Hyperkinetic Children Research Articles

Electrodiagnostic Testing of Visually Impaired Children under Sedation

The use of chloral hydrate as a sedative to enable electrodiagnostic testing of hyperkinetic children is discussed, and procedures for the administration of chloral hydrate are described. Case examples are presented to illustrate that assessment during the sleep-induced state enables further counseling regarding spasmus nutans, optic nerve hyoplasia, and Leber's congenital amaurosis. Management based on comparative electroretinogram and visual-evoked-response recordings is emphasized.

Toward competence: an eclectic approach.

Recent developments in children's rights have led to increased criticism of the presumption of total incompetency until adulthood, a concept inconsistently defined by state law. Citing proposals from several disciplines, this article calls for increasing actual competency in decision-making through systematic education in conjunction with developmental levels and experience. The elements of informed consent are suggested as one mechanism for learning to make educated decisions in a variety of settings. The treatment of hyperkinetic children is discussed as a case example.

New Evidence on Diet in Hyperkinesis

We wish to draw the attention of practicing pediatricians to two recent studies that converge on some important clinical implications for management of attention deficit disorder (ADD, hyperkinesis, MBD). Prinz and associates1 found in a sample of hyperkinetic and normal children that destructive-aggressive and restless behavior significantly correlated with the amount of sugar consumed by a child, with the ratio of sugar products to other foods, and perhaps most importantly, with the ratio of carbohydrate to protein in the diet.

Impulse control or selective attention: Remedial programs for hyperactivity

The purpose of the present study was to compare various cognitive treatment approaches for ameliorating the difficulties of hyperactive children on tasks requiring sustained vigilance and accuracy. Differential training techniques comparing training in attention to inhibitory control indicated that a combination of attentional and inhibitory control strategies was most efficacious in enhancing cognitive performance of these children. The findings from the present research further were interpreted to support the hypothesis suggesting that problems with impulse control and attention occur concurrently in hyperkinetic children, although remediation in attentional deploying strategies is necessary for enhancing cognitive performance of these children. The results from this study further indicated that training hyperkinetic children solely in inhibitory control simply is not sufficient for enhancing cognitive performance.

Reduced spinal motoneuronal excitability during wakefulness in hyperkinetic children: A replication and extension

This investigation is a follow-up of our recent report ( Pivik & Mercier, 1981) of reduced or absent secondary facilitation (100–300 msec inter-stimulus intervals) in the recovery function of the monosynaptic H-reflex in hyperkinetic (Hk) children during wakefulness (W). Subjects were 7 Hk and 6 control children, all males, 8–12 years old, unmedicated, free from organicity, and of average or above average intelligence. Hk diagnosis was based on scores of ≥ 15 on Conners Parent and Teacher Hyperactivity Index and the presence of DSM-III criteria of attention/deficit disorder with hyperactivity. Control children scored negatively on this index. Muscle action potentials elicited by pericutaneous tibial nerve stimulation were recorded from gastrocnemius-soleus muscles. Above threshold equal intensity stimuli were delivered in pairs at intra-pair intervals ranging from 40–2000 msec. Ratios of test (H 2) to conditioning (H 1) reflexes were averaged (5/interval) to generate a recovery function. Data were analyzed using repeated measures analysis of variance. Recovery functions were determined during relaxed W under two conditions, i.e., with and without the Jendraissik maneuver — a procedure thought to facilitate motoneuronal excitability via gamma (γ) efferent activation. Under both conditions reflex amplitude was depressed in Hk children relative to controls in the intervals spanning the time of secondary facilitation (C > Hk, 100 msec: p < .01; C > Hk, 300 msec: p < .05). Non-significant reflex amplitude increases were present in control subjects in Jendraissik relative to non-Jendraissik data, but results were inconsistent in Hk children. The present findings replicate our initial report of reduced facilitation during W in Hk children and argue for the use of this measure as objective index identifying a subclass of hyperkinetic children. The absence of reflex facilitation following the Jendraissik maneuver could be interpreted as a failure of γ-efferent activation in Hk children. However, since the role of this procedure in reflex facilitation remains controversial, the contribution of γ-efferent activity to the observed reduced motoneuronal excitability remains to be determined.

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

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.

Spinal motoneuronal excitability in hyperkinesis: H-reflex recovery function and homosynaptic depression during wakefulness.

