J. Child. PIyrhol. PThinr. Vol. 2 7 , No. 2, pp. 191-211, 1986 0021-9630/86 $3.00+ 0.

00
Printed in Great Britain. Pcrgamon Press Ltd.
01986 Association for Child Psychology md Psychiatry.

SHORT TERM EFFECTS OF METHYLPHENIDATE ON THE

COGNITIVE, LEARNING AND ACADEMIC PERFORMANCE OF
CHILDREN WITH ATTENTION DEFICIT DISORDER IN THE
LABORATORY AND THE CLASSROOM*?
R. G. BARR,M. E. O’NEILLand B. G. BRITTON
V. I. DOUGLAS,
Department of Psychology and Department of Pediatrics, McGill University-Montreal Children’s
Hospital Research Institute, Canada

Abrtrud-Sixteen children meeting diagnostic criteria for Attention Deficit Disorder with Hyperactivity
(ADD-H) were tested on methylphenidate(0.3 mgkg) and placebo on cognitive, learning, academic
and behavioral measures in a double-blindstudy. Assessments were carried out in the laboratory and
in the children’s regular classrooms. Results indicate methylphenidate-induced improvements on a
majority of the measures. Drug-induced changes reflected increased output, accuracy and efficiency
and improved learning acquisition. There was also evidence of increased effort and self-correcting
behaviours. It is argued that reviewers have underestimated the potential of stimulants to improve
the performance of ADD-H children on academic, learning and cognitive tasks.

Kcywordr: Methylphenidate, Attention Deficit Disorder/Hyperactivity, academic performance

INTRODUCTION

ALTHOUGH stimulant drugs have been used for many years in the treatment of attention
deficit disorder with hyperactivity (ADD-H), a number of questions remain regarding
their therapeutic action. These questions are linked, in turn, with questions about
the nature of the defective processes involved in ADD-H.
Different observers have favored attentional, inhibitory, arousal, reinforcement,
motor or stimulation-seeking theories to explain the etiology of ADD-H and to account
for stimulant effects (Barkley, 1977, 1977; Conners and Wells, 1978; Douglas, 1972,
1983, 1985; Douglas & Peters, 1979; Gittelman-Klein & Klein, 1975; Kinsbourne,
1977; Sroufe, 1975; Swanson & Kinsbourne, 1979; Wender, 1971; Whalen & Henker,
1976; Zentall & Zentall, 1983). Douglas (1983, 1984, in press) has suggested that
an underlying defect in self-regulation can account for the wide range of interrelated
behavioral symptoms and cognitive deficits these theorists seek to explain. She has
reviewed evidence from a number of cognitive tasks on which performance deficits
have been found and has argued that the deficits can be traced to a self-regulatory
defect involving the organization and facilitation of attention and the inhibition of
inappropriate responses. Because stimulant medication produces positive changes
*This research was supported by Grant No. MA. 6913 from the Medical Research Council of Canada.
?Publication No. 85017 of the McGill University-Montreal Children’s Hospital Research Institute.

Requests for reprints: Professor V. I. Douglas, Department of Psychology, McGill University, Stewart
Biological Sciences Center, 1205 Docteur Penfield Avenue, Montreal, Quebec, Canada, HSA 1B1.

Accepted manucript received 15 June 1985

191
192 V. I. DOUGLAS et al.

on many of these same tasks, Douglas has suggested that the stimulants act to
strengthen self-regulation.
Hypotheses regarding stimulant effects must take account of the fact that the drugs
produce positive changes in normal children and adults on some of the same tasks
on which improvements have been found in children with ADD-H (Laties & Weiss,
1967; Rapoport, Buchsbaum, Weingartner, Zahn, Ludlow & Mikkelson, 1980; Weiss
& Laties, 1962; Werry & Aman, 1984). Also, improvements have been reported in
ADD-H children on measures on which their performance off medication was
comparable to that of control groups (Sroufe, Sonies, West & Wright, 1973; Sykes,
Douglas & Morgenstern, 1972). These findings have led investigators to question
assumptions that the effects in ADD-H are ‘paradoxical’ or ‘unique’ (Rapoport,
Buchsbaum, Zahn, Weingartner, Ludlow & Mikkelson, 1978; Swanson & Kinsbourne,
1979).
Serious questions have been raised regarding stimulant effects on complex cognitive
functions and academic performance. Although it is generally agreed that the drugs
enhance performance on simple, repititive tasks, there is concern that they may impair
more complex mental operations. Stimulant-induced overfocusing and perseveration
in animals and normal adults have led some authors to predict impairment on tasks
requiring flexible reasoning (Margolin, 1978; Robbins & Sahakian, 1979; Sahakian
& Robbins, 1977). Swanson, Barlow and Kinsbourne (1979), on the other hand,
believe that paired associates tasks can be used to differentiate between favorable and
adverse responders to the stimulants because these tasks make heavy demands on
complex cognitive processes. They reason that most individuals will show a favorable
response on simple tasks. However, because paired associates require the acquisition
of new associations over repeated trials, they believe that a favourable response will
be found only in ‘true’ hyperactives. Douglas (1983) has hypothesized that ADD-H
children have a greater need for stimulants than normal individuals in order to function
within acceptable limits in situations where sustained, organized effort is required.
If this hypothesis is correct, different patterns of responsivity should be found in ADD-
H and normal children when factors such as task complexity and dosage level are
manipulated. Also, the stimulants may fail to bring the performance of ADD-H
children up to normal levels on some tasks.
A number of reviewers have concluded that stimulants do little to improve academic
performance in ADD-H children (Aman, 1980; Barkley, 1979; Barkley &
Cunningham, 1978; Gadow, 1983; Ottenbacher & Cooper, 1983; Rie, Rie, Stewart
& Ambuel, 1976; Sroufe, 1975). The negative results obtained in numerous studies
were suprising in view of well-documented changes in classroom compliance and
laboratory measures of attention. There is reason to believe, however, that conceptual
and methodological weaknesses in most of the early studies led to faulty conclusions.
Conceptual weaknesses have included failure to take account of secondary deficits
resulting from a history of failing to ‘stop, look, listen a-nd think’ (Douglas, 1980;
Douglas & Peters, 1979). If the children’s primary symptoms prevent them from
acquiring certain skills, medication cannot be expected to improve performance on
tasks requiring those skills unless remedial training is provided. Also, reviewers have
downplayed the importance of the few positive findings that have been obtained on
academic measures, arguing that the changes reflect ‘only’ improvement in attention
 METHYLPHENIDATE EFFECTS IN ADD-H 193

