474 STIMULANTS

merit, or they could be due to another’s sympathy for predicament of being in a situation where one’s stigma
one’s stigmatized status, or the desire to avoid the ap- could influence how one is treated and judged (Goff-
pearance of being prejudiced. man, 1963: Katz, 1981). No internalization of devalu-
Most classic discussions of stigmatization conceptu- ation or stigmatizing stereotypes is necessary for this
alize the experience of being stigmatized as involving predicament to influence the person’s experience. Fur-
some internalization of the stigmatizing images and thermore, stigmatized individuals actively cope with the
stereotypes of one’s group. Thus, it is often assumed predicaments that their stigma poses, using the same
that the experiences of stigmatization lead to low self- coping strategies that nonstigmatized individuals use
regard among the Stigmatized. Surprisingly, however, when faced with self-threats: social comparisons with
empirical research contradicts this widely held assump- others in a similar predicament: devaluing of the do-
tion. Crocker and Major (1989) reviewed studies com- mains in which one is disadvantaged by the stigma: and
paring the self-esteem of a wide variety of stigmatized attributing negative outcomes to external factors, in
groups, and concluded: “In short, this research, con- particular, prejudice and discrimination (Crocker & Ma-
ducted over a time span of more than 20 years, leads jor, 1989). Although these coping responses have costs
to the surprising conclusion that prejudice against for the stigmatized, both psychological and otherwise,
Copyright American Psychological Association. Not for further distribution.

members of stigmatized or oppressed groups generally these costs are more context specific, less internalized
does not result in lowered self-esteem for members of and permanent, and less inevitable and universal than
those groups” (p. 611). In general, research suggests is often assumed (Crocker, Major, & Steele, 1998).
that although some stigmatized individuals are vulner-
able to low self-esteem, diminished life satisfaction, and
particularly depression, the vast majority of individu- Bibliography
als, even severely stigmatized individuals, are able to
Crocker, J., & Major, B. (1989). Social stigma and self-
maintain positive views of themselves, of their groups,
esteem: The self-protective properties of stigma. Psycho-
and of their lives. Although stigmatized individuals logical Review, 96, 608-630.
confront many threats to their self-concepts, they also Crocker, J., Major, B., & Steele, C. M. (1998). Social stigma.
actively cope with those threats. Of course, some indi- In Gilbert, D.. Fiske, S. T., & Lindzey, G. (Eds.), The hand-
viduals cope with the self-threats posed by stigma more book of social psychology (4th ed., Vol. 2. pp. 504-553).
effectively than others. Research has focused on com- New York: McGraw-Hill.
parisons of stigmatized with nonstigmatized individuals Friedman, M. A.. & Brownell, K. D. (1995). Psychological
on measures of well-being, such as self-esteem, positive correlates of obesity: Moving to the next research gen-
affect, and life satisfaction, and tends to find small or eration. Psychological Bulletin, 117. 3-20.
nonsignificant effects. The absence of significant Goffman, E. (1963). Stigma: Notes on the management of
between-group effects may mask important differences spoiled identity. Englewood Cliffs, NJ: Prentice Hall.
Jones, E. E.. Farina, A., Hastorf, A. H., Markus, H., Miller,
within stigmatized groups in terms of which individu-
D. T., & Scott, R. A. (1984). Social stigma: Thepsychology
als are vulnerable to distress, and why (Friedman &
of marked relationships. New York: Freeman.
Brownell, 1995). Katz, I. (198 I). Stigma: A social-psychological perspective.
A more subtle consequence of social stigma is its Hillsdale. NJ: Erlbaum.
effect on cognitive and intellectual performance. Ac- Synder, M. L.. & Wicklund, R. A. (1981). Attribute ambi-
cording to Steele (1998: Steele & Aronson, 1gg5), guity. In J. H. Harvey, W. J. Ickes, & R. F. Kidd (Eds.),
awareness of negative stereotypes about intellectual New directions in attribution research (Vol. 3. pp. 197-
ability can undermine the academic achievement and 221). Hillsdale, NJ: Erlbaum.
performance of members of devalued or stigmatized Steele, C. M. (1998). Suspected by reputation: The stereo-
groups. This effect of stereotype threat occurs in partic- type vulnerability,disidentification,and intellectual per-
ular situations in which one’s performance may be in- formance of women and African Americans. American
Psychologist. 52, 613629.
terpreted in light of those stereotypes. African Ameri-
Steele, C. M., & Aronson, J. (1995). Stereotypevulnerability
can college students underperform relative to White and the intellectual test performance of African-
students on a difficult English test when they are told Americans. Journal of Personality and Social Psychology,
that the test is diagnostic of intellectual ability: when 69, 797-811.
told that the same test is not diagnostic of ability, Af-
rican American students perform as well as White stu- Jennifer Crocker
dents (Steele & Aronson, 1995). Similarly, women un-
derperform on very difficult math tests relative to men
when they are told that the test shows gender differ-
ences but perform as well as men when told that the STIMULANTS. The primary therapeutic use of psy-
test does not produce gender differences. chostimulants is for attention-deficit/hyperactivitydis-
Stigmatization is primarily a situational threat, the order (ADHD). The vast majority of treated patients are
http://dx.doi.org/10.1037/10522-199
Encyclopedia of Psychology, Vol. 7, edited by A. E. Kazdin
Copyright © 2000 American Psychological Association. All rights reserved.
 STIMULANTS 475

