A critical appraisal of recent drug research in mental retardation: the Coldwater studies

This paper attempts to assess public and professional attitudes toward drug treatment in mental retardation and concludes that considerable sentiment has developed in recent years against the use of pharmacotherapy. A number of factors contributing to this prevailing attitude were identified and discussed. In particular, a series of investigations carried out by researchers at the Coldwater Regional Center for Developmental Disabilities (Michigan), which have had negative implications for drug treatment, were summarized. These studies have suggested that psychotropic drugs, especially the antipsychotics, may adversely affect clinical management of mentally retarded persons, depress learning performance, and interfere with the efficacy of reinforcement contingencies. However, certain features of these studies, such as the procedures for selecting subjects, the doses utilized and overall guiding philosophy, appear to limit their relevance. Balanced against these are a number of other investigations showing circumscribed positive clinical effects, a lack of interference with learning and little or no disruption of reinforcement contingencies. It was concluded that all-encompassing judgments about the value of pharmacotherapy in mentally retarded people are premature at this time. We suggested that a major objective of clinical drug research should be to look for enhancement of adaptive functioning by discovering appropriate subject-treatment combinations, while remaining vigilant for adverse effects.