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Although short-term hospitalization has been shown to be effective in helping severely impaired psychiatric patients improve, such improvement is for some only temporary. Young, treatment-refractory patients who have failed to respond to previous brief hospitalization and outpatient treatments may benefit more from longer-term hospitalization. The authors report on a three-and-a-half-year follow-up study of 55 young adult and adolescent treatment-refractory inpatients after long-term hospitalization. Significant improvements in recidivism, quality of life, and overall functioning were found between discharge and the follow-up assessment. The authors conclude that potential benefits of long-term hospitalization for this subgroup warrant further empirical study.

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Lumbar cerebrospinal fluid (CSF) was obtained from children during and following treatment for acute lymphoblastic leukemia (ALL). One hundred ninety-two CSF samples from 50 subjects, which were selected to minimize the effects of the disease and its treatment (i.e., to approach "normality" as closely as possible), were analyzed for the monoamine precursors tyrosine (Tyr) and tryptophan (Trp) and the metabolites homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA). Levels of HVA (p less than 0.0001), 5-HIAA (p less than 0.002), and Tyr (p less than 0.05) decreased with age from 3 to 17 years. Significant correlations were observed between the acid metabolites HVA and 5-HIAA (r = 0.79) and between the amino acid precursors Tyr and Trp (r = 0.71). Within individuals, levels of all four compounds were relatively stable over time, with total mean coefficient of variation ranging from 20% to 25%. No significant sex differences for CSF levels of HVA, 5-HIAA, Tyr, or Trp were found. Assessment of CSF monoamine precursors and metabolites in children treated for ALL may provide a method for understanding the chronic effect of CNS trauma on the ontogeny of monoamine systems.

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CAT scans were performed in 66 patients with neuropsychiatric disorders of childhood (infantile autism, attention deficit disorder, Tourette's disorder, and language disorder) and a control group of 20 medical patients. Ventricular volume and brain density were determined by quantitative, computer-based methods by researchers blind to the patients' diagnoses. There were no significant differences among diagnostic groups or between neuropsychiatric patients and medical control patients in total ventricular volume, right-left ventricular volume ratio, ventricular asymmetries, ventricle-brain ratios, or brain density.

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Thirteen patients with Gilles de la Tourette's syndrome were treated with clonidine (0.125 to 0.3 mg/d) for at least 60 weeks. In a single-blind, placebo-controlled trial, 6 of the 13 patients were judged to be unequivocal responders to clonidine, and 6 other patients had an equivocal response. There was significant improvement in motor and phonic tics, as well as in associated behavior problems, and there were no serious side effects. Tolerance to clonidine did not develop. Further placebo-controlled, randomized, double-blind studies of clonidine in Tourette's syndrome are needed to establish the drug's efficacy.

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Whole blood serotonin (WB5HT) and tryptophan (WBTRP) levels were studied in 20 patients (aged 8 to 45 years) with Tourette's disorder under medication-free baseline conditions and following acute and chronic clonidine treatment. Compared to 87 normal controls, Tourette's disorder patients had lower mean baseline WBTRP levels (mean +/- SEM: Tourette's, 5993 +/- 304 ng/ml vs. 6822 +/- 169 ng/ml; p less than .03). No significant differences in mean baseline WB5HT levels were found. Three hours after an acute dose of clonidine (2.5 - 5.1 micrograms/kg, p.o. at 9:00 A.M.), no mean differences were observed (baseline vs. post 3 hours) in WB5HT or WBTRP levels. However, following chronic treatment (greater than 3 weeks) with clonidine (3-8 micrograms/kg/day, p.o.), WB5HT levels were increased in 9 of 14 Tourette's disorder patients. The mean increases in WB5HT levels following chronic clonidine treatment were significant when WB5HT levels were expressed per 10(9) platelets. (mean +/- SEM: baseline, 471 +/- 45 ng/10(9) platelets vs. chronic, 697 +/- 82 ng/10(9) platelets, p = .02). No mean differences in WBTRP levels were observed after chronic clonidine treatment. These findings are discussed in light of a proposed intermediary role of 5HT systems in the mode of action of clonidine in the treatment of Tourette's disorder.

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A battery of 37 tasks was assembled for neuropsychiatric assessment of cognitive functioning, motor control, perceptual abilities, vigilance, and neuromaturational status. In order to determine developmental changes within a normal population, a test battery was administered to 90 middle-class grade school children (50 boys and 40 girls), who ranged in age from 4 to 14. Statistical assessment of left- and right-handed differences produced only one significant finding, which was probably due to environmental adaptation. The only clear sex difference indicated a gross motor advantage for boys walking backward on the balance beam. All 37 tests correlated with age--with true value correlations ranging from .39 to .87.

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Perceptual, motor, and neuromaturational competence were assessed using a battery of tasks with three groups of children with diagnosed disorders of Tourette's syndrome (TS), attentional deficit with no known organic substrate (Constitutional AD), and attentional deficit disorder in children with epilepsy (E-ADD). The purpose was to determine how the three groups related to each other on these measures and to establish clinical validation of the test battery. As predicted, the control and the TS groups did much better than the ADD and seizure groups. The TS group differed from the controls on only a handful of measures, whereas the constitutional ADD and E-ADD children were far more deviant than the TS children. The E-ADD children as a group suffered difficulties in virtually every area.

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