A Procedure for Monitoring Stimulant Medication in Hyperactive Mentally Retarded School Children

Many hyperactive mentally retarded children in public school programs receive stimulant medication, but studies indicate that treatment monitoring practices are less than adequate. Standardized drug assessment instruments rarely are used, and the school typically plays a minor role in evaluating response to treatment. To improve upon this situation, a procedure developed originally for nonretarded children was adapted to evaluate drug effects in mentally retarded children in public school settings. This assessment procedure generates ecologically valid data, enables a high degree of precision in specifying target symptoms and measuring the magnitude of the therapeutic effect, and appears to generate useful information for making dosage adjustment decisions. Two case studies are presented to illustrate the use of this procedure and to highlight differences in the clinical utility of data from behavior rating scales versus direct observations. Although ratings and observations sometimes reveal similar dose–response profiles, the sole reliance on rating scales can lead to gross misperceptions of drug efficacy, even when the ratings are completed by highly motivated and cooperative teachers. Our experience in evaluating mentally retarded children supports (1) the value of assessment instruments designed specifically for this patient population (e.g., Aberrant Behavior Checklist), (2) the need for evaluating a broader range of target symptoms, and (3) the importance of being alert to the somewhat greater variability of responses to stimulant drugs in these children.