Motor timing deficits in community and clinical boys with hyperactive behavior: the effect of methylphenidate on motor timing

In a previous paper we showed that community children with hyperactive behavior were more inconsistent than controls in the temporal organization of their motor output. In this study we investigated: (1) various aspects of motor timing processes in 13 clinically diagnosed boys with attention deficit hyperactivity disorder (ADHD) who were compared to 11 community boys with hyperactive behavior and to a control group and (2) the effect of methylphenidate on the motor timing processes in the clinical group with ADHD in a double blind, cross-over, medication-placebo design, including 4 weeks of medication. The clinical group with ADHD, like the community group with hyperactivity, showed greater variability in sensorimotor synchronization and in sensorimotor anticipation relative to controls. The clinical group was also impaired in time perception, which was spared in the community group with hyperactivity. The persistent, but not the acute dose, of methylphenidate reduced the variability of sensorimotor synchronization and anticipation, but had no effect on time perception. This study shows that motor timing functions are impaired in both clinical and community children with hyperactivity. It is the first study to show the effectiveness of persistent administration of methylphenidate on deficits in motor timing in ADHD children and extends the use of methylphenidate from the domain of attentional and inhibitory functions to the domain of executive motor timing.     

Relative efficacy of methylphenidate and behavior modification in hyperkinetic children: An interim report

Children reported to be hyperactive in school and with behavior difficulties at home were randomly assigned to methylphenidate, behavior therapy and placebo, or behavior therapy with methylphenidate for an 8-week period. Rating scales were obtained from teachers and parents. Independent blind observers rated childrens' classroom behavior on a weekly basis. A behavior therapy program was implemented in the home and at school. Methylphenidate dosage was individualized. Ratings of behavior deviance were significantly reduced by all treatments. However, a significant advantage for the groups receiving methylphenidate was found over the group receiving behavior therapy and placebo. No significant differences between methylphenidate alone and methylphenidate combined with behavior therapy were obtained. Global ratings of improvement done by teachers favored the combined treatment of behavior therapy and methylphenidate over behavior therapy and placebo. No differences among treatments were found in the mothers' global ratings of improvement. The results indicate that though all three treatments were effective, methylphenidate was significantly superior to behavior therapy alone.This study was supported in part by grant MH 18579, and by grant No. 3-621 from the Long Island Jewish-Hillside Medical Center. The authors wish to thank the behavior therapists, Drs. Jeffrey Felixbrod and Marion Pheterson, as well as Ms. Patricia Ramsey, who was responsible for data analysis.     

Behavioral effects of caffeine, methamphetamine, and methylphenidate in the rat

It was possible to distinguish three closely-related psychomotor stimulants, caffeine, methamphetamine, and methylphenidate, by means of two operant behavior procedures, fixed interval and fixed number. Under the fixed interval procedure, the percentage change in the number of R_Bs per reinforcement was significantly smaller with caffeine than with methamphetamine or methylphenidate (p < .001). Under the fixed number procedure, the percentage change was significantly smaller with methamphetamine than with caffeine or methylphenidate (p < .001). Thus, methylphenidate had a methamphetamine-like effect under fixed interval and a caffeine-like effect under fixed number.     

BEHAVIORAL AND STIMULANT TREATMENT OF HYPERACTIVE CHILDREN: A THERAPY STUDY WITH METHYLPHENIDATE PROBES IN A WITHIN-SUBJECT DESIGN

Eight hyperactive children were treated with a behavioral intervention focusing on teacher and parent training over a period of 5 months. Three times, before therapy and after 3 weeks and 13 weeks of intervention, children received methylphenidate during 3-week probe periods. Each week in a probe they received either a placebo, .25 mg/kg, or .75 mg/kg methylphenidate. Classroom observations of on-task behavior suggested that effectiveness of the behavioral intervention was between that of the two dosages of medication before therapy. Both dosages resulted in higher levels of on-task behavior when administered after 13 weeks of behavioral intervention than when administered before therapy. Teacher rating data showed equivalent effects of therapy and the low dosage of methylphenidate alone but a stronger effect of the high dose alone; only the high dose resulted in improved behavior after 13 weeks of behavioral intervention. As a group, only when they received the high dose of methylphenidate after 13 weeks of behavioral intervention did children reach the level of appropriate behavior shown by nonhyperactive controls. However, this level was also reached by two children with the low dose and by one child without medication, and it was not reached by one child. The results suggest that the combination of psychostimulant medication and behavior therapy may be more effective in the short-term than either treatment alone for hyperactive children in school settings. In addition, parent ratings and clinic observation of parent-child interactions suggested that children had improved in the home setting, highlighting the importance of behavioral parent training in the treatment of hyperactivity.     

