Jeffrey Sverd

Methylphenidate in aggressive-hyperactive boys: I. Effects on peer aggression in public school settings.

One of the least documented known effects of methylphenidate in hyperactive children is the suppression of peer aggression. In this study, 11 aggressive-hyperactive children received a low (0.3 mg/kg) and moderate (0.6 mg/kg) dose of methylphenidate and placebo for 2 weeks each under double-blind conditions. Children were observed in public school settings during classroom seatwork activities, lunch, and recess. Results showed that methylphenidate suppressed nonphysical aggression (p = 0.06) in the classroom, and a moderate dose decreased physical aggression (p less than 0.01) and verbal aggression (p = 0.07) on the playground. The effect on the rate of appropriate social interaction was variable. The majority of subjects exhibited either the same or higher levels of appropriate social interaction on the 0.6 mg/kg dose compared with placebo. In the classroom, both doses of methylphenidate also resulted in reduced levels of motor movement, off-task behavior, noncompliance, and disruptiveness. Teacher ratings of hyperactivity and conduct problem symptoms revealed drug effects, whereas parallel parent instruments did not.

Methylphenidate in Hyperactive Boys with Comorbid Tic Disorder: II. Short-Term Behavioral Effects in School Settings

In this study, 11 prepubertal hyperactive boys with tic disorder received placebo and three doses of methylphenidate (0.1, 0.3, and 0.5 mg/kg) for 2 weeks each, under double-blind conditions. Each boy was observed for approximately 20 hours in the school setting (classroom seatwork activities, lunchroom, and playground). Results showed that methylphenidate effectively suppressed hyperactive/disruptive behaviors in the classroom and physical aggression in the lunchroom and on the playground. Methylphenidate also reduced the occurrence of vocal tics in the classroom and the lunchroom. None of the motor tic measures revealed drug effects, but the lowest mean rate of motor tics occurred on the 0.3 mg/kg dose. On an operationally defined minimal effective dose, only one boy experienced motor tic exacerbation.

Methylphenidate treatment of attention-deficit hyperactivity disorder in boys with Tourette's syndrome

The effects of methylphenidate on four boys diagnosed as attention-deficit hyperactivity disorder (ADHD) and Tourettes syndrome (TS) were examined under single-blind, placebo-controlled conditions. Clinical ratings and playroom observations showed improvement in ADHD symptoms with methylphenidate. Results also indicated that methylphenidate had no untoward effects on the frequency of tic occurrence. In all four children, the highest dose resulted in improved classroom ratings of tics compared with initial placebo treatment. In three cases, mild tic exacerbation was reported for a lower dose. Because variability of tic status was observed in the experimental conditions, the findings suggest the possibility that tic response was independent of clinical doses of methylphenidate. The findings were also consistent with the theory that methylphenidate, a dopamine agonist, might effect tic status by altering dopamine receptor sensitivity. Further investigation of these effects is indicated, given the efficacy of methylphenidate in treating ADHD symptoms of TS patients.

Brief report: Cases for an association between Tourette syndrome, autistic disorder, and schizophrenia-like disorder

Despite evidence supporting discontinuity between autistic disorder and schizophrenia (Green et al., 1984; Kolvin, 1971; Rumsey, Rapoport, & Sceery, 1985; Rutter, 1972; Volkmar & Cohen, 1991) increasing numbers of patients with coexisting autistic disorder and schizophrenia-like psychosis have been described (Cantor, Evans, Pearce, & Pezzot-Pearce, 1982; Clarke, Littlejohns, Corbett, & Joseph, 1988; Comings & Comings, 1991; Petty, Ornitz, Michelman, & Zimmerman, 1984; Realmuto & August, 1991; Szatmari, Bartolucci, Finlayson, & Krames, 1986; Volkmar, Cohen, Hoshino, Rende, & Paul, 1988; Wolff & Chick, 1980) and some investigators have reported an association between past history of autistic symptoms and present diagnosis of schizophrenia (Russell, Bott, & Sammons, 1989; Waterhouse, Fein, Nath, & Snyder, 1987; Watkins, Asarnow, & Tanguay, 1988). The following is a report of two children who were diagnosed as having co-occurring autistic disorder, schizophrenia-like psychosis, and Tourette syndrome (TS). Two additional autistic adults are described. Both of the latter patients showed tics and experienced episodes of schizophrenia-like psychosis. Evidence is reviewed to suggest that there exists a subgroup of autistic children who are at risk for the development of schizophrenia-like symptoms and that TS may underlie the coexistence of the disorders in some patients.