or test-taking behaviors (Barkley & Cunningham, 1978; Rie etal., 1976; Sroufe, 1975).
This viewpoint is puzzling, since it is generally agreed that ADD-H is characterized
by erratic deployment of attention and production deficits.
Existing studies also provide inadequate information about stimulant effects on
learning. There has been confusion between changes that reflect effects on production
and those reflecting effects on the acquisition of new learning. Sometimes, too, tasks
which assess processes believed to be essential to learning are mistakenly presented
as learning measures (Charles, Schain & Zelnicker, 1981). In other investigations
memory tasks which make minimal demands on learning are labelled learning tasks;
subjects in these studies may be required to process material during a single brief
trial (Peeke, Halliday, Callaway, Prael & Reus, 1984; Sprague & Sleator, 1977;
Weingartner, Ebert, Mikkelson, Rapoport, Buchsbaum, Bunney & Caine, 1980).
In addition, stimulant effects on long-term retention and retrieval of learned material
have rarely been investigated.
Several authors have discussed methodological weaknesses in the drug evaluation
studies (Barkley & Cunningham, 1978; Pelham, in press; Sprague & Berger, 1980;
Sroufe, 1975). Most academic achievement tests do not contain enough items at
appropriate difificulty levels to detect short term changes. Subjects u s u d y are assessed
only once in drug and placebo conditions. Few investigators have developed carefully
matched forms of tests for repeat testing. Investigators fail to control for order effects
in medication conditions or among tasks within test batteries. Assessments often are
limited to a few measures and children are usually tested in artificial laboratory settings.
There are a number of other problems associated with the drugs. Subjects frequently
fail to take their medication. Dosage levels, particularly in many of the early studies,
were probably too high. Time of testing may not conform to time-response
relationships in drug effects. In addition, comparison across studies is often difficult
because daily dosage may be given in a single dose or divided into morning and
afternoon doses and different methods have been used to establish dosage levels for
individual subjects.
The study to be reported addresses a number of these conceptual and methodological
issues. The overall project of which it is a part was designed to investigate: (1) short
term effects of methylphenidate on the performance of ADD-H children on a battery
of cognitive, academic, learning and behavioral measures; (2) the interrelationships
among stimulant-inducedchanges on these measures; (3) the effects of methylphenidate
on the acquisition, retention and retrieval of new learning; (4) criteria for differentiating
between positive responders, nonresponders and adverse responders, and (5) possible
state-dependent effects of methylphenidate. The first of these goals will be emphasized
in this paper.

METHODS
Su6jects
Children included in the study were referred to the Hyperactivity Project at the Montreal Children’s
Hospital by pediatricians or school personnel. Referral was based on the presence of the following
symptoms: inattentiveness, impulsivity, hyperactivity, restlessness, poor compliance and poor self-control.
Symptoms were of sufficient severity to prompt referring physicians to consider a trial on stimulant
medication.
194 V. I. DOUGLAS cf ~ l .

All children accepted for the study met criteria for a DSM-I11 diagnosis of Attention Deficit Disorder
with Hyperactivity (American Psychiatric Association, 1980). To be included, subjects also had to receive
ratings above 1.5 (on a 0-3 scale) on the HyperactivityIndex of the Revised Conners Parent and Teacher
Rating Scales (Goyette, Conners & Ulrich, 1978). Screening interviews were held with teachers and
mothers to obtain information on a number of additional criteria. Interviewers took detailed medical,
developmental, academic and family histories to rule out children with symptoms of psychosis and those
with serious visual, auditory or language deficits. Also excluded were children diagnosed as brain-damaged
and children whose restless behavior was attributable to emotional problems or a stressful home
environment.
Other criteria included appearance of the symptoms prior to age five and evidence that the symptoms
were chronic and pervasive. Information was obtained on all medications taken by the children. One
child had taken Ritalin previously and two were receiving stimulant medication at the time of referral.
Parent and teacher ratings for these two children were obtained when they were off medication. If a
child met all criteria for the study, the mother was given a detailed description of the project and informed
consent was obtained.
The sample chosen consisted of 15 males and 1 female. Ages varied from 7.0 to 11.6 yr (mean 9.2
yr; S.D. = 1.65). Intelligence quotients, as measured by the Wechsler Intelligence Scale for Children
or the Peabody Picture Vocabulary Test ranged from 89 to 125 with a mean of 103.19 and a standard
deviation of 11.09. Twelve of the subjects attended regular classes; their grades varied from Grade
1 to 6. The remaining four children were attending special classes for children with learning and behavioral
problems. The social class of the children’s families varied fmm I to V on the Hollingshead and Redlich
Index (Hollingshead & Redlich, 1958), with most of the families falliing within the third or fourth levels.
Means scores on the Teacher Hyperactivity Index was 1.93 (S.D. = 0.30); mean score on the Parent
Hyperactivity Index was 2.06 (S.D. = 0.36).

Expmmmtal design
Children were seen in the laboratory for a screening session about a week before testing began. They
were given practice on all tasks in the test battery and the appropriate level was established for each
child on tasks graded for dificulty level. The two children currently receiving stimulant medication
were taken off24 hr prior to screening and 48 hr prior to the first testing day.
During the week of testing, children received the total battery on five consecutive mornings. For
most children these sessions took place at the laboratory. Because of transportation difficulties, four
children were seen in an ofice at their school. Each child worked with the same examiner, in the same
setting, for all five sessions. In the afternoons the child returned to his regular classroom where his
teacher rated his behavior and administered the two classroom tasks (arithmetic and word discovery).
The research design provided a minimum of two assessments on each child in the drug and placebo
conditions. Because the paired associates task was also used to assess retention and state-dependent
effects, five testing days were necessary to include all possible drug-placebo orders. During the five
days of testing children received drug (D) or placebo (P) according to one of four possible orders: (1)
PDDPP: (2) DPPDD; (3) DDPPD; (4) PPDDP. Each child was in the same condition (D or P) for
both morning and afternoon testing.
Tasks in the morning battery were administered in one of four orders. The orders were chosen to
randomize test order, with two exceptions. The paired associates task was always administered last
and a retention test, based on the previous day’s paired associate test was administered first. These
limitations were set to minimize interference between lists used to assess acquisition and retention. The
four test orders were: (1) ABCDEF; (2) ACBEDF; (3) ADEBCF and (4) AEDCBF.
Prior to the study, the 16 drug and test order combinations for the morning test battery were ordered
randomly. As subjects entered the study they were assigned to these drug-plus-test order combinations
until all 16 subjects had been assigned. The order of the two tests in the afternoon battery (arithmetic
and word discovery) was alternated over children and each child received the tests in the same order
over the five days of testing.