children and, increasingly, adolescents and adults. ham, Hoza, Kipp, Gnagy, & Trane, 1990). suggesting
Pharmacological intervention with one of the central that all three major stimulants (MPH, amphetamine
nervous system (CNS) stimulant drugs is the most com- compounds, and pemoline) should be tried before a
mon mode of treatment for ADHD, and has been for child is switched to nonstimulant drugs. Although most
30 years. studies have focused on children, recent research has
Psychostimulants include methylphenidate (MPH: shown that beneficial effects continue into adulthood
Ritalin), pemoline (Cylert), and amphetamine com- as long as medication continues to be taken (Smith et
pounds (Dexedrine,Aclderall), with the majority of chil- al., 1998; Spencer et al., 1996).
dren receiving MPH. Stimulants act by facilitating Side effects or treatment emergent symptoms (TESS)
release and blocking reuptake of dopamine and nor- are sometimes associated with stimulant treatment.
epinephrine. Psychostimulants produce effects quickly Loss of appetite and insomnia are the most common
(in 20 to 60 minutes, depending on the preparation) adverse reactions. Other common TESS include stom-
and wear off quickly (in 4 to 6 hours for immediate achaches and headaches. Some symptoms dissipate
release and 8 to 12 hours for pemoline and sustained- with repeated administration (e.g., stomachaches),
release preparations). MPH and amphetamine are typ- while others do not dissipate (e.g., appetite loss) but can
Copyright American Psychological Association. Not for further distribution.

