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Sedatives ABSTRACT Reviewed on a Layman'slevel Was Research on Psychopharmacology with Theemotionally and Behaviorallydisturbed

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Sedatives ABSTRACT Reviewed on a Layman'slevel Was Research on Psychopharmacology with Theemotionally and Behaviorallydisturbed DOCUMENTRESUME EC 041 170 ED 058 694 McClain, William A.; Jerman,George AUTHOR Behaviorally Disturbed: A TITLE Psychopharmacology with the Review. Childrens Center, Laurel,Md.; INSTITUTION District of Columbia Howard County Board ofEducation, Clarksville,Md. PUB DATE [7 0] NOTE 39p. PRICE MF-$0.65 HC-$3.29 EDRS Therapy; *Emotionally DESCRIPTORS *Behavior Problems; *Drug Disturbed; *ExceptionalChild Research; *Research Reviews(Publications);Sedatives ABSTRACT Reviewed on a layman'slevel was research on psychopharmacology with theemotionally and behaviorallydisturbed. that the effect General conclusions drawnfrom the man y studies were functioning had not beendetermined and that of drugs on intellectual the learning process was there was littleevidence to indicate that consistently and reliablyaffected in certainpredictable ways. It informed when a subject was was advised thatthe psychologist be receiving drug medication,the drug name, anddosage. The review tranquilizers, and sedativesfrequently used by concerned stimulants, included pediatricians. Stimulantsreferred to in research dextroamphetamine, D-amphetamine,methylphenidate, rnonoaminoxidase inhibitors, amitriptyline,proamitriptyline, and cholinergics; methylphenidate was the drugused most often.Tranquilizers cited were thioridazine,chlorpromazine, reserpine,phenothiazines, hydrochloride, chlorprothixene diphenylmethanes, fluphenazine drugs hydrochloride, primazinehydrochloride, and thiorpropazate; advisable treatment forbehaviorally disordered were found to be an sodium and children. Sedatives coveredincluded diphenylhydantoin captodiamine hydrochloride. (CB) TiWjUPHARMACOLOG/ KTHaHE BEHAVICRALLYDISTUEBED: A -Et.TIEVI William A. McClain,Ph.D. .Counseliwr Psychologist D. C. Children'sCenter Laurel, Maryland 20810 Georse Jerman, M.Ed. Schcol Psychologist Howard County Board ofEducation Clarksville, Maryland U.S. DEPARTMENT OF HEALTH, EDUCATION & WELFARE OFFICE OF EDUCATION THIS DOCUMENT HAS BEEN REPRO. DUCE() EXACTLY AS RECEIVED FROM THE PERSON OR ORGANIZATION ORIG- INATING IT. POINTS OF VIEW OR OPIN IONS STATED DO NOT NECESSARILY REPRESENT OFFICIAL OFFICE OF EDU- CATION POSITION OR POLICY. I. INTROLUCTION Treatment for behaviorallydisordered children can be separated into three generalcategories: psychotherapy, milieu or environmentaltherapy, end chemotherapy. It is this latter group that isexplored in this paper. The paper originated fromthe writere' interest over the increasimc number ofchildren found in both thepublic schools and Institutionswho were receiving orhad recently been receiving some kindof internal medication of adrug form. Many reasons could beoffered to account forthis state of affairs. Several of the moreimportant ones include: samples supplied to 1. Overabundance of pomplimentary physicians by pharmaceuticalhouses make prescriptionof same a very.convenientchoice. workers, adequate pro6rams, 2. Shortages of mental health and child specialists havecreated "time" premiumsand priorities. In short, when case loadsbecome excessively large,and the demand, for long or shortterm therapy, althoughneeded, cannot "better than be provided, chemotherapyis sometimes used as a nothing" technique. Frequently, too, prescribersof drugs are not fullycognizant of the emotionalreferents underlying a problem. What occurs is treatmentof the major physical 2 the true emotional symptom(s), at the expenseof neglecting pathOlogy under1yine3 thesymptom(s). 3 Psychologicalpredispositions anddependencies instantaneous and existing in ourculture that aim for therapies may require a impulsive cures. Where traditional becomes overtly large number ofsessions before progress known phenomena of apatient visible, in additionto the well before gettingbetter, the characteristicallybecoming worse typically creates an use of drugs,in contradistinction, This occurrencebecomes a immediate diminuationof symptoms. and the doctorsuch that when reinforcer forteachers, parents, student or child success in drugtherapy is found for one to other there are oftenheard clamors forits dissemination of different students and children,frequently irrespective reflected by recentarticles behavior problems. The press, as television media to a in popular newsperiodicals, and the popularized to their lesser extent have,in many instances, results" of certaindrugs respective audiencesthe "miracle Likewise, apsychological in remediatingbehavior. problems; parcel of set to takemedication when"sick" is part and American tradition. to be an exhaustive 'These factors arenot meant in any way rather serve as astarting or mutuallyexclusive list, but specialists