A PRELIMINARY ANALYSIS OF INTERACTIVE EFFECTS BETWEEN COMMON CLASSROOM CONTINGENCIES AND METHYLPHENIDATE

To assess the drug—behavior interaction effects with an 8-year-old boy with attention deficit hyperactivity disorder, common classroom antecedent (e.g., seating arrangement) and consequent (e.g., peer prompts) stimuli were alternated within a school day while drug conditions (methylphenidate vs. placebo) were alternated across days. The results suggested that peer attention maintained disruptive behavior when methylphenidate was absent but not when it was present.     

The effects of methylphenidate on a functional analysis of disruptive behavior: a replication and extension

In the present investigation, a functional analysis of the disruptive behavior of a 18-year-old man who had been diagnosed with attention deficit hyperactivity disorder and moderate mental retardation was conducted, both when he was taking methylphenidate and when he was not taking the medication. The results of this functional analysis demonstrated that the participant's disruptive behaviors were reinforced by access to attention only when he was not taking methylphenidate.     

Psychoactive drug effects in a hyperactive child: A case study analysis of behavior change and teacher attention

The effects of methylphenidate on the behavior and teacher interactions of a 9-year-old hyperactive female were analyzed. Observations of the subject's task-related and disruptive behaviors and of interactions between the subject and her classroom teacher were made when the subject received the active drug and an inert placebo. Teacher's ratings of the subject's classroom behavior and measures of her academic performance were also obtained. Results showed that when the subject was receiving methylphenidate she engaged in task-related activities a greater percent of the time, had a higher percent of teacher interactions that were instructional in quality, and received lower behavior ratings by the teacher than when she was receiving a placebo. The results suggest that the use of medication may enable the hyperactive child to profit both behaviorally and academically.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

The normalizing effects of methylphenidate on the classroom behavior of ADDH children

This study examined whether methylphenidate normalizes the behavior of hyperactive children (ADDH). Twenty-eight ADDH children were treated for 8 weeks with a mean dose of 41.5 mg/d of methylphenidate. Their classroom behavior and that of normal children was recorded by observers who were blind to diagnosis and treatment. Before treatment, all measures significantly differentiated the ADDH and normal children. After treatment, the two groups were indistinguishable on measures of gross and minor motor movement, noncompliance, interference, and overall hyperactivity. ADDH children were significantly improved on measures of attention but continued to be significantly less attentive. In many ways, the ADDH children were not only improved but indistinguishable from their normal peers.This paper was supported by NIMH grants 30822 and 18579. We gratefully acknowledge the assistance of Beth Landa, Ph.D., who performed the statistical analyses.     

A RAPID METHOD FOR EVALUATING THE NECESSITY FOR BOTH A BEHAVIORAL INTERVENTION AND METHYLPHENIDATE

We examined the effects of a behavioral intervention and methylphenidate (MPH) on inappropriate behavior and sleep disturbance displayed by a 6-year-old boy who had been diagnosed with attention deficit hyperactivity disorder. Results showed that the behavioral intervention was effective in reducing inappropriate behaviors to near-zero levels regardless of the presence or absence of MPH.     

The spontaneously hypertensive rat as an animal model of attention-deficit hyperactivity disorder: effects of methylphenidate on exploratory behavior