Variations in amplitude of the spinal monosynaptic H-reflex were examined during relaxed wakefulness in three unmedicated groups of subjects, hyperactive children (n=5), an age-matched group of control children (n=5), and a group of young adults (n=10), using techniques involving equal intensity percutaneous stimuli delivered in pairs or trains at varying rates. The paired-stimuli procedure generates a recovery function, the outstanding features of which are early depression, a peak of facilitation occurring between 100-300 msec, and complete recovery by 2-5 sec. Trains of stimuli delivered at rates greater than or equal to 1/sec effect a reduction in reflex amplitude which is termed homosynaptic depression. Both procedures revealed differences between hyperkinetic children and comparison groups. The paired-stimulus technique revealed a generalized reduction in excitability for hyperkinetic children for intervals extending up to 800 msec. In particular, hyperkinetic children were characterized by a significantly increased variability at the longer stimulus intervals. Hyperkinetic children also showed a more rapid reduction in reflex amplitude to initial stimuli in stimulus trains delivered at rates greater than or equal to 1/sec. Trains of stimuli at rates effecting facilitation in terms of the paired stimulus technique, i.e., 3,4 and 5/sec, revealed sustained amplitude enhancement for control subjects only. The recovery function data are consonant with spinal motoneuronal hypoexcitability in hyperkinetic children. Possible neruophysiological and neurochemical mechanisms underlying the reduced capability of hyperkinetic children to respond to rapidly delivered, repetitive stimuli are discussed.

Sleep patterns in hyperkinetic and normal children.

Sleep patterns in nonmedicated hyperkinetic (n = 11) and normal control (n = 11) male children (8-12 years old) were compared to document possible sleep disturbance in hyperkinetic children. Electroencephalographic, electro-oculographic, electromyographic, and autonomic measures were monitored continuously for five consecutive nights. Analysis of sleep pattern variables revealed a significantly longer rapid eye movement onset latency (p less than 0.05) and marginally significant greater absolute and relative amounts of movement time (p less than 0.07) for the hyperkinetic group relative to controls. No other sleep parameters differentiated the groups. It was concluded that baseline tonic sleep parameters do not indicate marked sleep disturbance in hyperkinesis. The results are discussed within the context of hypothesized arousal dysfunction underlying this disorder. Key Words: Hyperkinetic children--Hyperkinesis--NREM and REM sleep cycles--Spontaneous skin potential responses.

The Diagnosis of Attention Deficit Disorder (Hyperkinesis) in Children

Thirty hyperkinetic children were selected on the basis of (1) a clinical diagnosis using the DSM-III criteria for Attention Deficit Disorder with Hyperkinesis; (2) having remained in treatment for at least six months and having been seen at least three times by a child psychiatrist, with the diagnosis maintained over that time; and (3) a maternal score greater than 18 on the Conners Abbreviated Parent-Teacher Rating Scale for Hyperkinesis on the initial day of testing. The children were tested on that day with the Continuous Performance Test (CPT) and the Draw-a-Line Slowly Test (DALS) for impulsivity. Age- and sex-normalized data from 15 of the hyperkinetic children and 83 normal school children of similar age selected on the basis of teacher ratings of less than 15 on the Conners Parent-Teacher Rating Scale were subjected to a discriminant function analysis. The stability of the discriminant function obtained, which contained the Continuous Performance Test, Errors of Commission (CPTC), Errors of Omission (CPTO), Mean Reaction Time (MRT), and DALS, was tested on the second group of 15 hyperkinetic children. Of the 15 hyperkinetic children, 9 were correctly classified, as were 99% of the normal school group (p < 0.001).

Canalization of arousal in the preweanling rat: effects of amphetamine on aggregation with surrogate stimuli.

Preweanling rats, 15 days of age, were placed in an unfamiliar cage containing 1 of a variety of surrogate conspecific stimuli. The surrogate stimuli consisted of a rat-sized aluminum tube covered with soft fluffy synthetic fur, a tanned rat pelt, felt, and an aluminum sheet. The surrogate was either maintained at ambient temperature or heated to body surface temperature (37 degrees C). The 1st experiment revealed that both furriness (length and softness of fur) and temperature of the surrogate stimulus are important determinants of conspecific aggregation (huddling). The 2nd experiment demonstrated that preference for the soft, fluffy surrogate was not mediated by temperature conservation by showing that the same huddling behavior was obtained when ambient temperature was raised to thermoneutrality (33 degrees C). The final experiment demonstrated that amphetamine restricted the range of surrogate stimuli that elicited huddling in the preweanling rat. The finding that amphetamine produces a steeper generalization gradient of approach to surrogate stimuli further confirms our previous hypothesis that amphetamine canalizes arousal toward salient environmental stimuli. These findings have implications for the use of amphetamines to treat hyperkinetic children.

Urinary excretion of catecholamine metabolites in hyperkinetic child syndrome.

Urinary excretion of catecholamine metabolites in hyperkinetic child syndrome.

Autonomic arousal in hyperkinetic children

Autonomic arousal in hyperkinetic children

Effects of play therapy on hyperkinetic children with psychomotor epilepsy.

Summary The hyperkinetic or restless behavior disorders improved remarkably in five of 11 cases. These five cases, involving the subjects who are now over 15 years of age, did not have any symptom for five years after psychotherapy. The other four cases became less hyperkinetic and their school adjustments were moderately above average. But they are slightly asthenic or occasionally violent to their families. The symptoms of the two cases were unchanged and the psychotherapy was stopped. The seizures occurred during psychotherapy in six cases of which three cases improved psychologically and two cases became less hyperkinetic and one case unchanged. The last case still suffers from psychomotor seizures.

