Table 2

Trials and case series

Reference	n/age in years Design	Disease	Drug/daily dose	Standardised tests used	Main findings	Limitations
See Appendix for list of test abbreviations.
De La Riva, 1957⁹	34/4–14 Open Case series	Various	ACTH/ cortisone	None Relatives’ reports and psychiatric assessments	61% of sample had psychiatric SE: 59% “depressive”, 41% “euphoric” Depressed group had usually shown euphoric symptoms first	No standardised tests used Little detail given about nature of psychiatric SE

Harris, 1986³⁰	16/4–16 Prospective Child as own control Repeated measures	ALL (14) Lymphoma (2)	Prednisolone (pred) 40–60 mg/day oral for 4/52 every 4/12	CSI CDI SHSQ	Night-waking increased on pred (NS). Irritability, tearfulness, argumentativeness, mild depressive symptoms and tiredness increased when on pred	CDI is for use in children over 8 y of age, excluding 6 of their sample. Not blinded

Suess, 1986²²	120/9–18 Prospective Comparison Single blind	Asthma	Non-asthmatic controls v theophylline only v theoph + pred (alt days 16 mg/day)	BVRT WMS	Increased delayed memory recall in steroid groups at 6–8 h. No significant difference between groups at 22–24 h or 46–48 h post-dose	No steroid alone group so ? differences due to steroid- theophylline interaction

Bender, 1988³¹	27/8–16 Prospective Comparison HD v LD	Asthma	Prednisolone (oral) 3.3 mg/day (low dose, LD) v 62 mg/day (high dose, HD)	CDI, CMAS, CPT, DRT, SRT, ultrasonic motion detector for hyperactivity, static steadiness tester for fine motor control	HD: decreased memory, increased anxiety + depressive symptoms. No differences in impulsiveness, hyperactivity, motor unsteadiness	No information gathered from parents/carers. Children not asked re other psychiatric Sx

Bender, 1991³²	32/8–16 Prospective Comparison HD v LD	Asthma	Prednisolone (oral) 7 mg/day (LD) v 62 mg/day (HD)	PPVT, CGAS, FGAS, CDI, CMAS, CPT, SRT, ultrasonic motion detector for hyperactivity, static steadiness tester for fine motor control	Confirmed above results No predisposing factors identified	Children not asked re other psychiatric Sx. ? Atypical sample in terms of social class

Nall 1992²⁹	19/7–15 Prospective Child as own control	Asthma	Prednisolone (oral) 1–2 mg/kg/day on or off	WRAT-R BRP-2	No difference in cognitive tests or behaviour scale score	Researchers not blind

Drigan, 1992³³	38/2.5–8.8 Prospective Comparison Repeated measures	ALL	Chemo + pred (oral) 40 mg/m²/day (Ch+LD) v chem + pred 120 mg/m²/day (Ch+HD) v chemo alone	Conners Parent-Teacher Hyperkinesis Index (amended) administered to parents only	Adverse changes in attention/hyperactivity, emotionality, sleep disturbance, depressed mood, listlessness + peer relations in Ch+LD and Ch+HD v Ch alone No differences in behaviours between Ch+HD v Ch+LD	Small matched sample size may have limited ability to detect difference between LD and HD groups

Bender, 1998²¹	102/6–17 Prospective Double-blind controlled multi-centre	Asthma	Beclomethasone (inh) 2×50 μg qds+placebo tab v theophylline+placebo inhaler	CBCL, WISC-R, W-J, SCWT, WCST, TT, BRVRT, SDLT, RAVLT	No significant differences in cognitive tests or behaviour between groups	Sample did not include children under 6 who may be most vulnerable to APSE from inhaled steroids

Klein-Gitelman, 1998¹¹	213/1–18 Case series	Acute rheumatic disease	Intermittent pulsed IV methylprednisolone 30 mg/kg	None	10% of sample had adverse psychological SE, including psychosis. Majority appeared post pulse and ceased within 48 h	Case series rather than controlled study

Soliday, 1999²⁸	10/ages not known Prospective Child as own control	Steroid sensitive idiopathic nephritic syndrome	“High dose” prednisolone therapy (oral)	CBCL	Anxious, depressive and aggressive behavioural changes at doses of >1 mg/kg/48 h	Small sample Not blinded