ically given with breakfast and lunch (or slightly after), be controlled by reducing the dose of medication. Stim-
and sometimes in a late, third afternoon dose to extend ulants can exacerbate or precipitate motor tics and mo-
into the evening, while the timed-release preparations tor movements, particularly of the mouth, jaw, and
and pemoline are usually given only with breakfast. tongue. However, in most affected cases the drugs do
Dosing should be done to cover the times of day and not appear to precipitate or worsen Tourette’s syn-
situations in which the child has impairment. drome.
The dose ranges that are described in pharmacology Long-term stimulant treatment (2 to 4 years) with
texts and ADHD treatment articles are considerably high doses and daily dosing results in a reduction in
higher than those typically used in actual practice. the rate of weight gain and to a lesser extent height
Doses at the lower end of the MPH range (0.25 to 0.4 gain, perhaps due to the anorectic effect. This can be
mg/kg per dose, with amphetamine requiring half as minimized or avoided by keeping the dose low, medi-
much medication and pemoline six times as much) are cating during school hours and on school days only,
more common in practice than doses in the higher and giving high-calorie nutrition to the child at meals
range, particularly when medication is combined with and snack time when he or she is not medicated.
behavioral intervention. Most of the gains from stim- Stimulant medication can also cause cognitive over-
ulant therapy derive from relatively low doses, with di- focusing, social withdrawal, and dysphoria-a response
minishing incremental gain from increased doses. Com- that has been popularized as the “zombie effect” of
pared to average ADHD children, obese children, medication. However, reports of such substantive ad-
adolescents, and adults may require less stimulant per verse effects of low to moderate doses are rare. It has
weight to obtain a maximally beneficial response. been argued that stimulants have “psychotoxic”effects
Beneficial effects of stimulants in ADHD children are through which they make children psychologically de-
among the best documented short-term effects in the pendent on them. There is no evidence to support this
field of treatments for childhood mental-health disor- belief and much evidence to the contrary (e.g., Pelham,
ders (Greenhill, 1995; Spencer et al., 1996: Swanson, Hoza, Kipp, Gnagy, 81Trane, 1997).
McBarnett, Christian, & Wigal, 1995). Stimulants have Many of the most serious TESS are rare, and irre-
positive acute effects on a variety of laboratory mea- versible side effects (e.g., liver toxicity) are extremely
sures of cognition (e.g.. attention, inhibition, and re- rare. However, their potential impact means that med-
sponse execution), classroom measures of disruption icated children should be carefully monitored, espe-
and daily academic task completion, teacher and parent cially when medication is initially prescribed, to ensure
ratings of behavior and attention, parent-child inter- that these adverse side effects are not caused or exac-
actions, aggression, and peer interactions. Acute stim- erbated by stimulant therapy.
ulant effects are often dramatic. Despite widely validated salutary effects, the stimu-
Seventy to 80% of children with ADHD show ben- lants have limitations in their clinical efficacy. First, as
eficial responses to stimulant medication: the others mentioned above, stimulants are not effective for all
show either no response or an adverse response. children, and even with drug responders there is still
Among the children who show a positive response, room for improvement for many stimulant-treated
however, there are large individual differences in mag- ADHD children.
nitude of response, dose-response functions, and re- Second, psychostimulant effects are limited to the
sponses across situations, and individual responsiveness time when the drugs are physiologically active. The
cannot be predicted (Pelham & Smith, in press). Chil- brief half-life of the immediate-release medications
dren also do not respond similarly to all stimulants (Pel- means that they must be administered at least twice
 476 STONE, C A L V I N P .

daily or in long-acting form to ensure adequate treat- attention-deficit/hyperactivity disorder across the life
ment throughout a child’s school day, with a possible cycle. Journal of the American Academy of Child and Ad-
third dose after school to affect late afternoon behavior. olescent Psychiatry, 35, 409-432.
The fact that the child must be given a pill at school is Swanson. J. M., McBurnett, K., Christian, D. L., & Wigal, T.
often problematic because some ADHD children and (1995). Stimulant medications and the treatment of
children with ADHD. In T. H. Ollendick & R. J. Prinz
school personnel actively avoid or prohibit medication
(Eds.), Advances in clinical child psychology (Vol. 17.
at school, resulting in poor compliance, which increas- pp. 265-322). New York Plenum Press.
ingly becomes a problem in early adolescence.
Finally, there is no evidence that stimulants have a William E. Pelham
long-term beneficial effect. ADHD children have a poor
outcome in adolescence and adulthood, and pharma-
cotherapy alone does not alter that outcome.
Therefore, the current standard of care is that stim- STONE, CALVIN P. (1892-1954), American psycholo-
ulants should be given only as one component of in- gist. Stone was born on a farm near the small town of
tensive, long-term treatment that includes behavioral
Copyright American Psychological Association. Not for further distribution.