Mea.sures
Arithmetic task. Tests were developed for six grade levels (1 -6). For each level there were 11 equivalent
forms (1 for screening, 5 for individual testing and 5 for class testing). Tests for each level contained
 METHYLPHENIDATE EFFECTS I N ADD-H 195

50 questions which were generated by computer. Tests for grade 1-4 contained only addition and
subtraction questions: for grade 5 and 6 multiplication problems also were included. Within each type
of question difficulty level was increased for ascending grade lewels. For example, as the grade level
increased the questions required operations on an increasing number of digits and there were more
frequent demands for ‘renaming’.
Questions were organized in 10 rows containing 5 examples each. The distribution of items was
designed to require the children to shift set among the different operations. This was achieved by varying
the order of question type for each row, the only constraints being &hat at least one example of each
operation was contained in each row and that the first and second halves of the test contained the same
number of each operation. The order of questions in each row was maintained over 11 equivalent forms
of the test.
During screening each child was assessed to establish the upper limits of his skills in each of the
mathematical operations tapped in the tests. The child was then given a 50-item screening test at the
highest g r d level at which he was capablc of working. His performance on this test was used to establish
an upper time limit (10, 15 or 20 min) using the criterion of 20-30 questions attempted. This criterion
was chosen to provide sufficient opportunity for improvement or deterioration of performance in the
drug and placebo conditions. The grade level and the upper time limit established during screening
remained the same for each child throughout the five individual and five classroom administrations.
Administration of the tests in the individual testing session was designed to require independent effort
by the child and to provide an opportunity for observing the way in which he used the time available.
The child was asked to do his best and to inform the examiner when he was finished. He was shown
how to change an answer by putting brackets around it and writing the new answer underneath the
old one. No eraser was provided. If a child said he was finished before the allotted time was up, he
was told he had a few more minutes, but was not pressured into spending more time on the task.
Measures computed from the arithmetic task included: number of questions attempted; number of
questions completed correctly; an accuracy score based on the percentage of items completed correctly
out of total number attempted; time spent (recorded in seconds) and an efticiency score (number of
items completed per minute spent).

Arithmetic self-cowection tusk. The self-correction task was administered only in the 5 individual sessions.
After the child finished the arithmetic test, he was told that the examiner was going to give him some
time to look over his work in order to see if he could find his own mistakes. He was given a colored
pencil and informed that, to change an answer, he should put brackets around his first answer and
write the new one underneath. The child was given 6 min to find his errors, with the examiner providing
minimal encouragement. Scores derived from the self-correction task included: number of correct
corrections; an accuracy score, based on percentage of errors corrected out of total number of errors
made; time spent (recorded in seconds); and the examiner’s effort rating.

Spelling tusk. Spelling lists were developed at each of seven levels of difficulty. At each level, 6 lists,
each containing 20 spelling words, were generated (1 for screening and 5 for individual testing). The
levels overlapped and contained an equal number of words from each of two grades. Equivalent forms
of the lists at each level were generated by choosing words from the Graded and Classified Spelling
Lists for Teachers (Forbes, 1968) that followed the same phonetic rule and were rated as being at the
same grade level. The child was administered one list each day and the order of list presentations was
randomized across subjects.
The list level to be used for each subject was decided during screening. Because five of the errors
made by the chid during the spelling task were to be used in a spelling study task, the criterion established
in choosing test difficulty level was 8-10 errors.
The examiner attempted to reassure the child by telling him that, although he would know some
words, others would be new to him. The examiner pronounced each word, used it in a sentence and
repeated it. The subject was allowed to write or print. If a child had difficulty with a word he was
encouraged to write as much of it as possible.
Although the spelling task was designed mainly to discover words that subjects could not spell, a
score (number correct) was assigned for the number of words spelled correctly from the list of 20 words.
196 V. I. DOUGLAS ef d.

Spelling study task. On each day of testing the examiner chose 5 words that were spelled incorrectly
from the spelling test administered that day. An attempt was made to vary the kinds of errors chosen
by avoiding errors involving the same phoneme. The child was told that, since some of the words were
quite difficult he would be given an opportunity to study a few of the ones that gave him trouble. He
was encouraged to use his own study strategies. He was told that he could use any method he wished
to help him remember the words. A pencil and paper were provided for his use. He was given up to
4 min to study the 5 words. The words were then read to him and he was asked to write or print his
answers.
Measures scored from the spelling study task included number of words spelled correctly, amount
of time spent studying the words and the examiners’ effort ratings.

Word discovq tusk. This task required the child to produce as many words as possible using the letters
contained in a long stimulus word. Pilot work was carried out to choose 12 words (2 for screening,
5 for individual testing and 5 for classroom testing) that provided approximately equal possibilities for
combining letters to make new words. The words contained approximately 10 letters, three or four
of which were vowels. The 10 words used in testing were divided into two sets, and the order of
administration was randomized across subjects and laboratory and classroom administrations. During
the screening session the task was explained and the child was given practice in producing words. The
examiner made sure that children became familiar with several strategies for forming new words by
explaining the strategies, providing examples, and encouraging them to produce further examples. Errors
were corrected and the reasons explained.
During individual testing sessions subjects were given a sheet of paper containing the stimulus word
for that day. They were asked to make as many words as they could out of the stimulus word and
to place their answers below the stimulus word. A maximum of 10 min was allowed to complete the
task. If a child indicated that he was finished before 10 min were up, he was reminded once that he
still had time left.
Scores included number of acceptable words produced, time spent (out of a maximum of 10 min)
and the examiner’s effort rating.

Paired associate learning (mrmoy) task. The paired associates task consisted of six lists (1 for screening,
5 for individual testing) of 15 arbitrarily associated word pairs. All words in the lists were one-syllable
concrete nouns selected from elementary school spelling and reading books and rated as high frequency
words by Thorndike & Lorge (1944). Within certain constraints the words were randomly paired and
randomly assigned to the six lists. Pairs of words that were related in any obvious way (e.g. rhyming
words, words from the same category or related in meaning) were avoided. Also, within each list, words
from a number of different categories were used to avoid withii-list interference.
Most subjects were administered lists of 15 word pairs. If a child’s performance on the screening
list indicated that the 15-pair list was too difficult, 10 or 12 word pairs were used. The child was asked
to listen carefully while the experimenter read through the list of word pairs so that he would be able
to remember the word that was associated with each stimulus word. He was also told that he would
have several tries to learn the pairs. After all pairs in the list had been read, the experimenter administered
the first trial. The stimulus word of each pair was named and the subject was asked what word went
with it. If the child answered incorrectly or did not know the associate for a word, the experimenter
told him the correct answer and proceeded to the next stimulus word. The same procedure was repeated
over two additional trials.
The measures derived from this task included number of pairs corr\ect on each of the trials (1, 2 and
3), the sum of correct pairs across the three trials, and examiners’ effort ratings.

