Those Mean Little Kids

Mother complains: "I don't know what's the matter--I just can't handle him. He won't do anything I tell him. He won't sit still for a minute, he smashes things, he's mean to his brothers and sisters, and when he wants something and I don't give it to him right away, he throws a temper tantrum." If Mother seeks medical help, the doctor is soon exasperated as the little monster upsets ashtrays, spins the examining stool, snaps the tongue depressors, and tries to grab the guppies in the fish tank. At such moments, says California's Dr. Daniel M. Martin, "it behooves the doctor to suppress that 'urge to kill' look in his eyes."

There are hundreds of thousands, possibly millions of such boys and girls in the U.S., and little is being done for them. There are not enough pediatric psychiatrists to treat them all, and most of them get no farther than the family doctor's office. Dr. Martin, a family physician, told the American Academy of General Practice what he has found works best: a daily dose of three or four tablets of methylphenidate, trade-named Ritalin by the Ciba Pharmaceutical Co.

Children with this disorder are distinguished from ordinary bratty youngsters, who may have one or two of the symptoms, by the fact that their behavior is disturbed in five or six different aspects. There is no single, simple explanation for what ails them, or even a generally accepted medical label for it. Martin elects to call it the hyperkinetic (excessively mobile) syndrome.

Victims, he says, have been described as brain-injured or brain-damaged, or as having an organic brain defect resulting in unsocialized, aggressive behavior. It is likely, most psychiatrists agree, that these children have suffered (perhaps in the womb or at birth) a minute brain abnormality that impairs their social behavior. But they are not mentally retarded; their intelligence is usually average or above.

Don't Touch Me. The first signs of hyperkinetic behavior, says Martin, may appear in the first weeks of life: "Even tiny infants with the disorder are constantly active and irritable, and have difficulty sleeping at night. They seem to stiffen and resent motherly coddling and loving. Their attitude appears to be 'Love me but don't touch me.' "These babies usually walk earlier than others. As they grow, they have excellent coordination and easily learn good balance on skates and bikes. They want playmates, but treat them so badly that they are soon shunned by the other kids on the block. In school they drive teachers up the walls with their disruptive, destructive behavior. If they reach adolescence without treatment, says Martin, they are candidates for the juvenile courts.

Most of the ordinary tranquilizing drugs make these children worse by inducing depression. Methylphenidate is classed as an antidepressant and mild stimulant. "It may seem paradoxical to be giving a stimulant to already overactive, restless children and expect them to calm down," says Martin, "but that is exactly what happens. It is fascinating and exciting to watch a child who awakes mean and irritable. Within 15 to 30 minutes after taking methylphenidate he becomes calm and cooperative and is able to sustain concentration for four hours."

Although ingenious theories have been advanced to explain this paradoxical effect of methylphenidate, the mechanism of its action is unknown. The drug has few side effects, the two most notable being a slight loss of appetite and a tendency to insomnia if the last dose is taken too late at night.

In his San Leandro practice, Dr. Martin has 90 patients aged three to 20 on methylphenidate, and he reports uniformly good results. One of his greatest satisfactions is hearing a mother say: "Now I can love this child again."

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