Hyperactive Children in Suburban Elementary Schools

R a y G. Miller, Jr., Ph.D.*

GoodaU School
Helen S. Palkes, M.A.
Saint Louis Children's Hospital
Mark A. S t e w a r t , M.D.
Washington University School o f Medicine

ABSTRACT: The prevalence of hyperactivity was determined in a

large population of suburban grade school children. This problem
was found in 1 out of 12 boys, b u t only about 1 in 100 girls. The
group intelligence were significantly lower than those of their class-
mates.

The primary aim of this study was to determine the prevalence of

the "hyperactive child s y n d r o m e " in a suburban elementary school
population. Werner, Bierman, French, Simonian, Connor, Smith, and
Campbell [1] determined the prevalence among 750 10-year-olds on
the island of Kauai. Their report presents the only estimate based on
interviews with parents and teachers. We felt it would be useful to
replicate the work of Werner and her colleagues in a different setting.
In another study, carried o u t at the same time as our investiga-
tion on prevalence, we found that hyperactive children w h o were
patients had lower measured intelligence than their classmates [2].
Before concluding that this intellectual deficit was true of hyperac-
tive children in general, we had to find whether nonpatient hyperac-
tive children scored lower on intelligence tests than their classmates.

* Dr. Miller is Principal, Goodall School, Webster Groves, Missouri 63119.

Ms. Palkes is Director of Psychology, Saint Louis Children's Hospital. At the
time of writing, Dr. Stewart was Professor of Psychiatry and Associate Professor
of Pediatrics, Washington University School of Medicine. He is now in the
Department of Psychiatry, University of Iowa School of Medicine. Statistical
assistance was provided by the Washington University Division of Bio-statistics
under the direction of Reimut Wette, Ph.D.

Child Psychiatry and Human Development Vol. 4(2), Winter 1973 121
122 Child Psychiatry and Human Development

T h e s t u d y o n p r e v a l e n c e gave us t h e o p p o r t u n i t y t o c o m p a r e t h e IQs
o f h y p e r a c t i v e c h i l d r e n w h o w e r e n o t selected f o r b e i n g p a t i e n t s w i t h
the IQs o f t h e i r classmates.

Method

The study was carried out in a school district serving one of the older
suburbs of Saint Louis. Two out of the 11 elementary schools in this district
were special "demonstration schools," 2 were in particular affluent neighbor-
hoods, and 1 school had a new administration. These five schools were not
considered for the study. Four schools were chosen at random from the
remaining six.
The senior author met with the teachers of each school, and made a standard
presentation in which he asked the teachers to screen their own classes for any
child who showed one or more of the following items: fidgetiness and restless-
ness, inattentiveness, being hard to manage, not being able to sit still, being
easily distracted, and not being able to accept frustration. He later interviewed
the teachers individually, using a questionnaire derived from the Pittsburgh
Adjustment Survey Scales [3]. The questionnaire (see Appendix) contained 28
statements from these scales that were judged to be particularly relevant to the
behavior of a hyperactive child. The teacher was asked to answer yes or no to
each of the statements, of which some were positive and some negative. The
general characteristics covered by the questions were overactivity, lack of con-
centration, impulsiveness, emotional lability, poor school performance, and low
self-esteem.
Children were diagnosed as hyperactive if the teachers reported that they
were overactive and distractible, and if in addition 5 or more other "symptoms"
from the list of 28 items were reported as present by the teacher.

Results

T a b l e 1 s h o w s t h e n u m b e r o f b o y s a n d girls w h o w e r e d i a g n o s e d
as h y p e r a c t i v e . T h e p r e v a l e n c e varied f r o m o n e g r a d e t o a n o t h e r , b u t
t h e r e did n o t s e e m t o b e a t r e n d r e l a t e d t o age. T h e r a t i o o f
h y p e r a c t i v e b o y s t o girls also varied, b u t again t h e r e was n o t r e n d
w i t h age.
Scores f r o m L o r g e - T h o r n d i k e intelligence tests w e r e available f o r
22 o f t h e b o y s i d e n t i f i e d as h y p e r a c t i v e , a n d 3 o f t h e girls. T h e i r
scores are p r e s e n t e d in t a b l e 2, t o g e t h e r w i t h t h e average scores o f
t h e i r classmates o n t h e s a m e tests. T h e h y p e r a c t i v e b o y s h a v e a
deficit in m e a s u r e d intelligence w h i c h is a l m o s t e x a c t l y t h e s a m e as
t h a t f o u n d b y Palkes a n d S t e w a r t [2] w h e n t h e y c o m p a r e d t h e
scores o f 35 h y p e r a c t i v e b o y s w h o w e r e p a t i e n t s in a p s y c h i a t r i c
 TABLE 1

PUPILS MEETINC CRITEWION OF HYPEPACTIVITY

T o t a l Sample Hy~eractlve P e r Cent

Grade

Boys ~irls Total Boys Girls Total Boys Clrls Total

3 iii 93 204 14 1 15 12.61 1.07 7.34

4 104 ~ 95 lqq 3 5.76 3.15 4.52

5 103 105 208 Ii 1 12 10.67 .95 5.76

6 122 116 238 in 1 Ii 8.17 .86 4.62

Clrls -- 409 -- -- 1.46 --

~a 440 . . . . 41 . . . . 9.32 . . . .

