its infancy.s-s

Childhood brain function differences in delinquent and non‑delinquent hyperactive boys.

Childhood electrophysiological and clinical measures were obtained in 110 hyperactive (HA) and 76 normal children, who were later followed up as adolescents. Official arrest data were obtained on all subjects and used to measure outcome. The usual interpretation, that the presence of a brain function abnormality suggests a poor prognosis, does not apply to the clinical EEG, EEG spectral and ERP measures obtained on these HA boys. In fact, the converse was found to be true, that is EEG and ERP abnormalities were associated with a good outcome, while normal values of these measures were associated with a poor outcome. Data were presented that suggest that there may be two distinct subgroups of HA boys. The first group was characterized by abnormalities in childhood brain function, abnormal changes in brain function with age, less antisocial and hyperactive behavior in childhood, and absence of delinquency in adolescence. The second group was characterized by normal childhood brain function, normal changes in brain function with age, more antisocial and hyperactive behavior in childhood, and teenage delinquency. Childhood EEG and ERP measures were found to be significantly different in these delinquent and non-delinquent HA groups, while social, familial and cognitive attributes were not. The N2 amplitude of the AERP in delinquent hyperactive (DHA) boys was found to be significantly larger than in the non-delinquent hyperactive (NDHA) boys. This N2 amplitude may prove clinically useful in selecting HA boys for delinquency prevention programs.

Longitudinal study of AERPs in hyperactive and normal children: relationship to antisocial behavior

Changes in AERP measures from childhood to adolescence were studied in 2 subgroups of hyperactive children (25 non-delinquent and 9 delinquent) and 1 group of 34 non-delinquent normal children. The 3 groups were selected on the basis of official delinquency measures obtained 8 years after their initial evaluations. All subjects were studied using the same AERP paradigm at both points in time. The major finding was that the non-delinquent hyperactive subjects were found to have abnormal maturational changes as reflected by AERP measures while the delinquent hyperactive subjects were found to have normal maturational changes in these same measures. This suggests that these 2 hyperactive groups are on a different developmental course and that they may represent different clinical entities. Results of the comparison of cross-sectional data in childhood and again in adolescence were consistent with the concept of 2 distinct subgroups.