My experiences in practice during the past ten years lead me to believe that "hyperactivity" is primarily an emotional problem. Currently, however, the diagnosis is often made-and drugs administered-on the basis of fragmentary information about the child's behavior and with little attempt to explore the child's inner state or the family relationships.
These statements are based on observations made while following up 290 children whose diagnosis was hyperactivity. I was the family pediatrician in these cases and, as such, was eventually admitted to the interior of the families. Additionally, I gathered school records for the children and medical records for most of the adult family members. This broad data base, combined with my long personal relationship with the families, is the basis for the conclusions I present here. I submit that the data base is both more intensive and extensive than that which an academic institution or clinic can usually achieve; that is why a relatively apparent aspect of hyperactivity has been, until now, neglected.
THE SAMPLE
The period covered is from July 1965 through June 1975. My practice at that time was in Hayward, a suburb of the east San Francisco Bay. Omitting consultations, I followed up 1,016 families with 2,427 children for a mean of 61 months (SD, 29 months). I have matched my practice demographically to both the U.S. census and several regional surveys and have found the practice to be within 5% on occupational, marital, racial, and economic criteria. The diagnosis of hyperactivity for the 290 patients whose cases I will discuss had been made by either school personnel, parents, another physician, or, in some cases, all three.