Stimulant drug therapy in control of on-task behavior: a case study.

Summary.-Stimulant drugs are often prescribed for the control of hyperactive behavior in the classroom without objective measurement of actual effects of the drug for a particular child in the school environment. This paper outlines a simple procedure for school personnel to measure actual effects. While the use of stimulant drugs such as methylphenidate (Ritalin) for the treatment of hyperactivity in children is common in the United States, the present assessment of the value of this treatment (1, 2) suggcsts that much more research is needed before unequivocal positive recommendations for drug treatment of these cases can be made. Concerns are possible side effects from extended use and a determination of acrual effectiveness on classroom behavior. The latter is of concern here. Ross and Ross (2) argue particularly for objective, in-classroom, double-blind assessments of behavior to determine whether the drugs have real merit in improving classroom behavior and academic achievement. Baxley and LeBlanc (1) argue that there is a real need for individual analysis of drug effects to isolate idiosyncratic styles and response patterns. It seems that behavioral assessment in class of each child placed on stimulant drug therapy would be warranted to determine whether there were objective improvements and whether these outweighed the disadvantages of use. This report presents one such attempt to make classroom observation to evaluate the effectiveness of srimulant drug therapy. The child was an 8-yr.-old male in the third grade of a suburban public elementary school. The child had been receiving Ritalin for several months, but his mother had stopped giving the drug, claiming no effect. School personnel, who had recommended the mother have the child placed on the drug originally, claimed that this drug had been helping the child; they felr char the child's behavior had become less acceptable when the drug therapy was suspended. I offered to make a behavioral assessment on the condition chat the child would receive the drug on some days but not others so that I could observe the child's behavior both with and without the drug. Arrangements were made so that I could observe the child for an entire day during which the drug was not given, and then on four subsequent occasions. On two of these four days, the child was to have taken the drug and on two others a placebo. The observer (this author), the teacher, the child. and. the mother were all unaware of the experimental condition while they interacted with the child. The mother selected a packet of capsules for an entire week from a third party who knew nothing of the experiment except that he was to make up the packets, record the week each was used, and seal the identities of the packets in an envelope until the observations were complete. Behavioral assessments were made according to a code devised by Arthur L Robin.' A rating was made every 30 sec. with 20 sec. for observation and 10 sec. for recording. The child's behavior was classified into one of five categories, with only one rating per interval. Only the frequency of occurrence of one rating-academic behavior-which was made only if the child maintained on-task behavior throughour the 20-sec. interval is reported. Observations were conducted during the entire school day on the initial school day, but during the experimental sessions the observations lasted between 45 and 75 min. The first two sessions, done a week apart, were of a reading lesson. The second two sessions,