Pharmacotherapy for behavior disorders. Typical treatment practices

The parents and teachers of 100 children receiving medications (primarily methylphenidate) for behavior disorders (primarily hyperactivity) were questioned about widely recommended treatment practices. The results showed that (a) in the majority of cases, pediatricians were responsible for supervising drug therapy; (b) most parents were satisfied with their current physician; and (c) approximately one half of the children had three or more office visits per year. However, teachers were rarely asked to use standardized procedures to evaluate drug response, and direct contact between teacher and physician was all but nonexistent. There was a considerable degree of disagreement between parents and teachers concerning drug efficacy, dosage, and the need for medication; and parents appeared to exert a considerable degree of control over treatment-related decisions. In general, drug-free periods were not scheduled on a regular basis, and evidence for an integrated multimodal treatment approach was lacking. The findings suggest that variables other than a clinically determined response to medication are often the salient elements of the treatment-related decision-making process.