Search PubMed⌕ Search

Biomedical subjects

D J Safer

Publications and source records attributed to D J Safer.

At least 37 records · Page 2Linked to original sources
PubMed1995

An outpatient/inpatient comparison of child psychiatric diagnosis.

A chart review was undertaken in three community mental health centers and an emergency room to compare psychiatric diagnoses given to youths as outpatients with those they had previously received as inpatients. Major disparities between the two sets of diagnoses were evident. A profound underdiagnosis of conduct disorder and a selective overdiagnosis of unipolar depression occurred in hospitals. Implications of the findings are discussed.

Adolescent↗
PubMed1994

The increased rate of stimulant treatment for hyperactive/inattentive students in secondary schools.

OBJECTIVE: To describe trends in medication use for hyperactive/inattentive (HA/I) secondary school students from 1975 through 1993 and to present differences in the treatment of HA/I relative to school grade. DESIGN: A comprehensive survey of the HA/I treatment of public elementary and secondary school students has been conducted biennially by school nurses in Baltimore County, MD since 1975. RESULTS: Although only 11% of all public school students on medication for HA/I were in secondary schools in 1975, the proportion gradually rose such that in the 1990s, 30% of all medicated students were attending secondary schools. Also in secondary schools, the gender ratio for students on medication for HA/I narrowed from a 1:12 female/male ratio in 1981 to a 1:6 female/male ratio in 1993. CONCLUSIONS: Many more elementary school students are now remaining on stimulant medication for HA/I into their teens. Compared with a decade ago, relatively more girls are on stimulant treatment for HA/I during their secondary school years.

Adolescent↗
PubMed1992

Effect of a media blitz and a threatened lawsuit on stimulant treatment.

OBJECTIVE: To enumerate and evaluate changes in the rate of medication treatment for hyperactive/inattentive students subsequent to negative media publicity about methylphenidate (Ritalin) and related lawsuits threatened or initiated from late 1987 to early 1989. DESIGN: Biennial 1971 to 1991 school nurse surveys of medication treatment for hyperactive/inattentive students; a 1989 school nurse questionnaire on parent attitudes about medication; annual 1984 through 1991 hyperkinetic clinic treatment data; annual 1986 through 1990 Drug Enforcement Administration estimates of retail sales of methylphenidate, nationally and locally. PRIMARY SETTING: All public and private elementary and secondary schools in Baltimore County, Maryland. PATIENTS: Students receiving medication for hyperactivity/inattentiveness. RESULTS: Whereas the medication rate for the treatment of hyperactive/inattentive students in Baltimore County doubled every 4 to 7 years from 1971 through 1987, it declined 39% in the 1989 and 1991 surveys from its 1987 peak. This drop occurred after the 1987 through 1989 media blitz against methylphenidate and after a well-publicized threatened lawsuit locally. Parents became fearful of media-reported medication "side effects" and school staff hesitated to refer restless, impulsive, and inattentive students to physicians. Most inhibited from the prospect of medication treatment were less affluent parents and parents of hyperactive/inattentive elementary schoolchildren who had never received medication. Drug Enforcement Administration data revealed that the Baltimore metropolitan area had a far greater decline in methylphenidate use than that which occurred nationally. CONCLUSION: Strong circumstantial evidence suggests that the prominent 1989 and 1991 declines in the initiation of stimulant medication for hyperactive/inattentive students were related to the apprehension of parents and involved professionals generated by the methylphenidate media blitz and the threatened lawsuit.

Baltimore↗
PubMed1991

Diet, behavior modification, and exercise: a review of obesity treatments from a long-term perspective.

Reviewed herein are the long-term weight loss outcomes of three fairly recent major modifications of standard dietary therapy for obesity. Appraised separately and in combination, these therapeutic approaches are very low calorie diets (VLCD), behavior modification, and exercise. The weight loss results from VLCD are impressive for only the first 6 to 10 months. Adding behavioral procedures to VLCD increases the weight loss for the first year or two, but not in 3 to 5 years. Adding exercise further increases the weight loss at 1 to 2 years, and those who continue regular exercise achieve the best weight loss results 1 to 6 years later.

Behavior Therapy↗
PubMed1989

Absence of tolerance to the behavioral effects of methylphenidate in hyperactive and inattentive children.

To determine whether the behavioral benefits of methylphenidate in hyperactive and inattentive children decline during long-term treatment, we analyzed data from 108 hyperactive students who responded well to methylphenidate therapy for 3 to 10 years. Responders were identified by their consistent improvement from baseline on standard teacher rating scales. The therapeutically effective drug doses were corrected for body size and evaluated in relation to increasing age and treatment duration. Body size corrections included milligrams per kilogram, milligrams per kilogram to the 0.7th power, and milligrams per square meter of estimated body surface area. The major findings were that (1) the dose of methylphenidate, when adjusted for growth, did not change significantly during the 3 to 10 years of treatment; (2) the loss of a previously satisfactory response to methylphenidate treatment was uncommon (6%) and when present was related to middle school enrollment, male gender, noncompliance with medication, and lower than customary dosage; (3) the dose calculations that minimized the effects of growth with age were milligrams per kilogram to the 0.7th power and milligrams per square meter of estimated body surface area; and (4) the commonly used milligrams per kilogram dose consistently overcorrected for growth with advancing age.

Attention Deficit Disorder with Hyperactivity↗
PubMed1988

A survey of medication treatment for hyperactive/inattentive students.

