A Double-Blind, Placebo-Controlled Withdrawal Trial of Dexmethylphenidate Hydrochloride in Children with Attention Deficit Hyperactivity Disorder

Objectives: d,l-threo-methylphenidate HCl (d,l-MPH) is the most common treatment of attention deficit hyperactivity disorder (ADHD). A previous report showed placebo-controlled efficacy for the purified disomer (dexmethylphenidate hydrochloride, d-MPH, Focalin™) with a 2:1 potency compared to dl, and suggested a 6-hour duration of action. This study complements that report by studying the effect of placebo-controlled discontinuation and retesting the duration of action. Methods: A 6-week, open-label titration of d-MPH (2.5–10 mg twice-a-day) was followed by a doubleblind, placebo-controlled, 2-week withdrawal study of responders. Results: In the open titration, 82% of the 89 enrolled patients achieved a Clinical Global Impression— Improvement (CGI-I) rating of much or very much improved. Only 5 patients discontinued for adverse events. Seventy-five patients continued into the placebo-controlled discontinuation. For the randomly assigned d-MPH (n = 35) and placebo (n = 40) groups, mean ages, respectively, were 10.1 ± 2.9 and 9.9 ± 2.7 years, 86% and 78% were male, and 70.6% and 80.0% took the ceiling dose of 10 mg twice-daily, respectively. Each group had 80% combined-type ADHD and 20% inattentive type. By the end of the 2- week, placebo-masked withdrawal, significantly more placebo patients (24 of 39) than d-MPH continuers (6 of 35) relapsed (61.5% versus 17.1%, p = 0.001). Compared to d-MPH continuers, placebo patients deteriorated significantly more in the 2-week period on teacher ratings of the 18 ADHD symptoms rated 0– 3 (p = 0.028), the 3 p.m. and 6 p.m. parent ADHD symptom ratings (p = 0.0026 and p = 0.0381, respectively), and clinic (2–3 p.m.) and home (6 p.m.) Math Tests (p = 0.024 and p < 0.0001, respectively). The 6 p.m. scores replicated the significant effect at 6 hours reported in the previous study. Conclusions: d-MPH is safe, tolerable, and effective, with a 6-hour duration of effect suggested by the significant difference from placebo at 6 hours on a double-blind discontinuation

Peer-Assessed Outcomes in the Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder

Peer-assessed outcomes were examined at the end of treatment (14 months after study entry) for 285 children (226 boys, 59 girls) with attention deficit hyperactivity disorder (ADHD) who were rated by their classmates (2,232 classmates total) using peer sociometric procedures. All children with ADHD were participants in the Multimodal Treatment Study of Children with ADHD (MTA). Treatment groups were compared using the orthogonal treatment contrasts that accounted for the largest amount of variance in prior MTA outcome analyses: Medication Management + Combined Treatment versus Behavior Therapy + Community Care; Medication Management versus Combined Treatment; Behavior Therapy versus Community Care. There was little evidence of superiority of any of the treatments for the peer-assessed outcomes studied, although the limited evidence that emerged favored treatments involving medication management. Post hoc analyses were used to examine whether any of the four treatment groups yielded normalized peer relationships relative to randomly selected- classmates. Results indicated that children from all groups remained significantly impaired in their peer relationships

Quantifying annual spatial consistency in chick-rearing seabirds to inform important site identification

Animal tracking has afforded insights into patterns of space use in numerous species and thereby informed area-based conservation planning. A crucial consideration when estimating spatial distributions from tracking data is whether the sample of tracked animals is representative of the wider population. However, it may also be important to track animals in multiple years to capture changes in distribution in response to varying environmental conditions. Using GPS-tracking data from 23 seabird species, we assessed the importance of multi-year sampling for identifying important sites for conservation during the chick-rearing period, when seabirds are most spatially constrained. We found a high degree of spatial overlap among distributions from different years in most species. Multi-year sampling often captured a significantly higher portion of reference distributions (based on all data for a population) than sampling in a single year. However, we estimated that data from a single year would on average miss only 5 % less of the full distribution of a population compared to equal-sized samples collected across three years (min: −0.3 %, max: 17.7 %, n = 23). Our results suggest a key consideration for identifying important sites from tracking data is whether enough individuals were tracked to provide a representative estimate of the population distribution during the sampling period, rather than that tracking necessarily take place in multiple years. By providing an unprecedented multi-species perspective on annual spatial consistency, this work has relevance for the application of tracking data to informing the conservation of seabirds

