9-page Cylert advertisement, 1975.|
Archives of General Psychiatry , Vol. 32, No. 5, pp. 589-597.
"He cannot sit still for one minute... He can't concentrate on a thing... He is easily frustrated and explodes... He just can't be reached for long."
He has disrupted his family... his teacher's classroom... and his own life. But he can't help it. He has MBD.
This child is not a model. In all the photos, as in this one, the children are MBD patients, and adults are healthcare professionals.
The diagnosis of MBD   ~   MBD is not uncommon
"Minimal brain dysfunction is probably the single most common disorder seen by child psychiatrists. Despite this fact, its existence is often unrecognized and its prevalence is almost always underestimated."(1)
It has been reported(2,3,4,5) that the hyperkinetic syndrome occurs in 3 to 10 percent of the elementary school population.
MBD most frequently recognized in the classroom   ~   The teacher appears to be the best barometer of change in a school-age child with symptoms of MBD such as hyperactivity. The child, who is usually a male, is generally having both disciplinary and academic problems.
Patient history is diagnostic key   ~   Because the child may function quite normally on a one-to-one basis, when he is receiving extra attention, clinical impressions from a single office visit can be misleading.
"...I want to re-emphasize that in the practical management -- the diagnosis and treatment -- of children suspected with MBD, the traditional (neurological) diagnostic measures are of little help."(6)
"The poor correlation of the neurological examination and electroencephalogram with the final diagnosis indicates that these procedures are of limited utility in assessing hyperactivity in childhood."(7)
"The diagnosis of hyperkinetic syndrome is based upon the history and the symptom profile rather than upon special tests or examinations."(8)
The MBD child may not exhibit unusual behavior on the initial office visit. Sometimes, however, subtle signs can be revealing. Note in the photos that the child's hands are in constant motion.
As a result of his disabilities, the MBD child is tormented by daily frustrations and feelings of failure. "Aware that their controls are inadequate, they can accurately foresee that they are likely to act in ways that have resulted and will continue to result in rejection, rebuff, loss of love, and shame or guilt."(9)
Treatment of hyperkinetic behavior   ~   In treatment of MBD, the stimulant drugs often serve as an adjunct to other remedial measures (psychological, educational, social). Specifically, they act to help redirect hyperkinetic behavior into controlled, purposeful activity.
Conners observes that "It is definitely the quality of activity, not the total amount of energy expended which is changed by these drugs."(10)
According to Wender, "The stimulant drugs are of the greatest practical use in the treatment of the MBD syndrome."(11)
"Because the ages of 5 to 12 are crucial to the child's development and self-image, treatments which permit the child to be more accessible to environmental resources are warranted and useful."(5)
Still, it is important to recognize that the stimulant drugs, including Cylert (pemoline), have limitations and are intended only as adjuncts in an overall treatment program.
Roughly one third of children treated with medication may show no improvement at all. In the remaining two thirds, the improvement may vary from marginal to dramatic. Drugs do not have a direct effect on learning ability, but they can serve to increase attention span and permit the child to attend more purposefully to the world around him.
Long-range considerations   ~   Some investigators feel that failure to take appropriate and adequate therapeutic measures may pose a threat to the future development and well-being of the child.
Wender points to two possible consequences: "(1) the possibility of long-term effects of early psychological deviancy on the child; (2) the possibility of long-term effects of non-treatment on the family."(12)
Sixty-four hyperactive children were restudied five years later at adolescence. "While the hyperactivity had diminished, other handicaps, notably social and intrapsychic* difficulties, attentional, and learning disorders persisted."(13)
Eisenberg observes: "The hyperkinetic syndrome is no mere matter of developmental phase to be endured until it is 'outgrown.' The data from the longitudinal studies reviewed earlier provide evidence for persisting educational handicap and enduring behavior disorder."(8)
1. Wender, P.H., Minimal Brain Dysfunction in Children, Wiley-Inter-science, New York, 1971, p. 1.
2. Masland, R., Testimony before a Subcommittee of the Committee on Appropriations, House of Representatives, 89th Congress, First Session, part 3, Washington, D.C., U.S. Govt. Printing Office, 1965.
3. Stewart, M.A., et al., Am. J. Orthopsychiatry, 36:861, 1966.
4. Huessy, H.R., Acta Paedopsychiatry, 34:130, 1957.
5. Report of the Conference on the use of Stimulant Drugs in the Treatment of Behaviorally Disturbed Young School Children, Sponsored by the Office of Child Development and the Office of the Assistant Secretary for Health and Scientific Affairs, Dept. of Health, Education and Welfare, Wash., D.C., Jan. 11-12, 1971.
6. Wender, P.H., Ibid., p. 72.
7. Kenney, J.K., et al., Jrnl. of Ped. 79:618, 1971.
8. Eisenberg, L., Pediatrics, 49:709, 1972.
9. Wender, P.H., Ibid., p. 147.
10. Connors, C.K., Jrnl. Learning Disabilities, 4:476, 1971.
11. Wender, P.H., Ibid., p. 93.
12. Wender, P.H., Ibid., p. 128.
13. Weiss, G., et al., Arch. Gen. Psychiatry, 24-409, 1971.
* Within the mind
As an adjunct in a treatment program for children with MBD...   ~   Abbott introduces Cylert® (pemoline)
An effective aid for transforming undirected hyperkinetic behavior into purposeful activity
Psychological tests   ~   Children on Cylert had significantly higher scores than those on placebo on many of the tests, including the full scale Wechsler Intelligence Scale for Children (WISC) and its Performance IQ Sub-component; the Wide Range Achievement Test (WRAT) (reading and arithmetic); and the Lincoln-Oseretsky Motor Performance Test Factor II.
Please see last page of this advertisement for Prescribing Information.         ABBOTT         504070
In May 2005, Abbott voluntarily chose to stop sales and marketing of Cylert in the United States. In October 2005, the FDA ruled "the overall risk of liver toxicity from Cylert and generic pemoline products outweighs the benefits of this drug," after allowing it on the U.S. market for 30 years.