Oliver J. David

Lead and Hyperactivity: Lead Levels Among Hyperactive Children.

Previous work has demonstrated an association between hyperactivity and increased body lead burdens in school-age children. In the present study it is shown that within a group of hyperactive children those for whom an organic etiology is present have lead burdens lower than in those for whom no apparent cause could be found. These data lead us to reject the notion that hyperactivity per se is responsible for the acquisition of elevated lead levels, and further strengthen the suspicion that for some children lower lead level absorption may be implicated in the development of the hyperkinetic disorder.

Decision to admit in an inner-city psychiatric emergency room: Beyond diagnosis—The psychosocial factors

A one week sample of all patients who presented to the psychiatric emergency room of a large general municipal hospial in an inner-city area were studied. Demographic make-up, clinical picture, nature of coping styles, support systems, social, work, and family adjustment were studied as they related to admission status. Diagnosis, psychiatric history, and clinical status predicted admission as well as the nature of the patients social functioning, coping style, and community supports. The implications of the socioeconomics of mental health for treatment planning were discussed.

Predicting psychiatric admission from an emergency room. Psychiatric, psychosocial, and methodological factors.

The determinants of psychiatric hospitalization, especially nonspecific issues, have been studied extensively. The methodological problem of correlational non-cross-validated findings are seen as contributing to our uncertainties about the critical issues involved in the decision to admit. A cross-validated multiple regression analysis of determinants of hospitalization in an inner-city municipal hospital revealed two determinants of hospitalization: severity of schizophrenic symptoms and active suicidal and/or homicidal ideation. They accounted for one third of the variance without shrinkage. Quasi-experimental designs may be the most efficient means of studying the remaining unexplained variance.

The relationship of hyperactivity to moderately elevated lead levels.

Controversy exists with respect to whether moderately elevated lead levels are toxic in certain children with various central nervous system dysfunctions. One way of addressing this controversy is to remove the lead; if the condition is ameliorated a presumption of toxicity becomes reasonable. Such a strategy is reported herein. Children with an operationally defined central nervous system dysfunction (hyperactivity) and moderately elevated lead levels were treated with a lead chelating agent in a random allocation double blind treatment regimen. The finding of statistically significant and obvious behavioral improvement reported by three separate evaluators (i.e., parent, teacher, and treating physician) of the child suggests that the presumption of a toxic relationship between moderately elevated lead levels and hyperactivity is supported.

Childhood lead poisoning: a re-evaluation.

Long recognized as an environmental toxin of fearsome lethality, lead effects are commonly described as extremely serious, particularly as regards the central nervous system. It is postulated here that this represents only part of the pathologic spectrum. Ohter lead-related conditions, as yet unrecognized, may include a wide range of central nervous system dysfunctions that although severe, are not so acutely dramatic or widely destructive as the classic encephalopathic or preencephalopathic states. These conditions remain etiologically unrecognized primarily because of (1) the variable nature of onset, (2) the variable nature of the manifestations, (3) the relative subtlety of the dysfunctions, and most importantly, (4) the absence of consistant, unequivocal evidence demonstrating the relationship of lower blood lead levels with pathologic effects. This last is seen as pivotal, and an extensive examination of the reasons for its absence is presented. It is postulated that biological variability, a concept widely used in medicine but rarely invoked in the researching of lead toxicity, is a crucial ingredient in lead research. It is further asserted that the grevious lack of etiologic recognition will continue until that factor is incorporated into research designs.

Chelation Therapy in Children as Treatment of Sequelae in Severe Lead Toxicity

Certain children who experience a toxic lead episode requiring hospitalization in infancy or early childhood will manifest central nervous system dysfunctions, including hyperactivity, as sequelae of this experience. In this study, findings indicate that persistent, higher-than-normal lead levels, dating back to the time of the initial toxicity, may well be a mechanism underlying some of these sequelae. Consequently, some part of these sequelae may be preventable and/or treatable.

Communication disturbances and hyperactive/conduct-disturbed behavior.

This study examines mother-child communication as one factor in the development of conduct-disturbed/hyperactive boys. Three groups of school-age children were compared: a group including conduct-disturbed/hyperactive boys who had a significant insult in their perinatal/developmental history; a group of conduct-disturbed/hyperactive boys in whom no insult could be found; and a group of normally active/non-conduct-disturbed/hyperactive boys. It was hypothesized that disturbed communication between mother and son would be found in boys who were conduct-disturbed/hyperactive, whether or not there was a probable organic cause for their dysfunction, and this hypothesis was confirmed. In addition, it was found that the communication patterns in children who had a probable organic etiology for their disturbance were different from those found in the group lacking an organic etiology. However, both of these groups exhibited communication patterns that were more disturbed than the communication from mother to son in the normally active, non-conduct-disturbed group.

COGNITIVE STYLE AND THE PERKY EFFECT

Depending on inner versus outer frames of reference in Witkins sense parallels a subjects tendency to distinguish between internal images and external percepts. A rank-order correlation of .69 (N = 22) was found between scores on a task designed to test the latter tendency and scores on the rod-and-frame task.

Confusional consequences of illogical interaction.

A personality theory rooted in interpersonal interaction is presented herein. The theory rests on a simple reward-punishment paradigm in which interpersonal interactions are viewed not as a series of discrete phenomena but as continuously recurrent experiences. Effects of interaction patterns thus reflect an accumulated experience rather than individual, discontinuous events. This basic learning paradigm keeps intact a simplicity and appealing logic. At the same time, invoking a cumulative learning experience, rather than the more common view, a series of individually discrete events, invests the theory with a conceptual underpinning sufficient to explain the role of interaction patterns in forming the complexity of thought, emotion, and behavior that is the reality of the human condition. Major dimensions of this identity-acquiring process are described herein. These vary hugely and are understood to underwrite in a direct, logical, ultimately simple way the various attributes that are the basis of identity. This applies to normal identity and can be applied as well to those identities that may form the core of such conditions as mania, depression, and even schizophrenia. The manner in which this theory incorporates tenets of other extant interactive theories is also described.