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To the Editor.—
As a child psychiatrist, I was surprised to note that the article by Sleator et al (229:316, 1974) seemed written solely from the pharmacologic-behavioral standpoint. It has been my experience that very few youngsters are afflicted with a hyperkinetic syndrome free of psychiatric problems. This crucial issue was ignored in the article.The article described a group of 26% of the youngsters in the study who experienced remission and no longer needed medication. The reader had no way of knowing how many of these youngsters underwent remission when psychiatric stress was removed. They may represent potentially symptomatic children who become symptomatic only under stress. They may represent a group whose biochemical immaturity is short-lived. They may constitute a group in which neurochemical defect is corrected permanently by methylphenidate. Or, also, they may represent a group whose symptomatology was almost entirely psychiatric in origin and which cleared
Ament A. Treatment of Hyperactive Children. JAMA. 1974;230(3):372. doi:10.1001/jama.1974.03240030014005