Dekayed reaction time tusk. This task was included as a ‘marker variable’. It will be discussed in another
paper.

Conners rating scale. At the end of each morning of individual testing the examiner rated the child’s
behavior during the session by completing the Hyperactivity Index from the Conners Revised Teacher
rating Scale (Goyette et al., 1978). The score for the index is based on the mean of the item ratings
on a 4-point scale (0-3). The item ‘Disturbs other children’ was omitted from the examiners’ scale
as it was not applicable in the individual testing situation.
 METHYLPHENIDATE EFFECTS IN ADD-H 197

Effort ratings. During the individual testing sessions examiners made effort ratings based on their
observations of the child’s approach to a few of the tasks. Effort was rated on a 7-point scale, where
0 indicated no effort; 3 reasonable effort, and 6 excellent effort. The scale was completed by the examiner
after each of the following tasks: Arithmetic Self-Corrections, Spelling Study Task, Word Discovery
Task and Paired Associates Learning. It was decided to augment Conners Ratings during the morning
session with these effort ratings because examiners’ observational notes during a pilot study suggested
that they were noticing drug-related shifts in the amount of effort the children were investing.

Drug treatment and procedure

Medications were prepared in opaque gelatin capsules and administered in a double-blind manner.
Capsules containing methyphenidate hydrochloride (Ritalin), were prepared in 5, 7.5, 10, 12.5 and
15 mg/kg capsule doses. On days when subjects were assigned to active medication, they received a
capsule containing the quantity of medication closest to a calculated dose of 0.3 mg/kg for each dose
(morning and afternoon). On days when they were assigned to placebo, they received identical capsules
containing 100 mg of lactose for each dose.
Children ate breakfast at home, approximately 1 hr before taking their morning capsule which was
administered by the examiner. Forty-five minutes later, the examiner began administering the morning
test battery which took 1 % -2 hr to complete. The second capsule, identical to the morning capsule,
was administered by the examiner before the child left for lunch and returned to school. Time between
the morning and afternoon capsule was approximately 3 H hr. Since the same drug condition was used
in the morning and afternoon, any overlapping effects from the morning dose were additive (Swanson,
Roberts & Zucker, 1978).

Procedure for clarzroom testing. In the afternoon, children returned to their regular classrooms. Prior
to the week of testing an examiner met with each child’s teacher to explain how to administer the classroom
tasks and fdl out the Conners Index. The teacher was provided with 5 Conners forms, 5 Word Discovery
tasks and 5 Arithmetic tests labelled with the day of administration. The examiner also explained how
the tests were to be administered, amount of time to be allowed for each task and order of administration.
All children were given a maximum of 10 min for the word discovery task, as in individual testing.
Similarly, on the arithmetic test each child was allowed the same amount of time as in individual testing.
The teacher was asked to administer the two tasks at a time when the class was engaged in work at
their desks and at approximately the same time each afternoon. Children worked on the tasks
independently. The teacher handed the child a test and told him to let her know when he was finished.
If he said he was finished before the allotted time, he was told that, if he wished, he could take a few
more minutes. Otherwise, the teacher collected the test at the end of the allotted time. Teachers recorded
the time each task was started and finished. The teacher also was asked to rate the child’s behavior
each afternoon on the Conners Index; ratings were based on the child’s behavior throughout the entire
afternoon. The examiner contacted teachers at the end of each afternoon to make sure tasks had been
administered and ratings completed.

Statistical analysis
Since the research design involved testing each child on drug and on placebo either two or three
times, scores were based on the average score of each subject in each condition. In a few cases where
there were missing data, scores from 1 or 2 days were used in computing means for drug and placebo
conditions. Two-way ANOVAS on drug order (4 levels) by drug state (2 levels) with repeated measures
were run for all measures. No significant main effects for drug order or for the interaction between
drug order and drug state were found. The F-tests reported for drug state are based on a sample of
16 subjects.

RESULTS

Measures fiom individual testing battery

F-ratios and P-values from the ANOVA analysis of measures obtained during
individual testing are reported in Table 1 .
198 V. I. DOUGLAS ct al.

TABLE
1. MEASURES
ASSESSED IN INDIVIDUAL TESTING MWN SCORES OF ADD-H
CHILDREN ON PLACEBO AND METHYLPHENIDATE;
Mean ANOVA
Measures Placebo Drug F-ratio P
Arithmetic task
No. attempted 30.79 39.43 8.67 0.01
(1 3.93) (10.61)
No. correct 24.52 34.46 10.56 0.007
(1 3.59) (1 1.12)
Accuracy 0.78 0.86 6.15 0.03
(0.19) (0.12)
Time spent (sec) 886.72 916.14 0.55 0.47
(350.75) (262.54)
Efficiency 1.90 2.58 10.97 0.006
(1.47) (1.50)
Arithmetic self-corrections
No. of corrections 0.30 0.65 3.80 0.08
(0.49) (0.77)
Accuracy 0.07 0.20 4.86 0.05
(0.13) (0.28)
Time spent (sec) 173.10 214.13 5.80 0.03
( 137.90) (1 29.42)
Effort rating 2.46 3.58 16.32 0.002
(1.68) (1.29)
Spelling task
No. correct 8.78 8.49 0.88 0.37
(2.79) (2.88)
Spelling study task
No. correct 3.01 3.35 2.06 0.18
(1.20) (0.93)
Time spent (sec) 120.92 126.74 0.81 0.39
(52.28) (56.36)
Effort rating 2.62 3.44 7.72 0.02
(1.22) (1.00)
Word discovery task
No. of words 11.26 13.10 2.15 0.17
(8.23) (6.51)
Time spent (sec) 362.79 441.54 3.91 0.07
(1 59.32) (115.25)
Effort rating 3.46 4.79 12.27 0.005
(1.46) (1.16)
Paired associates
(No. of pairs)
Trial 1 2.82 3.87 3.50 0.09
(2.54) (3.37)
Trial 2 4.19 5.39 5.64 0.04
(3.42) (3.61)
Trial 3 5.71 7.57 10.86 0.008
(3.53) (3.97)
Sum 1, 2 and 3 12.73 16.83 8.00 0.02
(9.20) (10.65)
Effort rating 3.11 4.37 11.13 0.008
(1.59) (1.22)
Conners rating scale
Examiner’s ratings 1.07 0.47 15.67 0.002
(0.64) (0.42)
‘Sample size = 16;placebo and drug scores are based on average of scores obtained
by subjects over 2 or 3 days of testing.
 METHYLPHENIDATE EFFECTS IN ADD-H 199

