Behavior Therapy and Withdrawal of Stimulant Medication in Hyperactive Children

Abstract

Psychopharmacological intervention has been the most frequent treatment for hyperactive children for two decades. Recent estimates suggest that approximately 2% of all U.S. elementary schoolchildren are receiving psychostimulant medication for hyperactivity.¹ Dextroamphetamine sulfate (Dexedrine) and methylphenidate (Ritalin) hydrochloride are the most frequently administered psychostimulant medications. The efficacy of these drugs in changing teacher ratings of hyperactivity and improving sustained attention has been well established.²

Despite the consistency of salutary effects of stimulants on hyperactive children in school settings, the exclusive reliance on drug treatment has been questioned repeatedly.^3-5 The concern stems from several sources. First, such treatment appears to have no long-term effect on academic achievement.^6,7 Second, such treatment does not appear to be associated with long-term amelioration of social problems.⁷ Third, increases in heart rate and blood pressure have been observed,⁸ and decreases in the rate of height and weight gains have been found in some studies.⁴ Although the decrease in weight gain in probably reversible, the same may not be true of the decrease in height gains. Fourth, the child's attribution of his behavior change to the medication may have deleterious long-range effects. The child may learn that the only way to control his behavior is to take a pill.⁹ Fifth, because of the anorexic and insomnious effects of the stimulant medications, they are usually not administered in the late afternoon. Since the effects of the medication last only three to five hours, change in the children's behavior at home is often not observed.¹⁰ Thus, the parents whose children are given medication without psychological consultation are often faced with serious problems at home.