Naturalistic Assessment of Neurological Diagnoses and Pharmacological Intervention

Abstract

There is sufficient reason to believe that drugs are inappropriately prescribed for and used by children who demonstrate learning and behavioral problems. The shortcomings of an exclusively medical or clinical approach to the administration and supervision of drug therapy are discussed. To insure precautions in the prescription and surveillance of drug treatment, certain minimal standards are proposed: (1) translation of the clinical diagnosis into measurable naturalistic behaviors; (2) collection of data by parents and teachers on behaviors to determine severity of the syndrome; (3) situational validation or disconfirmation of the clinical diagnosis; and (4) when indicated, formative assessment of drug treatment. The use of these four standards is illustrated with a preschooler who was scheduled for drug treatment. Resulting data permitted reconsideration of the clinical diagnosis and preempting of drug treatment.

Communication Between Professionals Concerning Medication for the Hyperactive Child

“…The results of this investigation also indicate no system of feedback from teacher to nurse. This information is even more critical in light of recent suggestions (Neisworth, Kurtz, Ross, & Madle 1976) that minimal standards for drug therapy should include data collection by teachers in the environment of the classroom.…”

Practical Considerations in Conducting School-Based Medication Evaluations for Children with Hyperactivity

“…These models for assessing drug response were developed primarily for specialized clinics, and with the exception of obtaining behavior rating scales from teachers (their one common feature), have not incorporated a high degree of school involvement in the assessment procedure, although there are some exceptions (e.g., Gadow et al, 1991;Neisworth et al, 1976;Slimmer & Brown, 1985). Further, they vary greatly with regard to the use of placebos, doses and schedules of medication, measures of therapeutic drug response and side effects, and their implicit rationales for treatment, all of which makes comparisons extremely difficult.…”