Total . . . . 849 . . . . 47 . . . . 5.53

t-t
t'@
124 Child P s y c h i a t r y a n d H u m a n Development

TABLE 2

Group intelligence test scores of hyper-

active children and their classmates.

Verbal IQ Non-Verbal IQ Full Scale IQ

S ~ ~ ~ s ~ s
Hyperactive Boys 22 94.0* 14.2 95.1"* 15.7 94.9** 14.1

Normal Boys 296 104.3 16.3 110.2 16.6 107.3 15.3

Hyperactive Girls 3 86.3* 7.8 80.3** 15.9 83.3** 9.6

Normal Girls 295 106.9 13.8 112.4 15.7 109.9 13.7

*p .01; **p .001 (Hyperactive children's score compared with the

corresponding score of normal children of the same sex.)

clinic with the scores of their classmates. The deficit in the IQs of the
hyperactive girls is striking but needs to be confirmed by examininga
larger group.

Di~usmon

The overall prevalence figures (5.5 percent) were close to those

found by Werner and her colleagues [1] ; their figure for boys was
slightly lower (8.7 percent), and for girls was higher (3.2 percent).
Their investigation was based on information given by parents and
teachers from check lists, and their criterion for hyperactivity was
that a child be described as unusually active, distractible, and irri-
table.
We do not know how m a n y of the hyperactive children in this
study were patients, but it seems a reasonable assumption that we
identified all hyperactive children regardless of whether t h e y were
patients. We think it unlikely that teachers were significantly influ-
enced by knowing that a child was under t r e a t m e n t for learning or
behavior problems.
There are several possible interpretations of our finding that
hyperactive boys had lower IQs, the first being that the apparent
deficit in intelligence reflected the hyperactive child's handicap in
taking intelligence tests. His impulsivity and distractibility are likely
Ray G. Miller, Jr., Helen S. Palkes, and Mark A. Stewart 125

to affect his performance, particularly in a group test. However, the

relative deficit was no greater than that which we f o u n d between the
scores of hyperactive patients and controls on individual tests. In the
earlier study we t o o k care to allow for the patients' distractibility (e.g.,
by repeating questions that were n o t answered immediately), and the
children's behavioral deficits tended to be at a minimum, as they usual-
ly are in a strange situation with one other individual.
Another explanation of our finding would be that "hyperactiv-
i t y " is associated with lower intelligence because duller children
develop behavior problems in school in order to compensate for, or
express their resentment over, their academic failure. However, many
or most mothers date the unusual behavior of their h y p e r a c t i v e
children to infancy or early childhood [4, 5]. This would argue
against the idea that "hyperactivity" follows the duller child's experi-
ence of school failure, though it is probable that the experience o f
school failure makes the hyperactive child's behavior worse. A third
possible explanation is that both hyperactivity and the intellectual
deficit are determined b y an independent variable such as quality of
the environment including child-rearing practices, or a genetic dis-
order. At this point we do n o t have evidence that would directly
support the third explanation, other than suggestive evidence that
hyperactivity is transmitted from one generation to another in fam-
ilies [6].
Further work is needed to find whether the intellectual deficit
stems from a lack of intellectual ability, or if it is related to the
hyperactive child's behavior. Meanwhile such children have a func-
tional deficit, whatever the explanation. This seems an important
practical observation because teachers' frustration over the poor
performance of hyperactive children may be due in part to their
expecting too much of these students. Their curiosity, unusual ener-
gy, tendency to talk out, and assertiveness may lead teachers to
overestimate the intelligence of such children. Teachers may also
confuse performance of assigned work with learning. Minde, Lewin,
Weiss, Lavigueur, Douglas, and Sykes [7] have clearly shown that
hyperactive children perform badly in school as well as having an
intellectual deficit. On the other hand, Palkes and Stewart [2] have
shown that the school achievement scores of such children are no
different from the scores of classmates who are matched for the level
of their intelligence. Strange as it may seem, hyperactive children
learn as much as classmates of the same ability even though their
day-to-day performance is inferior.
126 Child Psychiatry and Human Development

