Academic journal article Exceptional Children

Effect of Stimulant Medication on Children with Attention Deficit Disorder: A "Review of Reviews."

Academic journal article Exceptional Children

Effect of Stimulant Medication on Children with Attention Deficit Disorder: A "Review of Reviews."

Article excerpt

* An enormous scientific literature exists on the use of stimulant medication to treat children with attention deficit disorder (ADD). We provide an overview of the efforts of the University of California, Irvine (UCI), ADD Center to perform a research synthesis to locate this literature, describe it, and distill the panorama of findings and recommendations down to a manageable set of generalizations. Because of the number of excellent reviews on the effects of stimulants on children with ADD, the UCI ADD Center decided that yet another review would have limited impact. The state of the literature called for a "review of reviews" of original work published between 1937 and 1993, instead of the usual review of published articles reporting original research.

We first describe our strategy of reviewing existing review articles. Next, we compare three reviews selected from each of three different categories: (a) traditional narration descriptive reviews, (b) meta-analyses, and (c) general public reviews. Then we present conclusions that can be drawn from more recent reviews of research on stimulant medication and discuss limitations in the literature and current critical issues. (For our final report, see Swanson, 1993.)

METHODOLOGY

Our methodology was complex and is described in detail elsewhere (Swanson, 1993). Briefly, we adapted integrative review methodology described by Cooper (1989), and we used a liberal definition of a "review" paper. We combined a list of reviews located by "invisible college" (expert) recommendations and reviews located by an "ancestral" search of their citation lists with a list of reviews located by a simultaneous parallel computer search of four electronic databases in medical (Medline), educational (ERIC), psychological (PsycInfo), and government (GPO) publication arenas.

The electronic search identified 183 reviews. The expert search identified 245 reviews. Of the combined 428 retrievals, only 87 reviews were identified by both search strategies, resulting in 341 unique reviews with a search-strategy overlap of 26% (87/34 1). The electronic search failed to identify 158 reviews located by the primary approach (reviews and citations derived from the "invisible college" of experts). This represented 46% of the dual-search total and 64% of the expert-search total. The primary approach failed to identify 96 reviews that were retrieved by the electronic search, and this represented 28% of the dual-search total and 52% of the electronic-search total. Thus, the dual-search strategy was important for defining a broad review literature to be reviewed. Either of the single-method strategies would have missed a significant percentage of the 341 sources. Psychologists and physicians then evaluated each of the review documents on a list of variables, including several derived from Cooper's (1988) taxonomy of reviews. As we demonstrate here, differences in the taxonomy variables of Focus, Goal, Perspective, Coverage, Organization, and Audience often were associated with differences in the reviews' conclusions.

TRADITIONAL REVIEWS

Three influential reviews using traditional narrative-descriptive methodology were published in the late 1970s: Whalen and Henker (1976), Barkley (1977), and Adelman and Compas (1977). The traditional reviews show a surprising consensus about the actual effects of stimulant medication on children with ADD. First, they agreed that in a majority (about 75%) of cases, treatment with stimulant medication produces immediate and dramatic positive changes in parent and teacher perceptions and improvements in performance on tests requiring concentration and attention. Second, they acknowledged that placebo and expectancy effects, as well as pharmacological effects, contribute to the perceived positive effects of stimulants on children. Third, the reviews agreed that the short-term perceived positive change cannot be predicted by premedication physiological or psychological profiles of the children being treated. …

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