Portland, Indiana, the seventh of eight children. At the

parent training, classroom management strategies, and age of five, he experienced two family tragedies: His
behavioral interventions with the child. The only way father died, and on the day of the funeral the family
to know when stimulants are no longer needed for a home burned to the ground. His mother’s persistence
child is to have annual trials off medication and to stop and determination to rebuild and remain on the farm
the medication when such probes reveal no worsening perhaps influenced Stone, for these were two traits that
in functioning. he often displayed in his career. Stone completed as
much education as was locally available and, at the age
of 15, entered Valparaiso University, where he earned
Bibliography the equivalent of a high school diploma and a few col-
lege credits. For 3 years after completing the work at
Greenhill, L. L. (1995). Attention-deficit hyperactivity dis- Valparaiso, Stone taught high school, eventually be-
order: The stimulants. Child and Adolescent Psychiatric coming superintendent. He then entered Indiana Uni-
Clinics of North America, 4 , 123-168.
versity, where he completed both his undergraduate
Greenhill, L., & Osman, B. (in press). Ritalin: Theory and
(1914) and master’s degrees (1916). The master’s thesis
patient management (2nd ed.). New York: Liebert.
Hinshaw, S. P. (1994). Attention deficits and hyperactivitg in was supervised by the comparative and educational
children. Thousand Oaks, CA: Sage. psychologist M. E. Haggerty. Stone enrolled at the Uni-
Pelham, W. E., Greenslade, K. E., Vodde-Hamilton, M. A., versity of Minnesota in 1919, after spending a year as
Murphy, D. A., Greenstein J. J., Gnagy, E. M., Guthrie, a research psychologist at a reformatory and 2 years in
K., Hoover, M., & Dahl R. E. (1990). Relative efficacy the military.
of long-acting CNS stimulants on children with atten- At Minnesota, Stone earned his doctorate in psy-
tion-deficit/hyperactivity disorder: A comparison of chology under Karl Lashley (1921) and began a pro-
standard methylphenidate, sustained-release methyl- gram of research into sexual behavior that continued
phenidate, sustained-release dextroamphetamine, and for two decades and resulted in numerous publications.
pemoline. Pediatrics, 86. 226-237.
In 1922, Stone accepted a position at Stanford Univer-
Pelham, W. E., Hoza. B., Kipp, H. L., Gnagy, E. M., &Trane,
S. T. (1997). Effects of methylphenidate and expectancy sity, where he remained for the rest of his career.
on ADHD children’s performance, self evaluations, per- Stone’s research was always marked by its thor-
sistence, and attributions on a cognitive task. Experi- oughness and precision. His early work on sexual and
mental and Clinical Psychopharmacology, 5 , 3-13. maternal behavior in rats is considered today as classic.
Pelham, W. E., & Smith, B. H. (in press). Prediction and Stone’s sex research program was generously supported
measurement of individual responses to Ritalin by chil- by the Committee for Research in Problems of Sex and
dren and adolescents with ADHD. In L. Greenhill & B. illustrates Stone’s interdisciplinary interests and critical
Osman (Eds.), Ritalin: Theory and patient management role in developing the new borderland of the scientific
(2nd ed.). New York: Leibert. study of sex. After World War 11. Stone began a re-
Smith, B. H., Pelham, W. E.. Evans, S., Molina, B., Gnagy, search program on the effects of electroconvulsive
E.. Bukstein, 0.. Greiner, A., Myak, C., Presnell. M.. &
shock that continued until his death in 1954. His hy-
Willoughby, M. (1998). Dosage effects of methylpheni-
pophyseal research, begun just 2 years before his death,
date on the social behavior of adolescents diagnosed
with attention deficit hyperactivity disorder. Journal of was his last.
Experimental and Clinical Psychopharmacology, 6 , I 8 7- Throughout his career, Stone involved his students
204. in his research, as well as collaborating with them on
Spencer, T., Biederman, J.. Wilens, T., Harding, M., their own projects. His collaborative work included top-
O’Donnell, D.. & Griffin, S. (1996).Pharmacotherapy of ics both within and outside his principal interests. He