environment for the moment that will be personally and developmentally right for revelation.) It is surprising that neither writer suggests that parents be advised to consult at the time of disclosure, since it is a task likely to challenge even the most sophisticated. Dr. Donovan’s emphatic opposition to the fiction “she really loved you, but . , . ” is excellent. I would add to it, however, that there is in that circumstance an important positive affirmation to be made: namely, the adoptive parents’ need for the child. To the imagined question “Why was I given up?’ an honest ignorance can be opposed; but, to the question “Why was I adopted?”, the obvious truth-which is, however, not at all obvious to the child-is that “We needed you.” Such an answer can go a long way toward repairing the injury of abandonment. I have long been familiar with a verse that beautifully replies to the child‘s and parents’ predicament: Not flesh of my flesh, nor bone of my bone, Yet still miraculously my own. Always remember and don’t forget for a single minute, You grew not under my heart but in it. (Anonymous) Regarding the child’s birth, the cardinal task of the therapist and the parents of a adopted child is to help them remember what for so many reasons is obliterated. Dr. MacIntyre is certainly right when he characterizes this as an extended process of mourning. But it is a mourning possible only when the child’s ego has acquired both the development to understand and the strength to afford the loss. I cannot take for granted as Dr.Donovan does “that the average adopted child will ask when he or she is developmentally ready to deal with the issue.” Why should an adopted child-more than any other bereaved child-be expected, without the support of ritual or even acknowledgment, to raise the issue of his loss. The adoptive parents, adequate in other ways, may not be up to helping the child with this task. Thus, the parents and the child should be offered and alerted to the need for consultation around this difficult discovery. They should also be made to understand that whenever the discovery takes place, a continuing adjustment to it will occur along the whole developmental course. Gregory T. Lombardo, M.D., Ph.D. Cornwall, NY
Stimulants and School Performance
Jacobvitz, D., Sroufe, L. A., Stewart, M., Leffert, N, (1990), Treatment of attentional and hyperactivity problems in children with sympathomimetic drugs: a comprehensive review. J . Am. Acad. Child Adolesc. Psychiaw, 29:677-688. Richardson, E., Kupietz, S. & Maitinsky, S. (1987), What is the role of academic intervention in the treatment of hyperactive children with reading disorders? In: The Young Hyperactive Child: Answers to Questions about Diagnosis, Prognosis, and Treatment, ed. J. Loney. New York: The Haworth Press. -Winsberg, B. G., Maitinsky, S., & Mendell, N. (1988), Effects of methylphenidate dose on behavior, cognitive performance, and reading achievement in hyperactive reading-disabled children: II. reading. J . Am. Acad. Child Adolesc. Psychiatry, 27:7887.
Depression and Growth Hormone To the Editor: In the recent article by Jensen and Garfinkel (1990), depressed growth hormone responsivenessin children with major depression was further documented. We would like to add to that information five male children (7-13 years) with major depressive disorder, diagnosed by research diagnostic criteria, compared with 13 male controls of similar ages. These children were studied using a %-hour constant withdrawal pump and growth hormone stimuli (Kowarski et al., 1971). Our results support those of Jensen and Garfinkel by revealing decreased growth hormone responses to a variety of stimuli as well as a decrease in 24-hour growth hormone concentrations(reported in part by Richards et al., 1985) in children with major depressive disorder. These children had lower growth hormone response to insulin-induced hypoglycemia (p < 0.03), arginine (p < 0.03), and oral clonidine (p < 0.05), measured by area under the curve. The growth hormone response to L-dopa and 5-hydroxytryptophan showed no difference between the groups. The circadian studies revealed a lower 24-hour integrated concentration of growth hormone in the depressed boys than in the normal group (3.9 2 0.7 vs. 7.6 2 0.5 ng/ml, p < 0.002). This was irrespective of the time of day: 8 A.M. to 8 P.M. (2.6 2 0.4 vs. 5.7 & 0.4 ng/ml, p < 0.0002) and 8 P.M. to 8 A.M. (5.1 & 0.9 vs. 9.2 2 0.8, p < 0.01). Additional studies of the night growth hormone secretion and growth hormone response to normal physiological stimuli, such as exercise and food, are indicated. Growth rates of these children during depressive episodes are needed to document the physiological importance of these changes.
To the Editor: In their review of the current status of drug treatment of attentional and hyperactivity problems in children, Jacobvitz et al. (1990) state that “to date there is no evidence that stimulants enhance academic performance” (p. 680). We wish to call these authors’ attention to our work (Richardson et al., 1987, 1988). We found that readingdisabled hyperactive children, classified as good methylphenidate responders (in the first 2 weeks of drug treatment), attained significantly higher reading achievement scores in a 6-month treatment period than those classified as poor responders. (The two groups did not differ significantly in reading achievement before the remedial sessions.) In our study, drug dose was administered systematically and within a clinically effective range (0.3 mgkg to 0.7 mgkg), an effective remedial reading program was provided for a sufficient length of time, and the child’s response to medication was monitored continuously. Apparently Jacobvitz et al. were unaware of our finding, which we regard as a clear demonstration that methylphenidate treatment can enhance reading achievement. Samuel S. Kupietz, Ph.D. Ellis Richardson, Ph.D. Betrand G. Winsberg, M.D. The Nathan S. Kline Institute for Psychiatric Research Orangeburg, NY J.Am.Acad.ChildAdolesc. Psychiatry,30:2,March1991
Walter J. Meyer III, M.D. Gail E. Richards, M.D. Anita Cavallo, M.D. Kay G. Holt, M.D. Msoud S. Hejazi, M.D. Cindy Wigg, M.D. Robert M. Rose, M.D. The University of Texas Medical Branch REFERENCRS
Jensen, J. B. & Garfinkel, B. D. (1990), Growth hormone dysregulation in children with major depressive disorder. J . Am. Acad. Child Adolesc. Psychiatry, 29295-301. Kowarski, A., Thompson, R. G., Migeon, C. J. & Blizzard, R. M. (197 l), Determination of integrated plasma concentrationsand true secretion rates of human -mowth hormone. J . Clin. Endocrinol. Metab., 32:356-360. Richards, G. E., Cavallo, A., Holt, K. G., Hejazi, M. D.,Rose, R. M.& Mever. W. J. (1985). Cortisol and growth hormone diurnal rhythm and responsiveness.to provocativestimuli in children with major and other depression. Poster presented at Proceedings of the 32nd Annual Meeting of the American Academy of Child Psychiatry.