Medication for Hyperkinetic Children

One must be cognizant of the fact that there is probably more confusion in relation to diagnosis and appropriate criteria for the use of medication for the treatment of hyperkinetic children than there is regarding the choice of medication. Many physicians, as well as the general public, do not truly appreciate the differential diagnosis of the overactive child. The symptoms may be an expression of basic personality, anxiety, subclinical seizure disorders, strictly in the eyes of the beholder, or true hyperkinesis; the latter is the only condition in which stimulants might be expected to be beneficial. The use of drug therapy in the management of the hyperkinetic child does not differ appreciably from drug therapy in other treatable maladies. In both instances prescription drugs should be prescribed only by appropriately licensed physicians. Although the screening of patients may frequently be done by other disciplines, the ultimate selection of patients remains the responsibility of the prescribing physician. Rarely is hyperkinesis an isolated symptom. Hopefully, the selection of the drug to be used is based on such factors as history and physical examinations with appropriate emphases and the weighing of risks (that is, the ramifications of the untreated patient versus side effects and long-term sequelae of medication). A satisfactory means of evaluating the effects of therapy and periodic reevaluations (follow-up) should be included. Whatever the diagnostic nomenclature, the “indications” depend largely on clinical acumen rather than pathognomonic findings. There is some agreement about the indications for the clinical use of stimulant drugs for hyperkinetic children even though there must be a trial on the medication before its efficacy can be determined for a particular child. The hyperkinetic child is typically one of normal intelligence who fails to learn at a normal rate even though he is given the same educational opportunities as children with equal intelligence. He usually exhibits to some degree (1) short attention span, (2) easy distractibility, (3) impulsive behavior, and (4) overactivity. Although other behaviors oftentimes are seen in children with norma! intelligence and academic lag, stimulant drugs seem to be most effective in the four behaviors just mentioned. Little is known about the effect of stimulant drugs on such things as poor motor integration, deficits in the perception of space, form, movement and time, and disorders of language or symbol development. Of the agents available, apparently the most effective and probably the best documented stimulants are dextro#{225}mphetamme and methyiphenidate, though many others are under investigation at this time. Selection of the agent and the proper dosage must be tailored to the individual child as there is wide individual variation in the amount necessary to affect a change in behavior. Unfortunately, far too many clinicians abandon treatment after a brief, inadequate trial period. An appropriate regimen for the average-sized 6-year-old child begins with a minimal dose each morning at breakfast (5 mg of dextroamphetamine, or 10 mg of methyiphenidate). A 2to 3-day trial should follow. If no improvement results, dosage can be increased in like increments, with a maximum daily dose of 40 mg of dextroamphetamine or 80 mg of