Sir.—Dr. Newton brings up an excellent point that goes beyond the issues covered in my marginal comment, the main point of which was to put in better perspective the issue of neurological "soft signs." It was my thesis that there is perhaps too much preoccupation with the ritual of the specialized neurological examination in this group of patients. In so doing, I took a relatively negative point of view, but it was certainly not my intent to suggest a limitation of the role of the physician in this problem.
On the more positive side, I agree that the physician is in a key position to do all of the things Dr. Newton suggests, if he is willing and prepared to do so. At a minimum, he must remain alert for the important treatable organic disease processes that may very rarely show up with school failure and hyperactivity.