Spontaneously hypertensive rats (SHR) show a pervasive hyperactivity in several paradigms. Thus, these rats may be used as an animal model of childhood hyperactivity also called Attention-Deficit Hyperactivity Disorder. This disorder is frequently treated with psychomotor stimulant drugs, but little is known about the effects of such drugs on behavior. The present study investigated the behavioral effects of 1-24 mg/kg methylphenidate (Ritalin) on the exploratory behavior of male SHR and Wistar-Kyoto control rats (WKY) in a two-compartment free-exploration open field. Except following very high doses. SHR spent most of the session time in the field while WKY stayed in the home cage. Low and medium doses were followed by increased activity in the field for SHR and increased activity in the cage for WKY. The response-stimulatory effects of low to medium doses of methylphenidate are less in SHR than in WKY. Starting at medium doses, activity decreased and stereotyped behavior increased progressively by increasing dose. Locomotor activity in the field decreased following lower doses than locomotor activity in the cage, and vertical activity (rearing) was reduced by lower doses than horizontal activity (crossing). The following conclusions were drawn. (i) There is no "paradoxical" inhibition of SHR hyperactivity following methylphenidate. On the contrary, SHR activity is in fact stimulated, albeit to a lesser degree than that of WKY. (ii) The stimulatory effects of low to medium doses are, in general, most pronounced for the kind of exploratory behavior most frequently used by the rat during baseline conditions. (iii) Rearing might be more susceptible to adverse effects of methylphenidate than ambulation.     

RITALIN VS. RESPONSE COST IN THE CONTROL OF HYPERACTIVE CHILDREN: A WITHIN-SUBJECT COMPARISON

A within-subject comparison was made of the effects of methylphenidate (Ritalin) and response cost in reducing the off-task behavior of two boys, 7 and 8 years of age, who had been diagnosed as having an attentional deficit disorder with hyperactivity. Several dosages of Ritalin (5 to 20 mg/day) were evaluated with the results indicating varying effects of the drug for both children. Response cost (with free-time as the reinforcer) was superior to Ritalin in raising levels of on-task behavior and in improving academic performance.     

Effects of methylphenidate on kinematic aspects of handwriting in hyperactive boys

Poor handwriting in hyperactive children often contributes to academic failure. Beneficial effects of methylphenidate on the quality of handwriting have been shown. Using a digitizing tablet, the handwriting of 21 hyperactive boys was examined both during methylphenidate treatment and following withdrawal of the drug. Half of the hyperactive boys were tested first on methylphenidate and then following withdrawal of the drug and the remaining hyperactive boys were examined in the reverse order. Twenty-one control boys underwent the same examination. Velocity and acceleration of handwriting movements were measured. Furthermore, every writing specimen was independently rated by four examiners regarding the quality of handwriting. Following withdrawal of the drug, the quality of handwriting specimens of hyperactive boys was poorer than during treatment with methylphenidate. Statistical comparison of writing movements of hyperactive boys on and off methylphenidate revealed that the medication resulted in a deterioration in handwriting fluency. The results showed that following withdrawal of medication, hyperactive children did not differ from control boys in handwriting movements. The improvement in hyperactive behavior through methylphenidate was associated with increased legibility and greater accuracy of handwriting. The intention to write neatly may interfere with the fluent writing process.     

Sequential evaluation of behavioral treatments and methylphenidate dosage for children with attention deficit hyperactivity disorder

We used a sequential approach to evaluate the relative and combined effects of different types of behavioral treatments, as well as dosage of methylphenidate (MPH), on the disruptive behavior of 3 students who had been diagnosed with attention deficit hyperactivity disorder. Results showed that individualized behavioral treatments produced decreases in disruptive behavior equivalent to MPH for all 3 participants and demonstrated the need to evaluate behavioral treatments and medication dosage on an individual basis.     

Some effects of methylphenidate on stimulus control of ratio avoidance behavior in the rat

After exposure to an avoidance schedule which included a warning signal, a rat was placed on a multiple schedule in which the first component was the same as before, i.e., a single response reset the response-shock interval, delaying shock, and the second component differed only in that four bar-presses were required to postpone shock. A fixed ratio requirement of four responses (FR 4) generated behavior resembling a fixed ratio requirement of one response (FR 1) since responding was controlled by the warning signal but more shocks were received. At a dosage of 2 mg/kg, methylphenidate given intraperitoneally decreased shock frequency during FR 4 periods while FR 1 behavior was not affected; at 4 mg/kg, stimulus control of avoidance responding was impaired during both components. Results at 4 mg/kg were partially confirmed by two animals exposed to an FR 4 avoidance schedule which included a warning signal but with different parameters. Response distributions showed that methylphenidate increased response rates in the absence of the warning signal, i.e., stimulus control of ratio-avoidance behavior was impaired although the increased response rates reduced shock frequency. One hour later responses again occurred more frequently during the signal than in its absence but shocks were less frequent than during control (non-drug) periods.     