The majority of placebo-drug comparisons on the arithmetic task yielded significant

differences. The children attempted significantly more questions and solved more
questions correctly when they were receiving medication. Their accuracy score, based
on proportion of questions answered correctly, was higher in the drug condition and
they solved more questions correctly per minute spent on the task. The only comparison
failing to reach significance was total time spent on the task.
Differences in favor of the drug condition also were found on the arithmetic self-
correction task. The accuracy score, based on the proportion of his own errors which
the child found and corrected yielded significant differences, as did time spent and
the effort rating. Total number of corrections showed a trend (f‘= 0.08) in favor of
the drug condition.
Results from the spelling task and the spelling study task showed little evidence
of a drug effect. The only significant difference was on examiners’ ratings of effort
on the study task. Differences on time spent and number of words spelled correctly
on the study task were in the expected direction but were not statistically significant.
O n the word discovery task, only the placebo-drug comparison on the effort rating
reached the 0.05 level of significance. The difference on time spent approached
significance (P=0.07). Although more words were generated in the drug condition
this difference was not significant.
The majority of the placebo-drug comparisons on the paired associates learning
task yielded significant differences. Subjects recalled more associates on the second
and third trials and across the three trials when they were receiving medication.
Examiners also rated the children as demonstrating significantly more effort in the
drug condition.
A significant difference in favor of the drug condition was found on examiners’
ratings on the Conners Hyperactivity Index.

Measures taken in the Classroom

Most measures from the two tasks administered in the classroom demonstrated
strong differences in favor of the drug condition, as did behavioral ratings by the
children’s teachers (see Table 2).
On the arithmetic task children attempted more items, got more correct, were more
accurate, spent less time on the task and solved more questions correctly per minute
when they were receiving medication. All differences were statistically significant.
Subjects also produced significantly more words on the word discovery task in the
drug condition. The difference on time spent was not significant.
The drug-placebo difference on teacher’s ratings on the Hyperactivity Index was
almost indentical to that found in the individual testing sessions and was statistically
significant.

DISCUSSION

Overall, the results provide evidence of methylphenidate-induced improvements on

mathematical computations, the relatively complex cognitive processes assessed by
the word discovery task and learning acquisition as assessed by paired associates.
200 V. I. DOUGLAS cl al.

TABLE
2. MEASURFS
ASSESSED IN CLASSROOM MEAN SCORES OF ADD-H CHILDREN
ON PLACEBO AND METHYLPHENIDATE~

Mean ANOVA

Measure Placebo Drug F-ratio P

Arithmetic task
No. attempted 31.32 40.21 6.94 0.02
(16.00) (1 3.68)
No. correct 26.33 36.93 10.42 0.007
(14.24) (13.62)
Accuracy 0.84 0.91 8.63 0.01
(0.15) (0.10)
Time spent (sec) 993.13 904.38 8.09 0.02
(27 1.36) (279.52)
Efficiency 1.91 2.82 7.56 0.02
(1.43) (1.84)
Word discovery task
No. of words 10.63 12.91 5.56 0.04
(7.28) (10.60)
Time spent (sec) 514.00 545.33 0.76 0.40
(1 85.77) (1 58.15)
Conners rating scale
Teachers’ ratings 1.07 0.56 17.13 0.001
(0.60) (0.60)
~

*Sample size = 16; placebo and drug scores are based on average of scores
obtained by subjects over 2 or 3 days of testing.

Academic tasks
Although the various scores from the arithmetic task do not reflect independent
processes, they do provide some insight into the kinds of changes the medication was
producing. The changes were very similar in laboratory and classroom testing. An
increase in number of items attempted, together with improved effort ratings, suggest
that the children worked harder while on methylphenidate. Higher accuracy and
efficiency scores indicate that the effects extended beyond increasing output.
Performance became more efficient and ‘fine tuned’ to task demands. Interestingly,
the only measure not showing a significant drug effect during individual testing was
amount of time spent on the task and, in classroom testing, the children spent
significantly less time in the drug condition. These time scores, together with the
improved efficiency scores in both testing environments, indicate that the medication
did not simply ‘slow the children down’. It enabled them, rather, to make more
effective use of the time spent. These results underscore the inappropriateness of
simplistic interpretations of latency measures as indicating only impulsive responding
(Douglas, 1983).
Findings from the arithmetic self-correctiontask provide further evidence that self-
regulatory processes are implicated in stimulant effects. Because the number of errors
the child could correct on this task is confounded by the number of errors he originally
made, the most appropriate measure of self-correction is the accuracy score. Accuracy
 METHYLPHENIDATE EFFECTS IN ADD-H 20 1

scores, examiners’ ratings of effort expended, and the amount of time devoted to
self-checkingall showed sigmfkant drug effects. Although these results are encouraging,
the small percentage of errors corrected in both conditions (20 % in the drug condition
vs 7 % in the placebo condition) suggests that ADD-H children require additional
training in strategies for correcting their own work.
Results from the spelling and spelling study tasks showed little drug effect. Only
examiners’ effort ratings showed sigdicant change. The negative results on the spelling
task were not surprising because, during screening, examiners presented difficult words
until subjects misspelled enough words for use in the study task. The study task was
probably too brief to reflect reliable drug-placebo differences. We were misled by
a pilot study in which we had found significant drug-placebo differences using only
5 items. Modest improvements found on regular and nonsense word spelling tasks
by Pelham and his associates (Pelham, in press; Stephens, Pelham & Skinner, 1984)
suggest that task design problems contributed to our weak findings on spelling.
There have been a number of other recent reports of stimulant-induced changes
on academic measures. Pelham, Stephens and their associates have demonstrated
improvement on arithmetic tasks, spelling tasks, and assignments from reading
comprehension work books (Pelham, in press; Pelham, Bender, Caddell & Booth,
1982; Pelham, Swanson, Bender & Wilson, 1980; Stephens et al., 1984). Gittelman,
Klein and Feingold (1983) found significant differences in favor of a group receiving
methylphenidate on several academic test measures; their subjects were children with
reading disorders; although they were not rated as hyperactive they were rated as
inattentive. Using a single subject design, Rapport, Murphy & Bailey (1982) found
that methylphenidate improved completion rates on mathematics and phonics tests.
Ballinger, Varley & Nolen (1984) report that methylphenidate improved performance
significantly on language processing but not oral reading tests. However, all three
of their reading tasks showed trends (< 0.10) toward higher scores in the drug
condition. There have been suggestions that stimulant effects are stonger on arithmetic
computation than on reading tasks (Gittelman et al., 1983; Pelham, in press). Whether
these differences are due to the cognitive processes involved, factors in research designs
(Gittelman et al., 1983) or properties of the assessment instruments used remains to
be seen.
Our results and those from other recent studies are considerably more encouraging
than earlier findings. Barkley & Cunningham (1978) reported that, of 52 dependent
academic measures used in 17 short-term studies, 82.6% were not significantly
improved by the stimulants. It now appears that many of the negative findings resulted
from insensitive assessment techniques and failure to take methodological precautions
to reduce error variance. Gittelman et al. (1983) mention, for example, that if they
had limited their arithmetic assessments to the less sensitive measures they used in
an earlier study (Gittelman-Klein & Klein, 1976), they would have replicated their
previous negative findings.
The extent of improvement found on our arithmetic tasks was substantial.
Percentage increase over placebo levels on number of items solved correctly in the
laboratory and in the classroom was approximately 40% and efficiency scores increased
by over 35 % . We believe that the sensitivity of our tasks was enhanced by the fact
that 50 items, tailored to each youngster’s ability were used on each testing day. Since
202 V. I. DOUGLAS ef al.

