Selected Abstracts from Pediatrics

This Journal and Pediatrics are collaborating to provide readers with selectedabstracts of papers from each other's journals which might not ordinarily bereadily available to our respective readers, Dr. Robert .J. Haggerty, Editor ofPediatrics, sends us prepublication abstracts of articles to appear in his journal, andwe do thl' same fill' him with our abstracts, enabling us both to select abstracts ofinterest to our readers and to publish them at approximately the same time thatthe paper appears in the journal of origin. The first Journal abstracts appearedin Pediatrics, September 1978 (62:3), and the Pediatrics abstracts appear in thisissue of the journal.

Melvin Lewis, M.D., Editor

Sheldon Wolf and Alan Forsythe, Behavior disturbance, phenobarbitol, andfebrile seizures (61 :728-731, 1978).

Of 109 children treated daily with phc-nobarbitol followiug the first febrile convul­sion, 42% developed a behavior disorder, usually hyperactivity. Daily phenobar­bitoltherapy was prematurely discontinued in 54% of the children with behaviorabnormality (20% of those treated). The behavior disturbance usually appearedwithin several months, was not correlated with high blood barbiturate levels, dis­appeard in 73%, and improved in all children when barbiturate therapy wasdiscontinued. No characteristics of the child, the initial febrile seizure, or recur­rence of febrile seizures were significantly correlated with the occurrence of thebehavior disorder, except for behavioral abnormality preceding the initial febrileconvulsion.

Of the children who received no phenobarbital 18% developed behavior disor­der, most often hyperactivity. The behavior disturbance spontaneously disap­peared in 52%. Among these children not given phenobarbital, the group withnormal behavior had a greater frequency of family history of seizures, especiallyfebrile convulsions, and a lower frequency of prcseizurc behavior disturbance;abnormalities of pregnancy, labor, delivery, and neonatal period; delayed mile­stones; long seizures; abnormal results of neurological examination; abnormalEEG; and recurrent febrile seizures.

.J. Ivan Williams, Douglas M. Cram, Frances T. Tausig, and Evelyn Webster,Relative effects of drug and diet on hyperactive behaviors: an experimentalstudy (61:811-817, 1978).

In a test of Feingold's hypothesis that food additives trigger the hyperactive re­sponse, 26 hyperactive children were randomly assigned to treatment conditionswhereby they were given active or placebo medications in combination with chal­lenge cookies with artificial food colors or control cookies without the additives.The children were crossed over into each of the four treatment conditions andexperimental procedures were employed, including double-blind assessmentsthrough the completion of behavior checklists, by teachers and parents.

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196 Selected Abstracts from Pediatrics

Stimulant medications were clearly more effective than diet in reducinghyperactive behavior. The parent ratings indicate strong drug effects and incon­clusive diet effects. Drug effects are marked in teacher ratings as well. However,when the children were receiving placebos, their hyperactive behaviors in theclassroom were greater when eating cookies with artificial colors than when eatingcookies without artificial colors.

According to the ratings, approximately seven children were no longer hyperac­tive. There is evidence to suggest that the behavior of three to eight children wasdiet-responsive. depending on the criteria used. There is evidence, particularly inteacher ratings, in support of Feingold's hypothesis if it is modified.

Further research is required to specify which subtypes of hyperactive childrenrespond to a diet free of artificial food colors.

Barbara M. Korsch, Richard N. Fine, and Vida Negrete, Noncompliance in chil-dren with renal transplants (61 :872-876, 1978).

Fourteen patients (13 of them adolescents) interrupted immunosuppressivetreatment following renal transplantation. There were 12 girls and 2 boys. Sixsubsequently lost their allografts and eight had impaired renal function. Non­compliance was suspected when diminution in cushingoid features, unexplainedweight loss, or changes in renal function occurred. Noncompliance was confirmedby interview with psychosocial staff.

Available psychosocial data from family interview and personality tests obtainedearlier as part of systematic follow-up study were analyzed to explore the reasonsfor noncompliance. Noncompliant patient families had lower incomes, morefatherless households, and communication difficulties within the family and withthe medical establishment. Using a stepwise discriminant analysis, a discriminantfunction was derived which selected 13 of 14 noncompliant patients.

Noncompliance may be a preventable cause of allograft failure. These data canaid in identifying high-risk patients and planning intervention programs.

Sara Sparrow and Edward Zigler, Evaluation of a patterning treatment for re­tarded children (62: 137-150, 1978).

Three groups, each with 15 seriously retarded institutionalized children, wereemployed to evaluate a modification of the sensorimotor patterning treatmentdeveloped at the Institutes for the Achievement of Human Potential (lAHP). Thetreatment group received a program modeled after the IAHP methods for ap­proximately two hours per day, five days per week, for one year. For the samelength of time, a matched motivational control group participated in activities withfoster grandparents designed to create positive, success-oriented interactions toimprove self-esteem and feelings of efficacy. A no-treatment group continued toreceive the standard care of the institution, which was enlightened and resident­oriented. A wide variety of behavioral measures was employed, including theIAHF Developmental Profile, IQ. motor and language development scales, andmeasures of affective. social, and maladaptive behaviors. On the majority of themeasures. there were no differences in posttest performance among any of thethree groups. In no case did the pattern of change of the treatment group differfrom that of its crucial comparison, the motivation group. However. all threegroups showed some improvement in performance between the beginning andend of the study. It W'lS concluded that the patterning treatment investigated bythis study cannot be recommended for seriously retarded children.