Educators at the UCLA Neuropsychiatric Hospital and Inpatient School, Los Angeles, CA, and the Division of Special Education, University of Iowa, I0, discuss the issues in child psychopharmacology that are of importance to teachers and stress the need for greater interdisciplinary collaboration between the medical profession and the schools. The beneficial and adverse classroom effects of four major classes of psychotropic medication are discussed: 1) CNS stimulants; 2) anticonvulsants; 3) neuroleptics or antipsychotics; and 4) antidepressants.

A so-called “metanalysis” of available research data by special educators involved 135 studies of stimulant medications used for treatment of hyperactivity. Benefits were demonstrated not only in attention and memory but also in academic performance. Children on stimulants gained the equivalent of a 15% rank increase in achievement while those treated with major tranquilizers for severe behavior disorders showed a 20% rank increase on various cognitive measures. Other metanalyses of certain classroom interventions such as perceptual motor training or diet treatments resulted in gains of only 5 or 6 percentile ranks. The authors allude to an antimedication bias and the application of different standards to drug studies compared to other classroom intervention techniques. Little systematic data on side-effects of medication were available in the studies analyzed.

Studies of antidepressants were limited and few had valid educational variables or measures suited to the classroom performance. One study demonstrated the importance of interpretation of behavior of children on medication in light of behavior of other untreated children in the classroom. What appeared to be significant effects of medication was actually a reflection of the overall disruptive or inattentive behavior of the whole classroom. [1]

COMMENT. The pressures of clinical practice sometimes preclude physicians' visits to schools and close collaboration with patients' teachers. The point of this report is that as pediatricians, neurologists and psychiatrists increase their use of psychopharmacological agents, teachers must have increased access to information about the classroom effects and side-effects of these medications. Medical researchers are not always aware of the possible problems that drug treatments may present in classroom situations, and regular reports from teachers can provide valuable information regarding their overall effects.