Methylphenidate oral dose plasma concentrations and behavioral response in children

The relationship between methylphenidate (MP) oral dose and plasma concentration to social and cognitive behaviors was studied in 25 boys diagnosed as having “attention deficit disorder with hyperactivity”. Children were administered successive 1-week treatment conditions under the following schedule of fixed oral doses given twice daily: placebo; 0.25 mg/kg; 0.50 mg/kg; 1.0 mg/kg; placebo. Teacher and parent ratings showed increased improvement in social behavior as a function of MP dose. No drug effects were obtained on cognitive performance. MP plasma concentrations were significantly associated with oral dose and with measures of social behavior. No relationship was found with cognitive behavior. Side effects at the largest dose were severe enough to require discontinuation of treatment for five children, but were relatively mild for the remaining children.

Behavior Disorder and Attention Deficits in Boys with Tourette Syndrome

Abstract Behavior disorders in a group of Tourette syndrome (TS) boys and in a group of boys referred with behavior difficulties only were compared. The two groups were similar with regard to teacher and parent ratings of behavior disturbance and with regard to clinical diagnoses of behavioral and attentional disorders. Over 90% of TS boys were diagnosed as having attention deficit disorder. Some boys with mild TS were found to have attentional and impulse control problems. Increased severity of TS symptoms was associated with an earlier onset of behavior disturbance. The findings suggest that attention deficits and behavior disorder are common in psychiatrically referred TS boys and that they may share common neurobiological mechanisms with the tic disorder. J. Am. Acad. Child Adolesc. Psychiatry , 1988, 27, 4:413–417.

A General Population Screen for Attention Dficit Disorder with Hyperactivity

The Conners Abbreviated Rating Scale (ARS), developed for documenting behavior change during pharmacotherapy, was examined for its utility as a primary screen for Attention Deficit Disorder with Hyperactivity. A sample of 92, 6–9-year-old boys was used to determine the parents ARS score which identified 90% of DSM-III diagnosed cases I year later. The total ARS proved useful for primary screening, and a 5-item subset correctly classified 91% of the hyperactive boys and 73% of the nonhyperactives. Both screens were superior to longer scales rated by parents and teachers at the time diagnoses were made.

Learning Ability and Methylphenidate (Ritalin(®)) Plasma Concentration in Hyperkinetic Children: A Preliminary Investigation

Abstract The present study was undertaken to determine whether a relationship exists between methylphenidate (Ritalin(®)) concentration in blood and learning performance in hyperkinetic children. Blood samples were obtained and paired-associate learning performance was evaluated in 5 boys during a predrug baseline and at 1, 2, 3, 5, and 7 hours following their clinically effective dose. A regression analysis yielded a significant negative slope relating plasma concentration and learning errors, suggesting that methylphenidate blood level may significantly influence the academic performance of children being treated with this psychostimulant.

Co-occurrence of body dysmorphic disorder and Tourette's disorder : Three patient examples

Body dysmorphic disorder (BOD) is a somatoform disorder characterized by an affected persons preoccupation with an imagined defect in appearance, which results in significant distress and impairment in functioning. -7Onset of the disorder usually occurs in adolescence,2.3.5.7 and onset in childhood has not been previously described.2.3·7 High rates of affective and anxiety disorders in BOD patients and their relatives suggest that a significant relationship may exist between these disturbances and BDD,-6 and it has been proposed that BOD should be conceptualized as an obsessive-compulsive spectrum disorder and more broadly as an affective spectrum disorder.3.s Favorable response to serotonergic antidepressants in open trials suggests an important role of central nervous system serotonergic dysfunction in the pathogenesis of BDD.-4 Tourettes disorder (TO) is a common hereditary neurobehavioral spectrum disorder whose onset usually occurs in childhood or early adolescence.9-5 In addition to motor and vocal tics, patients may experience a wide array of neuropsychiatric disturbances, including attention deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder (OeD), and affective and anxiety disorders.9-2 It has been proposed that the associated disorders are genetically related to the tic disorder9-12 and that the TO spectrum of disorders is identical o to the

Effects of propranolol in tourette syndrome

Alternate medications for the treatment of Tourette syndrome are required because haloperidol in some patients either may be ineffective or may cause disturbing side effects. Propranolol, a beta-adrenergic blocking agent, has been reported as effective, in uncontrolled trials, in ameliorating symptoms of tic disorder, tardive dyskinesia, and drug-induced extrapyramidal syndrome. Propranolol, in doses up to 120 mg per day, was administered to five patients with Tourette syndrome in a placebo-controlled study and was found ineffective in ameliorating symptoms of Tourette syndrome. Results underscored the importance of placebo-controlled investigation when evaluating the effects of drugs in Tourette syndrome.