Hyperkinesis revisited

Abstract

Four decades after Bradley's introduction of amphetamines for the treatment of childhood behavior disorders¹ and two decades after the confirmation of his clinical observations by placebo-controlled trials, there is an ongoing debate about the effectiveness of stimulants, the indications for their use, whether hyperkinetic behavior disorder is a syndrome, and what inferences can be made about its cause. The paradigm of the double-blind trial was correct as far as it went, but it has become evident that it did not go far enough; that is, there is no reason to doubt the repeated demonstration of symptomatic benefit in the four to eight weeks of experimental studies, but investigators were slow to appreciate the long-term nature of the clinical problem.