478 While still a junior faculty member on the staff of the St Louis Children’s Hospital, Warren Weinberg startled the pediatric, psychiatric, and neurologic communities in 1973 by pub- lishing an article in The Journal of Pediatrics 1 in which he showed that depressive illness occurred frequently in chil- dren with school difficulties and that the diagnosis could be readily made by applying specific criteria during a structured evaluation session. Weinberg had taken a bold step: he regarded affective illness (depression being one form) as a neurobiologic condition that did not respect age barriers and he then tailored for children the already accepted criteria symptoms used to diagnose depression in adults. 2 Wein- berg’s article so contradicted entrenched establishment views 3 that Waldo E. Nelson, editor of The Journal of Pedi- atrics, found it necessary to include along with the article a disclaimer stating: “Although this paper has been recom- mended for publication (subject to revision of the original manuscript) by two selected reviewers, the Editor feels it necessary to stress extreme caution (1) in identifying any child as having a depressive illness and (2) in prescribing any medication for such a disorder.” 1 Slowly, over the next decade, the medical community recognized the validity of Weinberg’s observations on childhood affective illness 1,4,5 and accepted that depression indeed could occur in children, using what became termed the “Weinberg Criteria” to diag- nose childhood depression. 6–8 Petti even incorporated the Weinberg Criteria into the Bellevue Index of Depression. 9,10 As the American Psychiatric Association progressed through its Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (DSM-III), 11 DSM-IIIR, 12 and DSM-IV 13 nosolo- gies, the diagnosis of depression in children by physicians and psychologists became acceptable and even common- place, 14,15 such that the younger generation of clinicians now cannot even conceive of the controversy that surrounded the original descriptions by Weinberg and his colleagues. 1,4,5,16 Not being satisfied that affective illness alone was suf- ficient to explain many of the behavioral problems in chil- dren referred to his offices, Weinberg continued his careful clinical analyses. This meticulous observation and docu- mentation of neurobehavioral signs and symptoms permit- ted Weinberg to identify a group of inattentive children who previously had been classified under the rubric of attention-deficit disorder, but seemed unique. His careful study revealed that this subgroup of children labeled as Special Article Weinberg’s Syndrome: A Disorder of Attention and Behavior Problems Needing Further Research Roger A. Brumback, MD ABSTRACT A subset of inattentive children have an underlying problem in sustaining wakefulness (“vigilance”). This disorder of vig- ilance, termed Weinberg’s syndrome, is characterized by difficulty in maintaining wakefulness and alertness as evidenced by (among other symptoms) motor restlessness (fidgeting and moving about, yawning and stretching, talkativeness) and complaints of tiredness. During tasks requiring concentration (continuous mental activity) such as reading, children with Weinberg’s syndrome will daydream, lose interest, complain of boredom, and become increasingly restless. Napping, while infrequent, usually is not refreshing. A distinct personality described by family members and friends as kind, affectionate, compassionate, or “angelic” also seems to characterize this condition. Weinberg’s syndrome has a familial pattern sug- gesting autosomal-dominant inheritance. Additional neurophysiologic, pharmacotherapeutic, epidemiologic, and genetic studies will be necessary for a full understanding of Weinberg’s syndrome. ( J Child Neurol 2000;15:478–480). Received May 3, 2000. Accepted for publication May 4, 2000. From the Departments of Pathology, Neurology, Pediatrics, and Psychiatry & Behavioral Sciences, University of Oklahoma College of Medicine and Veterans Affairs Medical Center, Oklahoma City, OK. Address correspondence to Dr Roger A. Brumback, David Ross Boyd Professor, University of Oklahoma College of Medicine, BMSB 451, 940 Stanton L. Young Blvd, Oklahoma City, OK 73104. Tel: 405-271-2422; fax: 405-271-2568; e-mail: roger-brumback@ouhsc.edu.