scores were combined over 2 or 3 days, drug and placebo means are based on at
least 100 items. Also, the sets of items for repeated testing were carefully matched.
The amount of improvement in other recent studies also has been significant.
Stephens et al. (1984) found a ‘clinically significant’ improvement of 25% on their
nonsense word spelling test. Subjects in the study by Pelham et al. (1982) completed
approximately 30% more mathematics problems on medication, with no loss in
accuracy. Although these investigators did not obtain a significant difference on
proportion of problems completed correctly, this is probably attributable to ceiling
effects imposed by relatively easy tasks. Gittelman et al. (1983) report ‘functionally
meaningful gains’ on several mathematics and social studies measures. O n one
mathematics test, for example, a group receiving reading remediation plus
methyphenidate showed an advantage of eight-tenths of a year over a group receiving
remediation plus placebo. Furthermore, the drug-treated children approached grade
levels on some measures. Gittelman et al. attribute these gains to medication because
these subjects received only reading training. It is noteworthy that the gains were
no longer evident at follow-up when the children were off medication.
These large stimulant-induced changes are encouraging, particularly when, as in
our own and other studies, they occur at levels approaching the upper limits of
children’s current competence. The changes compare very favorably with those
obtained in a frequently cited study on the effects of contingency management on
academic performance in hyperactive children (Ayllon, Layman & Kandel, 1975).
Ayllon et al. report that three children of average intelligence, ages 8-10 yr, showed
improved performance on mathematics operations when they were rewarded for correct
responses. The operations assessed, however, were limited to addition of whole
numbers under 10.
Reports of dexedrine-induced changes in the performance of normal adults on simple
arithmetic problems may provide some clues about the nature of the processes affected.
In their review of these studies, Laties & Weiss (1967) conclude that the size of drug
effects is related to amount of time subjects are required to work. Sleep deprivation
also enhances the magnitude of the changes. Laties & Weiss suggest that amphetamine
prevents the ‘inevitable’ drop in performance when subjects are fatigued. Thus, there
appear to be some parallels between the effects of stimulants on ADD-H children
and effects on fatigued adults. Laties and Weiss also cite evidence to prove that the
gains made did not ‘simply reflect a willingness to attempt more problems’. As in
our study, both productivity and accuracy improved in the drug condition.
No doubt, debate about the clinical significance of these stimulant-induced changes
will continue. Reviewers typically have pointed to failures to demonstrate long term
improvements and have drawn the conclusion that any short term changes are of
little importance. The short term changes have been dismissed as ‘readily attributable
to better attention during testing’ (Barkley & Cunningham, 1978) or as reflecting
changes in ‘performance rather than ability’ (Sroufe, 1975). Gittelman et al. (1983)
look at the changes they obtained from two perspectives. O n one hand, they describe
stimulants as improving ‘performance or the ability to apply mastered skills’ and
suggest that they ‘may not enhance learning or the acquisition of skills’ (p. 209).
On the other hand, they conclude that their findings support parents’ and teachers’
impressions that methylphenidate has a positive effect on academic performance. We
 METHYLPHENIDATE EFFECTS IN ADD-H 203
readily agree that improvements in our study and the other studies we have reviewed
reflect short-term changes. Indeed, our research design dramatically demonstrates
that the changes can be manipulated on a day-to-day basis. This is not sufficient reason,
however, to dismiss these changes as unimportant. ADD-H children are diagnosed
on the basis of their inattentive and impulsive behaviour and any intervention that
minimizes the impact of these symptoms on academic performance merits serious
consideration. In addition, our arithmetic tasks closely resemble examinations typically
used in the classroom. Moreover, the effects were evident in the children’s regular
classroom environment.

Cognitive tasks
The drug-induced increase in number of words produced on the classroom
administration of the word discovery task suggests that methylphenidate can also
improve the performance of ADD-H children on relatively complex cognitive tasks.
The medication appears to have strengthened such information processing strategies
as examining stimulus words carefully and considering them from several perspectives
in order to discover new words that can be constructed from them. There was also
a trend in the laboratory data suggesting that subjects spent more time trying to
produce additional words when they were receiving medication. Increased time on
this task may reflect increased persistence because, unlike the arithmetic tests in which
subjects know how many items they must complete, the word discovery task provides
no information about how many words it is possible to construct. Success on this
task probably requires a flexible cognitive set, sustained over the time required to
search exhaustively for words. Thus, our results do not support the hypothesis that
stimulants produce ‘overfocusing’ or ‘perseveration’ in ADD-H children (Robbins
& Sahakian, 1979; Sahakian & Robbins, 1977). Although Dyme, Sahakian, Golinko
& Rebe (1982) have published a small pilot study in support of this hypothesis, more
data are required. Also, these investigators used a high dose of methylphenidate (1 .O
mg/kg).
We believe that the sensitivity of our word discovery task was increased by the
training subjects received during screening. Our purpose was to minimize practice
effects and also to assure that children possessed necessary task skills. We could
probably improve the task further by increasing the length or number of stimulus
words.
Like the findings from our arithmetic tests, results from the word discovery tasks
extend the evidence for ‘ecologically valid’ changes reported by Pelham et al. (1982).
Pelham et al. studied stimulant effects in a laboratory classroom in which a contingency
management program was in effect. Our data were gathered under regular classroom
conditions. Solanto (1984) has suggested that earlier failures to find academic changes
may be attributable to the fact that stimulants do not improve the children’s ability
to respond differentially to relevant and irrelevant classroom stimuli of equal salience.
Our results do not support this hypothesis; in fact, results from the word discovery
task were stronger in the classroom environment.
There have been several other reports of stimulant-related improvements in ADD-H
children on cognitive tasks requiring relatively complex perceptual and conceptual
skills. Tasks on which positive findings have been reported include: the Raven
204 V. I. DOUGLAS ct al.