Since 1971, the Baltimore County Health Department has conducted nine biannual surveys of school nurses in all of the county's public and private schools to determine the prevalence of medication treatment for hyperactivity/inattentiveness among students. The results reveal a consistent doubling of the rate of medication treatment for hyperactive/inattentive students every four to seven years such that in 1987, 5.96% of all public elementary school students were receiving such treatment. Related trends from 1971 to 1987 have been that stimulants increased from 76% to 99% of the medication prescribed; methylphenidate hydrochloride rose from 40% to 93% of the total; the male-female ratio dropped from an average of 8:1 to 5:1; the rate of medication treatment for hyperactive/inattentive students rose faster in secondary than in elementary schools; and 25% of students receiving stimulant medication in 1987 were in special education classes or schools.

Adolescent↗
PubMed1987

Substance abuse by young adult chronic patients.

Of 41 chronic psychiatric patients between the ages of 19 to 39 seen at a community mental health center, 44 percent were current substance abusers, 29 percent had a history of substance abuse, and only 27 percent had little or no substance abuse history. The three subgroups were similar in diagnosis, gender, and age at first hospitalization. However, the persistent substance abusers had a psychiatric hospitalization rate more than twice as high as the other two groups, and for these patients substance abuse frequently preceded hospitalization. The author recommends that consideration be given to routinely testing all hospitalized young adult chronic patients for drug and alcohol abuse. He also suggests using outside sources to obtain information on substance abuse, since most patients deny abuse. He stresses the need for more data on the physical and psychological effects of abused substances on the young mental patient.

Adult↗
PubMed1983

Trends in medication treatment of hyperactive school children. Results of six biannual surveys.

In biannual school surveys from 1971 through 1981, it was found that the rate of medication treatment of hyperactive students increased two- to threefold over the decade. This increase applied similarly to parochial, public elementary, and public middle/junior high school students. Other findings over the decade include the following: methylphenidate use increased from 40 per cent to 91 per cent of all the medication prescribed for hyperactivity, administration of medication for hyperactivity in the school increased from 61 per cent to 87 per cent of the total, and the number treated with medication prescribed by the family doctor decreased from 98 per cent to 59 per cent. Noteworthy findings in 1981 were as follows: 19 per cent of public elementary school students in special education classes were treated with medication for hyperactivity; hyperactive students in middle/junior high school had received medication treatment for an average of five to six years; the most common school period of medication use was grades one through four; entrance into first grade and secondary school corresponded to an increased use of medication for hyperactivity; and female, relative to male, students were treated with medication for hyperactivity less often than would be expected in teacher surveys of classroom hyperactivity, a finding particularly striking in middle/junior high school.

Age Factors↗
PubMed1981

A behavioral program for disruptive Junior High school students: results and follow-up.

The 5-year annual and 4-year follow-up results of a collaborative community mental health center--junior high school program for disruptive students are presented. The program is a comprehensive, behavioral, in-school, regular education project characterized by a token economy, parent contracting, major subjects taught in the morning, small class enrollment, small group and individualized instruction, an early release from school contingency option and frequent parent-school communications. Annual controlled outcome results revealed that the program led to significant and consistent reductions in expulsions, suspensions, and grade failure, and variable, often significant, gains in attendance and achievement. Follow-up findings indicated that former program students in senior high school achieved a significantly higher entry rate, greater attendance, better classroom conduct, and a lower frequency of withdrawal from school.

Achievement↗
PubMed1976

A motivational environment for behaviorally deviant junior high school students.

A contingency management program was established in a junior high school to better manage and educate students having histories of severe misconduct. School administration selected 46 eighth-graders having multiple suspensions for misbehavior. Students (N = 32) in two of the schools remained in traditional programs, serving as controls, whereas students (N = 14) in the third school participated in a token reinforcement program. Reinforcers provided in the afternoon were contingent upon achievement and discipline during morning academic periods. Home-based reinforcers were established to support school behavior. Compared with the control group, significant reductions in negative school behavior as well as greater increases in academic achievement were obtained for the treatment group, thus supporting the efficacy of contingency management for adolescents school misbehavior.

Behavior Therapy↗
PubMed1975

Growth rebound after termination of stimulant drugs.

To explore further the report of an accelerated weight gain following termination of treatment with a stimulant drug, 66 biannual growth measurements were obtained from 1970 to 1973 on hyperactive schoolchildren who were receiving medication. All received either dextroamphetamine or methylphenidate during the school year; some also received it during the summer. The data revealed that those whose stimulant medication was terminated at the start of summer subsequently grew in weight and height at a significantly greater rate than those who continued to receive medication from June to September. In fact, discontinuance of the medication resulted in a growth rebound for this period which was 15-68% above the age-expected increment.

Adolescent↗
PubMed1975

Stimulant drug treatment of hyperactive adolescents.

The characteristics and classroom behavior changes of hyperactive (HA) school children treated with stimulants during the years, 1969-1974, were evaluated in relation to the age of the child. Fourteen children who began taking stimulants before age 8 were compared to 11 who were initiated on stimulant treatment at age 13-16. Next, 13 children who continued on stimulants into their teens were studied to compare their pre-teen with their teenage drug response. The major findings were: 1) The therapeutic response of stimulants for hyperactivity did not significantly change from age 6 to age 16. 2) Pre-treatment teacher ratings indicated that as a group, teenage HA children were as inattentive as younger HA children, but less aggressive and overactive. 3) The mean dose of stimulant medication to achieve a successful classroom response for school age HA children did not significantly increase with age. 4) Parental resistances to stimulants were not related to the age of the HA child, but behavioral resistances by the child increased significantly during the teens. 5) There were no reports of abuse of stimulants by HA teenagers.

Adolescent↗