to add point for hiEhlightingthe need for child 3 3 to their professionalarmamentarium of skills. Nor are the writers questioning thelegitimacy of such prescriptions after careful study of theproblem, other alternatives, and in,consultation with a professionalteam. Rather, emphasis is placed on suggestingthat if drug therapy continues to increase in popularity asthe treatment of choice, then definite implications emergefor the role and functionof the psychologist. In short, he will needto be minimally conversant in the basicterminology of psychopharmacology, and to some degree beable te assess theanticipated effects, purposes, advantagesand disadvantages of aparticular drug in relation to thelearning process. This dissemination of factual information andconsultation may occur with aphysictan, a teacher,and/or parent. As a member of apsychological services team he may onoccasion even initiatereferrals for possible drug therapy, orsuggest other, more efficient alternatives in its place.. Review of the availableresearch did produce anumber of sources thatdescribed the drugs andtheir observed effects that are in present usefor treating disturbedand. socially disordered youngsters. Although far short of acomprehensive reView of chemotherapeutic agentsfor psychiatric disorders, a numberof'studies are reportedthat deal with many of the drugs that are inregular pediatric usageand that have been encountered frequently by thewriters. L. This review is organized in the threegeneral drug classes: stimulants, tranquilizers, and sedatives. It appears that this arrangement give greatestconsideration to presenting studies in an order that allows somecomparison of their respective behavioral effects. The drugs have been referred to by their generic or chemical namesin this treatment. To facilitate brandnaMe associations and to encourage continued reference to this work, a table isincluded that lists the generic name alphabetically accordingto general drug groups. This name is followed by thebetter known brand or trade name of the drug. All efforts have been made toreduce the technical aspects of this scientific field to aminlmum so that drug therapy can be understood on afp.irly basic level. For this reason little mention is made ofphysiological or anatomical effects. Certainly the behavioral elements give Usenough concern to warrantcentering this investigation there. 5 STIMULANTS It has been knoim for some yearsthat stimulant drugs, such asdextroemphe.tamine, may have a beneficial effect onschool performance of hyperkinetic oremotionally disturbed children (Bradley, 1937). Children treated with thesestimulants rarely be:lome excited, butrather tend to become more calm, purposeful, and organized intheir behavior. In some children the alteration in behaviorhas been described as truly remarkable. Side effects -- other thanmild anorexia and insomnia -- are rare, andthese tend to diminish inmost children, even with highdosage of.the medication(Bradley, 1951; Bradley, 1958). A recent study appearsto lend strong support toclaims that this drug action has itsmain behavioral effect on increaSing drive level and response vigorin children. Fifty-eight children from a publicschool system, who had been selected by teachers ashaving serious learningproblems, were randomly assignedto two groups. One group received a daily treatment of'dextroamphetamine, the other amatched placebo for onemonth. At the end of this time,the treatments were switched. All treatments weredouble-blind. Measures obtained by .of intellectual performanceand ar,sertiveness were objective, factor analyzedtest measures. Teachers also rated 6 The results after eachtreatment. the childrenbefore and performance andclassroom indicated thatimproved school the objectivetest changes behavior wassubstantial, but (Connors et.al.,1967). werequestionable discussed someadditional changes Solomons(2965) has therapy andcites loss of produced bydextroamphetamine interference withsleep activity, appetite,restlessness and and nervousnessafter pale and sallowfacial appearances, certain kindsof activities. D-Amphetaminewith other Zrull et.al.,(1963) compared 7 to 14 ofoverall average drugs. Sixteen children ages medications in adouble-blind, intelligencereceived three eight-week period. A battery of cross-oyerpattern for an and teachersand medicalpeople, tests, ratingsby parents physical changeswereanalyzed. and laboratoryfindings of all children werenoted and Considerableimprovements in children. The D-Amphetamine continued tosustain in some chlordiazepoxide inthe was judged moreeffective than the hyperkineticsyndrome. reduction ofmanifestations of significantly moreeffective than Bothdrugs.appeared to be the placebo. successfully usedat times Amphetamines havealso been been in usefor behavior. They have in modifyinghyperactive 1930) in thetreatment of many years(since approximately (Bradley, 1958;Denhoff, 1961; brain dnmagebehavior symptoms
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