The effects of methylphenidate on the handwriting of children with minimal brain dysfunction.

Fifty children with minimal brain dysfunction who had handwriting deficits received methylphenidate or placebo under double-blind conditions. Twenty-six children (52%) showed improvement in hand-writing following treatment with methylphenidate for four weeks. One child receiving placebo had improvement in handwriting, but his handwriting improved further after he was switched to methylphenidate. In general, handwriting tended to deteriorate promptly when drug treatment was discontinued. Thirty-six patients (72%) receiving methylphenidate for four weeks were rated behaviorally improved by teachers; in contrast, seven children (14%) showed behavioral improvement following treatment with placebo. Improvement in attention and behavior, which was ascertained by the use of Conners' Abbreviated Teacher Rating Scale, did not always correspond with improvement in handwriting. Advances in handwriting skills following treatment with methylphenidate may have been directly related to improvement in fine motor coordination. Gains in handwriting were maintained for up to 26 months of follow-up in 21 children who received methylphenidate on a long-term basis.

The effects of methylphenidate on the soft neurological signs of hyperactive children.

The neurological examination of many hyperactive children reveals the presence of abnormal neurological signs. Of 40 hyperactive children who had three or more neurological abnormalities on an initial neurological evaluation, 29 (72.5%) showed marked improvement or complete resolution of the neurological signs following treatment with methylphenidate hydrochloride (Ritalin) for 60 days. The administration of placebo did not change appreciably the neurological status of 20 hyperactive children. Improvement in behavior, which was ascertained by the use of Conners' Abbreviated Teacher Rating Scale, did not always correspond with resolution of the abnormal neurological signs. This finding suggests that methylphenidate affects behavioral and motoric functions separately and independently. Repeat neurological assessment, looking for resolution of abnormal neurological signs, should be included as part of the follow-up medical examination in treated hyperactive children. Coupled with other objective and subjective test information, improvement of the neurological status provides supportive evidence of overall improvement in the hyperactive child who is receiving drug therapy.