Progressive Matrices (Gittelman et al. 1983), visual scanning and matching tasks
(Campbell, Douglas & Morgenstern, 1971; Flintoff, Barron, Swanson, Ledlow &
Kingsbourne, 1982), tasks requiring visual search (Dykman, Ackerman & McCray,
1980), picture recognition (Sprague & Sleator, 1977), story recall (Rie & Rie, 1977),
and word recall and recognition tasks (Peeke, Halliday, Callaway, Prael & Reuss,
1984; Weingartner et al. 1980). In addition, Reid & Borkowski (1983) found stimulant
effects on several tasks they describe as assessing ‘information processing efficiency’.
Improvements on word recall and picture recognition tasks also have been found
in normal children (Rapoport et al. 1980; Weingartner et al. 1980; Werry & Aman,
1984). Interestingly, Weingartner et al. report qualitative differences in the drug-
induced changes observed in their normal and ADD-H groups and Werry and Aman
report that they obtained more dramatic improvement in ADD-H children than in
a control group of eneuretic children. Unfortunately, ethical considerations make it
difficult to pursue this issue of possible qualitative and quantitative differences in
the response of normal and ADD-H children to the stimulants.
Although we found no evidence of deleterious drug effects in our study, it is essential
to pursue this question further using more complex tasks and dosages higher than
0.3 mg/kg. Findings reported by Sprague and Sleator and their associates suggest
that dosages as high as 1.0 m g k g produce cognitive impairment (Brown & Sleator,
1979; Sprague & Sleator, 1977). Findings from the Sprague and Sleator study also
point to possible interactions between ‘information load’ and dosage level. Thus far,
results from other dose-response studies with ADD-H children in which moderately
complex tasks have been used provide only weak support for Sprague and Sleator’s
hypothesis. Peeke et al. (1984) compared the effects of placebo, 10 and 21 mg of
methylphenidate using a verbal recall and recognition task. They found inprovement
only on the lower dose. Pelham et al. (1980) report linear dose-response curves on
reading comprehension and arithmetic, with performance improving up to a dosage
of 0.6 mgkg; however there is a suggestion of a decline on one of their measure above
the 0.3 mg/kg dosage. Clearly, we need to know a good deal more about effects of
task demands, dosage level and the interaction between these variables.
Stimulant drug studies with adult subjects provide some support for the hypothesis
that beneficial effects of stimulants do not extend to complex tasks and there is some
evidence of adverse effects (Weiss & Laties, 1962; Laties & Weiss, 1967). Weitzner
(1965) found improved performance on a simple coding task, but not on a more
complex one. Smith, Weitzner, Levenson & Beecher (1963) obtained positive
amphetamine effects on a digit-letter coding task, but not on calculus problems. In
a study by Burns, House, Fensch & Miller (1967) amphetamine improved reaction
times when subjects simply had to press keys located in front of a series of lights when
the lights were turned on. When the keys were randomly assigned to different lights
so that subjects had to learn which key was associated with each light, there was a
trend toward poorer performance in subjects receiving amphetamine. Kornetsky (1958)
obtained no significant amphetamine effects on a similar task in normal adults.
Kornetsky, Mirsky, Kessler & Dorff (1959) found improved performance in sleep-
deprived adults. Andrews (1940) found no amphetamine effect on the solution of
syllogisms. Hecht & Sargent (1941) also failed to find effects on rate of solving
anagrams. At least superficially, the anagrams used by Hecht and Sargent appear
 METHYLPHENIDATE EFFECTS IN ADD-H 205
to tap cognitive processes similar to those assessed by our word discovery task.
Weiss & Laties (1962) caution, however, that many of these studies were
methodologically flawed. In the studies employing syllogisms and anagrams, for
example, the time allowed between ingestion of the drug and assessment of response
was not optimal for showing stimulant effects. Moreover, recent findings by Rapoport
et al. (1980) are considerably more positive. They report significant
dextroamphetamine-inducedimprovements on a word recall and recognition task in
both normal boys and men. Further research is clearly needed to resolve these
inconsistencies.

Learning acquisition tasks

Although investigators have referred to several of the tasks just discussed as learning
tasks, most do not require the acquisition of learning over repeated trials. Paired
associates tasks meet this criterion (Swanson, Barlow & Kinsbourne, 1979). Results
from our paired associates tasks demonstrate that ADD-H children establish
associations between pairs of unrelated words more effectively when they are receiving
methylphenidate. Thus, the medication helps correct the deficit on paired associates
learning reported by Benezra and Douglas (Benezra, 1980; Benezra & Douglas, in
preparation). Because scores on paired associates reflect a number of factors it is difficult
to define those that are responsible for the poor performance of ADD-H children
and the stimulant-induced improvements. However, data from the Benezra and
Douglas study of memory in ADD-H children provide some clues.
A paired associates task involving unrelated pairs of words proved to be one of the
few measures on which Benezra and Douglas found normal-ADD-H differences. Pairs
consisting of related pairs failed to discriminate between ADD-H and normal children.
Interviews with subjects to determine the strategies they used to remember the
unrelated words revealed less elaborative rehearsal in ADD-H children than in normals.
Also, significant differences were found between ADD-H and control children on
Trial 3 but not on Trials 1 or 2. Taken together, these results suggest that the
deficiencies of ADD-H children become more apparent when processing demands
are increased and when elaborative rehearsal is required (see also Weingartner et al.,
1980).
Drug-placebo differencies over learning trials in the present study parallel the pattern
of ADD-H-normal differencies found by Benezra and Douglas. The drug effect
reached statistical significance only on Trials 2 and 3, suggesting that beneficial effects
became more apparent as the children were confronted with increasing processing
demands. An analysis of the percentage of variance accounted for by each of the three
trials provides further support for this interpretation. Calculations based on the sums
of squares of scores in the drug and placebo conditions revealed that the percentage
of variance accounted for by drug effects over Trials 1, 2 and 3 was 18, 24 and 58 76
respectively. Conners & Eisenberg (1963) reported a similar pattern over trials on
a paired associates task; drug effects were significant only on the last block of trials.
Similar findings have been reported on a self-paced tracking task (Humphries,
Swanson, Kinsbourne & Yiu, 1979) and on a vigilance task (Sykes, Douglas &
Morgenstern, 1972, 1973).
Stimulant-induced improvements on a number of versions of paired associates tasks
206 V. I. DOUGLAS ef af.