Quantifying annual spatial consistency in chick-rearing seabirds to inform important site identification

Animal tracking has afforded insights into patterns of space use in numerous species and thereby informed area-based conservation planning. A crucial consideration when estimating spatial distributions from tracking data is whether the sample of tracked animals is representative of the wider population. However, it may also be important to track animals in multiple years to capture changes in distribution in response to varying environmental conditions. Using GPS-tracking data from 23 seabird species, we assessed the importance of multi-year sampling for identifying important sites for conservation during the chick-rearing period, when seabirds are most spatially constrained. We found a high degree of spatial overlap among distributions from different years in most species. Multi-year sampling often captured a significantly higher portion of reference distributions (based on all data for a population) than sampling in a single year. However, we estimated that data from a single year would on average miss only 5 % less of the full distribution of a population compared to equal-sized samples collected across three years (min: −0.3 %, max: 17.7 %, n = 23). Our results suggest a key consideration for identifying important sites from tracking data is whether enough individuals were tracked to provide a representative estimate of the population distribution during the sampling period, rather than that tracking necessarily take place in multiple years. By providing an unprecedented multi-species perspective on annual spatial consistency, this work has relevance for the application of tracking data to informing the conservation of seabirds

Visual-Motor Tracking by Hyperkinetic Children

Two studies of a visual-motor tracking task purported to be an effective discriminator of subtypes of minimal brain dysfunction are presented. Performances of 16 psychiatric inpatients were compared with those of 14 hyperactive males and of 15 normal controls. A second study evaluated effects of practice and drug sensitivity on tracking. The task discriminated patients from normals but did not discriminate the groups of patients from each other. Interactions of practice, age, and diagnosis were found. Some degree of sensitivity of the task to stimulant medication was also obtained. Visual-motor tracking is a useful measure of stimulant drug action but does not measure a defect specific to hyperkinetic patients. </jats:p

A Comparison of Staff Training Procedures Behavioral Applications in the Child Psychiatric Inpatient Setting

The present study sought to determine the most efficient means of staff management by comparing three training procedures: (1) in-service training, using Brown and Presbie's (1974) Behavior Modification Skills, (2) direct feedback of actual staff performance, and (3) role-playing, involving instruction, modeling, behavioral rehearsal, feedback, and reinforcement with an experienced behavior therapist. Direct naturalistic observational procedures were used to obtain behavioral data to eight staff members' (nurses and aides) interactions with children on an inpatient psychiatric unit. The phases of the study, which spanned twenty-one weeks, included: baseline 1, in-service training, in-service plus direct feedback (administered sequentially across subjects), baseline 2, and role-playing. Results indicated that (1) the in-service training had little effect on staff behavior, (2) direct feedback in some cases resulted in increased frequency of appropriate staff responding, including greater use of positivereinforcement and vocalizations, but these gains were not maintained across time, and (3) the greatest gains in staff behavior occurred as a result of role-playing. These results are discussed in terms of both the specific advantages anddisadvantages of each of the training procedures, and the practicality and political issues involved

The Behavioral Treatment of Hysterical Paralysis in a Ten-Year-Old Boy: A Case Study

This paper describes the use of behavioral techniques with a 101/2-year-old boy diagnosed as having hysterical paralysis of both legs. The case demonstrates the use of withdrawal of reinforcement for hysterical behavior and the use of positive reinforcement for successive approximations of walking behavior. The patient regained full mobility within 2 weeks after the beginning of the program, and showed other behavioral improvements as well (increased vocalizations, decreased isolative behavior and lethargy-dejection). At 6-month follow-up, the patient had maintained his gains, with no symptom substitutions. The treatment is discussed within its context (a pediatric psychiatric inpatient facility) with consideration to the role of psychiatric staff in employing behavioral methods