Appendix

Questionnaire on Pupil Behavior

1. Never seems to be still for a moment. YES NO
2. Interrupts whoever is speaking. YES NO
3. Disturbs other children with his/her boisterous behavior. YES NO
4. Does things to attract attention. YES NO
5. a. Acts up when I am not watching. YES NO
b. When angry will do things like banging the desk or slam-
ming the door. YES NO
c. Does not take orders when other children are in charge. YES NO
6. Finishes classroom assignments. YES NO
7. Is able to concentrate on things. YES NO
8. Seems to be off in a world all his/her own. YES NO
9. Tends to give up if he/she has something hard to finish. YES NO
10. Will not ask questions even when he/she doesn't know how to
do the work. YES NO
11. Distractible, cannot concentrate. YES NO
12. Does his/her homework. YES NO
13. Acts in a daredevil, fearless manner. YES NO
14. Does things which are normal for children much younger. YES NO
15. Is easily upset by changes in things around him/her. YES NO
16. Has changeable moods. YES NO
17. Has a chip on his/her shoulder. YES NO
18. Is popular with classmates. YES NO
19. Drags his/her feet when requested to do something. YES NO
20. Hits or pushes other children. YES NO
21. Does not respect other people's belongings. YES NO
22. Poorly coordinated when doing things with his/her hands
such as coloring or pencil work. YES NO
23. Reading ability at least one grade level below age expectation. YES NO
24. Arithmetic skill at least one grade level below age expectation. YES NO
25. Spelling performance at least one grade level below age expec-
tation. YES NO
26. Seems to think he/she is worthless. YES NO
27. He/she is interested in schoolwork. YES NO
28. Fails to carry out tasks (homework, assignments, seat work,
etc. ) YES NO

References

1. Werner E, Bierman JM, French FE, et ah Reproductive and environmental

casualties: A report on the 10 year followup of the children of the Kauai
pregnancy study. Pediat 4 2 : 1 1 2 - 2 7 , 1968.
2. Palkes H, Stewart MA: Intellectual ability and performance of hyperactive
children. A m e r J Orthopsychiat 4 2 : 3 5 - 3 9 , 1972.
3. Ross AO, Lacey HM, Patton DA: The development of a behavior checklist for
boys. Child Dev 3 6 : 1 0 1 3 - 2 7 , 1965.
Ray G. Miller, Jr., Helen S. Palkes, and Mark A. Stewart 127

4. Stewart MA, Pitts FN, Craig AG, et ah The hyveractive child syndrome. Amer
J Orthopsychiat 36:861-67, 1966.
5. Mendelson W, Johnson N, Stewart MA: Hyperactive children as teenagers: A
follow-up study. JNerv Ment Dis 153:273-79, 1971.
6. Morrison JR, Stewart MA: A family study of the hyperactive child syndrome.
BiologPsychiat 3:189-95, 1971.
7. Minde K, Lewin D, Weiss G, et al: The hyperactive child in elementary school:
A 5 year controlled follow-up. Exceptional Children 38:215-21, 1971.

P~eS
STATEMENT OF N P SEE INSTRUCTIONS
OW ERSHI .M A N A G E M E N T AND CIRCULATION ON PAGE 2 REVER

CHILD p S y c l t I A T R y A N D H'~JH~i4 D E V E L O p ~ T 10/12/73

Quarterly

72 Fifth Avenue, N~ York. .g York 10011

72 Fifth A r g u e . N~ York, N~ York 10011

Behavloral P u b l l c a t l o ~ , lnc., 72 Fifth A v ~ . N~ York. N~ Y o rk 10011

John C. Dully, M,D. 0 Sul~e 2. 1735 Fort L ~ e l l Road, T U C S ~ , A r l z ona 85719

Jean B l a c k b u ~ , Behavioral Publlca~ions, Inc., 72 Fifth Ave.~ N.Y., N.Y. i0011

Hu~n Sciences. Inc. 72 F i f t h Avenue~ N e w York, N~ York 10011

NAME

. EXTE.T A.O mATVRE Or CmCULAT+ON I E A C X .SSUE O U . m G I S+mGL~ , ~ U ~ P ~ L . S . ~ O .EAR+ I

I A. TOTAL . O C~,eS Pro.TeD r H . , ~ . R..~ I 1,500 1,371

B ,, S*L~S ~ . n O ~ . DE*~M *.O r ST.EET I none none

r 2 u*iL svB~mpr,o.s I 725 944

[ c+ TO~ALPAIOCleCULATION [ 725 944

io.
I 2. ~ I H o m v m s u v ~ o vo ~ e ~ AGENTS. aUT ~OV ~ L D I none n~e

IE, V O T ~ mSTa.SUV~O~ r~ O~C~ ~; I 785 1.004

I~ o~s*cs us~, ~eFV~Ve., U~A~OU~TeO. S~OILeD ~S~S~ I
~mNV~S 715 567

o. VOT~C ~ ar ~ ~ - ~ . ~ e ~ ~ -- ~ ~ ~; 1,500 1,371