have been reported by other investigations. Conners and his associates found significant
effects in early studies using samples of children from out-patient psychiatric clinics
(Conners & Eisenberg, 1963; Conners & Rothschild, 1968; Conners, Rothschild,
Eisenberg, Schwartz & Robinson, 1969). In a study with hyperactive children,
Gittelman-IUein (1975) report that stimulant-induced improvement on a paired
associates task correlated significantly with overall evaluations of improvement by
teachers and psychiatrists. In a later study they found no significanteffectson paired
associates in children described as having ‘learning lags’ (Gittelman-Klein & Klein,
1976). In an extension and replication of the second study, Gittelman et al. (1983)
again failed to obtain a drug effect in children with learning problems. A number
of investigators have used variations of a paired associates task developed by Swanson
& Kinsbourne (1976). Improvements in acquisition scores were reported by Gan &
Cantwell (1982), Shea (1982) and Swanson & Kinsbourne (1976); however,
Steinhausen & Kreuzer (1981) and Stephens et al. (1984) failed to find significant
effects.
The paired associates technique also has been used to assess stimulant-induced
changes in adults. Laties and Weiss cite a study by Weitzner (1965) as being ‘the
first umambiguous demonstration that amphetamines can improve verbal learning’
(Laties & Weiss, 1967, p. 805). This finding conflicts with the assumption that positive
effects in adults are limited to simple or repetitive tasks. Recently, however, Wetzel,
Squire & Janowsky (1981) reported a decrease in learning acquisition with
methylphenidate. It is noteworthy that this effect was found only at the highest dose
used in the study (0.5 mg/kg).
Some reviewers have downplayed the importance of changes on paired associates
by emphasizing the rote nature of the learning involved (Sroufe, 1975). On the other
hand, paired associates scores correlate with academic measures (Stevenson, 1972)
and learning in the classroom frequently involves rote associations. Also, our paired
associates task required relatively complex rehearsal strategies. Clearly, the crucial
issue of stimulant effects on learning should be investigated using a wide variety of
learning tasks.
In reporting our results on paired associates we have discussed only drug effects
on acquisition. Additional data assessing effects on retention, retrieval and re-learning
and the issue of state-dependencywill be discussed in a later paper. All of these aspects
must be thoroughly investigated before conclusions can be reached about the long
term impact of stimulants on learning.

Behavioral measures
The highly significant differences obtained on examiners’ and teachers’ ratings
on the Hyperactivity Index of the Conners Rating Scales demonstrate that cognitive,
academic and learning changes produced by stimulant medication are accompanied
by a reduction in disruptive behaviors both during individual testing and in the
classroom. Results from our effort ratings confirm that observable changes in the
deployment of effort also occur. Correlation data demonstrating the relationship
between drug-induced changes on behavioral and other measures will be reported
in a future paper.
 METHYLPHENIDATE EFFECTS IN ADD-H 207

CONCLUSIONS

Results from the present study, together with other findings reviewed, demonstrate
stimulant-induced improvements in ADD-H children across a wide range of academic,
learning, cognitive and behavioral measures. Changes in our study were observed
in the laboratory and in the classroom. Clearly, early reviewers underestimated the
potential benefits of stimulants in ADD-H. Demonstration of these effects requires
sensitive assessment instruments and careful control of a number of methodological
variables. The effects can be observed on a day-to-day basis as the children are shifted
from placebo to drug.
Beneficial effects extend beyond improving test-taking attitudes, increasing on-task
behaviors or facilitating vigilance. Self-regulatory behaviors involving organized and
sustained deployment of mental effort, accurate and efficient information processing
and correction of one’s own errors are also implicated.
There appear to be both similarities and subtle qualitative and quantitative
differences between the stimulant-induced changes observed in ADD-H children and
normal children and adults. Also, the medication frequently fails to bring the
performance of ADD-H children up to normal levels. We agree that similarities in
the changes that have been observed in ADD-H and normal subjects disprove the
notion that the response of ADD-H children to the stimulants is paradoxical. We
do not believe, however that these findings rule out constitutional explanations of
the disorder. Rather, they emphasize the need for a neuropsychological model that
can account for the responses of both ADD-H and normal individuals.
The fact that amphetamine-induced improvements in normal adults frequently are
found under conditions involving fatigue, boredom, or low motivation (Laties & Weiss,
1967) makes it tempting to speculate that ADD-H children typically perform as if
they were in a bored, fatigued, or unmotivated state. Other authors have made similar
suggestions (Solanto, 1984; Zentall & Zentall, 1983). Suggestions that the children
show low levels of instrinsic motivation also recur in the research and clinical literature
(Douglas, 1983; Wender, 1971).
However, findings from adult studies establish that stimulants ‘do more than merely
restore performance degraded by factors such as muscular fatigue, sleep deprivation,
and boredom’ (Weiss & Laties, 1962, p. 32). Significant stimulant effects in normal
adults performing under normal conditions confirm an intuitively obvious fact: people
seldom work at the limit of their capabilities. One need only assume that the
discrepancy between capability and output is greater in ADD-H children than in
normal individuals and that stimulants act to decrease this discrepancy. Douglas (in
press) has speculated that this effect is mediated through central self-regulatory
processes.
It is sobering that, after so many years of research on stimulant medication in ADD-
H and normal individuals, most of the results must be discarded because of conceptual
and methodological errors. The new findings of stimulant-induced improvements in
short term studies also cast doubt on reviewers’ conclusions that the drugs have no
long term effects on learning and academic performance. As Pelham (in press) has
argued, long term studies have been so severly flawed by methodological shortcomings
that little confidence can be placed in them. Even if investigators institute
208 V. I. DOUGLAS ct al.

methodological improvements, however, long term investigations will continue to

be plagued by variables over which researchers have little control. Before undertaking
further costly long term studies, brief assessments could be used to explore such critical
questions as the effects of stimulants on the acquisition, retention and retrieval of
learning and the interactions between dosage levels and such task characteristics as
interest value, duration and complexity.

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