Growth Disturbances in Hyperkinetic Children

Roche et al (Pediatrics 63:847, 1979) have provided a good clinical review of recent data on stimulant-induced growth disturbances in hyperkinetic children. They have clearly shown that substantial differences exist among published studies in methodology used, drug dosages employed, and measurement techniques cited. The clinician in the field needs this type of review to clarify the confusing reports on stimulant side effects. We wish to make two points. The authors might have stressed that the stimulant drugs available may have differential growth suppression effects.

Intratask distractibility in hyperkinetic and nonhyperkinetic children

Previous laboratory studies that have either introduced extraneous enviromental stimulation or tested children in cubicles have failed to provide support for the common clinical notion that hyperkinetic children are highly distractible. Based on the Rosenthal and Allen (1978) proposal, distractibility was investigated by introducing irrelevant information within the task context. Intratask distractibility was examined by comparing the performance of hyperkinetic and nonhyperkinetic children on a speeded classification task. Errors measured for responses to slides containing either zero, constant, one varying, or two varying irrelevant stimulus dimensions. Dimensional salience of the three dimensions used in the study was measured for each child. The data indicate that hyperkinetics made more errors than nonhyperkinetics when constant irrelevant or two varying irrelevant dimensions were presented, but the two groups made equal errors when there was no irrelevant information presented within the stimulus array. No group differences in distractibility were found when the irrelevant dimension was low salience. It was concluded that salience of distractors presented within the task context may be useful in specifying the particular task conditions in which hyperkinetic children exhibit high distractibility.

Hyperkinetic syndrome and diet--a therapeutic alliance? (author's transl)

The international literature on dietary treatment of the hyperkinetic syndrome is reported and analyzed critically. So far there is no sufficient scientific evidence in favour of this therapeutic intervention with hyperkinetic children.

Abnormal eye movements in hyperkinetic children with learning disability.

Eye movements were studied in 29 school children aged 6--12 years diagnosed as having Hyperactivity (HA) with Learning Disabilities (LD) and compared to an age matched control group of 32 children. The children had to track a moving target on a metronome and a canopy, to maintain eye fixation on a stationary target and to read a standard reading material. Accuracy, nystagmoid, reversal and overshoot movements were observed, as well as head movements and blinks. Persistence and deviations were monitored during fixation; duration, accuracy, number of fixations and reversals were monitored during reading. The tracking accuracy and fixation persistence were significantly inferior in the HA-LD children as compared to the control group in most items. This correlated well with the inferior performance on the reading task. This study supports the hypothesis that children with MBD and learning disabilities have primary defects in the motor control of eye movements which contribute significantly to their reading difficulties.

Pharmacokinetics of methylphenidate in hyperkinetic children.

1 Pharmacokinetic study has been carried out following oral administration of 10-20 mg of methylphenidate hydrochloride to four behaviorally disorders children. 2 It is indicated that the drug is metabolized to ritalinic acid with an apparent plasma half life of 2.5 h. 3 The variability in magnitude of plasma concentration seems to be due not to its metabolism to ritalinic acid but due to the variability in the apparent volume of distribution. 4 The brief half life of methylphenidate which parallels the short duration of action of methylphenidate in behaviorally disordered children may be explained in part by its low protein binding which results in high percentage of free drug being made available for metabolism to pharmacologically inactive metabolites.

THE HYPERKINETIC CHILD AND SOCIETY

HYPERKINESISThis article examines the behavioural “hyperkinetic child” syndrome. Historically there is confusion as to a precise definition of the syndrome and little epidemiological work has been carried out with a view to removing this confusion.The behavioural symptoms, as they have been identified, are examined for the ages infancy through to adulthood. It is apparent that in these areas alone there is a great need for research to be carried out before a comprehensive list of symptoms can be achieved.There appears to be four categories of etiological influence, each of these is examined in turn. The author, given that not one of these influences predominates, suggests that the etiology may be either multifactor or interactive or both.One major area in which the literature is lacking is in respect of the hyperkinetic adult. What is the behaviour of these people? Do they adjust to the disability? Questions such as these and many others still remain unanswered.

Methylphenidate in Hyperkinetic Children: Differences in Dose Effects on Impulsive Behavior

This research tested the hypothesis that in hyperactive children a low dose of methylphenidate (0.3 mg/kg) would produce scores superior to those with a high dose (1.0 mg/kg) or placebo on the matching familiar figures test (MFF), a primary index of impulsivity. The hypothesis was based on an earlier finding that the highest percentage of correct responses on a short-term memory task were found in hyperactive subjects who were receiving 0.3 mg/kg of methylphenidate whereas at 1.0 mg/kg the percentage correct returned to the placebo level. The hypothesis was verified in that the low dose reduced the number of errors on the MFF significantly more than did placebo or the high dose. This work demonstrates that, for both learning and impulsivity in hyperactive children, the lower dose of the two doses of methylphenidate studied produced the preferable effect.