Ratings of medication effects in hyperactive children: Viable or vulnerable?

Because of their practicality, availability, and adaptability, rating scales serve a pivotal role in the evaluation of child therapies. It is rarely possible or even desirable, however, to obtain ratings from objective and uninvolved respondents throughout the course of treatment. The two studies reported here examined how ratings of attention deficit-hyperactive children are influenced by knowledge about treatment effects and familiarity with the children. In Study 1, scores provided by naive raters were compared with scores provided by staff raters during double-blind medication assessments. The comparisons yielded highly similar methylphenidate (Ritalin) effects, with both rater types detecting clear placeborelated increases in behavior problems and medication-related increases in dysphoria. This strong concordance in the detection of treatment effects was accompanied, however, by small but significant differences in absolute scores, with the staff providing more positive scores than the naive raters. Study 2, which followed similar procedures with different raters and children, replicated the Study 1 findings. Discussion focused on distinctions between the use of ratings for absolute versus relative purposes, that is, for diagnostic and subject selection decisions, on the one hand, versus treatment evaluations on the other. Also discussed were the compatibility of research and clinical methodologies and the effects of medication on internalizing as well as externalizing dimensions of behavior.