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Insulin tolerance tests (ITT) were carried out in 46 drug-free prepubertal children. Thirteen met unmodified Research Diagnostic Criteria (RDC) for major depressive disorder, definite endogenous subtype. Seventeen were classified as nonendogenous major depressive disorder and 16 as nondepressed neurotic disorder (DSM-III). During the depressive episode, depressed children showed no difference from those with neurotic disorders or between depressive subgroups on baseline and ITT-stimulated levels of cortisol or prolactin. On full recovery from depression, ITT-stimulated levels of prolactin and cortisol were unchanged but baseline prolactin and cortisol were elevated in the endogenous subgroup with respect to other groups. These largely negative results contrast with persistently impaired growth hormone responses to the same test reported elsewhere, both during the depressive episode and during recovery.

The Psychosocial Schedule (PSS) is an instrument derived from several pre-existing rating scales, which was designed to measure and record clinical data (other than the symptoms of the present episode of disorder) which are likely to be relevant to child psychiatric disorder. These data include: developmental and past symptomatic history, demographics, family functioning, and relationships. Reliability was tested by interrater and test-retest designs with mothers of prepubertal children. Overall, the instrument appeared to be quite reliable. Although it is subject to minor modifications, especially for use with adolescents, it is concluded that the PSS is a practical instrument which should be tested now in adolescents, and can be utilized in future studies with prepubertal subjects.

A study is in progress to examine the relationship between clinical response to imipramine (IMI) of prepubertal major depressive disorder at 5 weeks and plasma levels of IMI and its metabolite desmethylimipramine (DMI). Data are presented on the first 13 children in the study. A strong correlation is emerging in nondelusional subjects between total plasma level and clinical response. A total plasma level of 146 ng/ml separates respondent from nonresponders. These data parallel those previously reported in adult major depressive disorder by several investigators.

A group of 13 prepubertal children fitting unmodified Research Diagnostic Criteria for major depressive disorder in adults was identified. The clinical characteristics of the group are described as well as the results of an open trial of imipramine. Pilot data from this study point to the possibility that adult and prepubertal major depressive disorders are basically the same illness occurring at different points in development.

The Kiddie-SADS-E is a structured psychiatric interview designed to elicit and record past episodes of child and adolescent psychiatric disorder. In order to test the accuracy of retrospective diagnoses made with this instrument, a blind interviewer reassessed 17 children. The children had been initially evaluated with a parallel instrument, the K-SADS-P (present episode), between 6 months and 2 years prior to reassessment. Diagnostic agreement between the two different assessments of the same episode of disorder was high. Although this is only a pilot study, it does suggest that the retrospective assessment of child psychopathology based on interviews with parent and child may be a technique capable of yielding reliable information.

Growth patterns in previously unmedicated hyperactive boys were assessed monthly for 1 year or more while they received treatment with d-amphetamine (N = 13) or phenothiazines (N = 8). The d-amphetamine group, who sustained their behavior improvement throughout the study, underwent sleep and endocrine studies before and after 6 months on drug therapy. By 1 year, the phenothiazine group had achieved a 7-point increase in weight percentile and a 4-percentile gain in height, but the d-amphetamine group had lost 16 percentile points in weight and 10 percentile points in height. Height and weight velocities had fallen significantly (p

A prospective study of growth was undertaken in two groups of hyperkinetic children: a d-amphetamine-treated (index) group and a phenothiazine-treated (control) group. This study was coupled with longitudinal overnight sleep-endocrine assessments in the index group. At the end of the first year seven index subjects have been studied for growth and sleep-endocrine measures and eight control subjects have been studied for growth changes only. The significant findings are: (1) growth retardation in the index group; (2) inhibition of mean sleep-related prolactin secretion; (3) a highly significant correlation between loss of expected height percentile during the first year and decrease of mean sleep related prolactin at 6 months, as compared to baseline. These findings suggest that growth inhibition secondary to chronic d-amphetamine administration in hyperkinetic children might be mediated by inhibition of prolactin secretion.

Growth patterns in eight previously unmedicated hyperactive boys were assessed monthly for 1 year while they showed behavioral improvement on a mean methylphenidate dose level of 1.3 mg/kg/day. The group lost 13 weight percentile points and 3 height percentile points. Although weight velocity fell significantly ( p