Religiosity and obsessive-compulsive behavior in Israeli Jews

Individual differences in obsessive-compulsive (OC) behavior in various cultures correlate with religiosity. The current paper explored the so far unstudied relationship between religiosity and OC behavior in Israeli Jews. Two studies were conducted. Study 1 focused on the relationship between religiosity and OC behavior in a representative sample of Israeli students. Study 2 focused on religious change and OC behavior in a non-random sample of 31 individuals who had become more religious (the MR group), and 30 individuals who were less religious (the LR group) than their parents. Instruments used were the Maudsley obsessive-compulsive inventory (MOCI), the student religiosity questionnaire, and questions about parental home observance, upbringing, and changes in religiosity. In the first study, no association was found between religiosity and OC behavior. Religiosity was related to some degree to perfectionism and to the parental attitude to upbringing. In the second study, a significant difference was observed between the MR and the LR groups on OC behavior as measured by the MOCI. Conclusion, among Israeli Jews a lot of religious observance is non-reflective, and is not associated with individual differences in personality or OC symptoms. Those who undergo religious change may do so in response to their behavioral propensities. One such path is that the more OC become MR, and the less OC less religiously observant.     

Hoarding in obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study

Hoarding behavior occurs frequently in obsessive-compulsive disorder (OCD). Results from previous studies suggest that individuals with OCD who have hoarding symptoms are clinically different than non-hoarders and may represent a distinct clinical group. In the present study, we compared 235 hoarding to 389 non-hoarding participants, all of whom had OCD, collected in the course of the OCD Collaborative Genetics Study. We found that, compared to non-hoarding individuals, hoarders were more likely to have symmetry obsessions and repeating, counting, and ordering compulsions; poorer insight; more severe illness; difficulty initiating or completing tasks; and indecision. Hoarders had a greater prevalence of social phobia and generalized anxiety disorder. Hoarders also had a greater prevalence of obsessive-compulsive and dependent personality disorders. Five personality traits were independently associated with hoarding: miserliness, preoccupation with details, difficulty making decisions, odd behavior or appearance, and magical thinking. Hoarding and indecision were more prevalent in the relatives of hoarding than of non-hoarding probands. Hoarding in relatives was associated with indecision in probands, independently of proband hoarding status. The findings suggest that hoarding behavior may help differentiate a distinct clinical subgroup of people with OCD and may aggregate in some OCD families. Indecision may be a risk factor for hoarding in these families.     

Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder--particularly those living in rural areas--do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.     

An evaluation of methylphenidate as a potential establishing operation for some common classroom reinforcers.

We conducted reinforcer assessments for 3 boys with a diagnosis of attention deficit hyperactivity disorder who alternately received either placebo or previously prescribed methylphenidate. Our purpose was to evaluate whether methylphenidate altered the relative reinforcing effectiveness of various stimuli that are often used in classroom-based behavioral treatment programs (e.g., activities, tangible items). Results showed clear differences for some stimuli between reinforcer assessments conducted when participants had received methylphenidate compared to placebo. Results suggest that methylphenidate might act as an establishing operation for some common classroom reinforcers. Implications for the development and evaluation of behavioral treatments are discussed.     

Telephone-Administered Cognitive Behavior Therapy for Obsessive-Compulsive Disorder

Exposure with response prevention and cognitive behavior therapy are widely recognized as effective treatments for obsessive-compulsive disorder. Unfortunately, many people with obsessive-compulsive disorder - particularly those living in rural areas - do not have access to therapists providing these treatments. Accordingly, we investigated the efficacy of telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Two open trials are reported, for a total of 33 people with obsessive-compulsive disorder (without major depression). The first trial consisted of 12 weeks on a waiting list followed by 12 weeks of treatment (delayed treatment). The second trial consisted of 12 weeks of immediate treatment. Obsessive-compulsive symptoms did not change during the waiting period. Symptoms declined from pre- to post-treatment, with gains maintained at 12-week follow-up. For the pooled sample our pre-to-post-treatment effect size was as large or larger than those obtained in other studies of reduced contact treatment, and similar to those of face-to-face exposure with response prevention. Our proportion of treatment dropouts tended to be lower than those of other reduced contact interventions. The results suggest that telephone-administered cognitive behavior therapy is effective and well-tolerated, at least for people with obsessive-compulsive disorder without major depression. It remains to be seen whether this treatment is safe and effective when comorbid major depression is present.