Committee on Drugs an Evaluation of the Pharmacologic Approaches to Learning Impediments

agents to children with learning impediments or disabilities is not a new method of treatment. Publications of related investigations date back more than 30 years. An accurate assessment of the effectiveness of the chemotherapeutic approach poses enumerable difficulties. These stem from factors such as ( 1 ) the lack of uniform terminology, ( 2) marked variability in methodology for evaluation, ( 3 ) the absence of standardized requirements for precise diagnosis and classification of the symptomatology constituting learning impediments, and (4) the paucity of longterm, properly controlled studies. As a resuit, a valid evaluation of response and ohjective comparison of the effectiveness of drugs administered in an attempt to mitigate or lessen learning impediments becomes impossible. The clinical manifestations that collectively constitute learning disabilities are grouped as general classifications; or, in attempts to be specific, they are classified into etiologic and/or descriptive terminology. For instance, the symptomatology referred to by the broad term “minimal brain dysfunction syndrome” consists of learning and behavioral impediments “associated with impairment in perception, conception, language, memory and control of attention, impulse or motor function.” A subcategory of this syndrome includes the slightly more specific hyperkinetic syndrome, which is the term most generally used and the behavior impediment most commonly investigated in the studies reviewed. The use of general terms which allude to varied conchlions makes the specificity of diagnosis imperative prior to the administration of any drug, especially in evaluating efficacy. The more specific vocabulary used in the classification of learning impediments ineludes cortical brain dysfunctions, lethargy, fluctuations in mood and thought, stuttering, speech-voice disorders, 14-6 cps EEG patterns, and learning deficits which consist of “poor attention span; reading, spelling, audio-verbal receptivity impairment, poor performance in arithmetic and/or English.”2 Although not as generalized as “minimal brain dysfunctions,” these terms still lack clarity and distinction between the organic and/or psychogenic etiological factors either before or after the administration of the drug under evaluation. The methods used in evaluating the drugs consisted of varied techniques dependent on the behavioral manifestations under assessment. Standardized objective tests used to determine changes in such areas as intelligence and personality included Bender-Gestalt, Goodenough Draw-APerson, WISC, Wechsler-Beilevue forms, Hundleby and Cattell ( personal function), Rorscharch inkblot, Raven Progressive Matrices, and others. An actometer was used to measure the motor activity of some children. EEG patterns provided another criteria of evaluating changes in the subjects, as well as criteria for participation in some studies. Other methods consisted of investigator-devised and/or standardized tests for coordination and perception; personality and behavioral rating forms; and written or oral personal observations by parents, teachers, physicians, interviewers, and oth-