Research Briefs

Psychopharmacology: Concerns and Best Practices

Volume 3 / Issue 4 / Summer 2003

Ideally, the decision to treat a child with medication for psychological disorders should involve the child and a team of caregivers, including parents, teachers, counselors, the child’s pediatrician, and a psychologist.

Drs. Ronald T. Brown and Morgan T. Sammons report that the use of medications for children with learning disorders or other psychological difficulties has increased dramatically in recent years and that research on the safe use and effectiveness of these medications is lacking. Advances in the neurosciences and the growing availability of medications are two of the reasons for their increased use. Another, unfortunately, is a cost-driven health care system that limits access to mental health services and forces pediatricians into the role of sole treating practitioners. Pediatricians can work well as case managers if they team up with psychologists and other caregivers.

Primary care providers prescribe the majority of psychotropic medications for children.

The benefits of a team approach include better communication, monitoring of drug effectiveness, and treatment outcomes. This is especially true when a child behaves differently in various situations or is unable or unwilling to explain his or her behavioral problems and reactions to medication. Observations from different parties help create a more reliable picture of the child’s mental health and response to the treatment. The pediatrician is uniquely positioned to obtain and coordinate information from all parties and to guide the diagnosis and treatment.

Research shows that parents, teachers, and psychologists alike favor a combination of medication and psychoeducational intervention. Brown and Sammons caution against using medication as the sole form of treatment. In the short term, doing so may reduce costs; however, in the long run, medical treatment with counseling and special educational programming is more effective.

The effects of medication should be monitored and assessed through physical exams, structured interviews, behavioral rating scales, direct observation, and measures of performance. Parents can play an important role by gathering infor mation and reporting accurate observations. The following issues are of special concern for the practitioner:

• These medications cause side effects, and particular caution is called for in dosing children, who differ in physiology and metabolism from the adults for whom the medications may have been designed.
• The parents’, the teachers’, and the child’s own reports of his or her physiological reactions and psychological responses to the medication may differ. So all opinions should be gathered before the treatment is assessed.
• The pursuit of a given treatment regimen is complicated by the viewpoints of the child, the parents, and the teachers and often depends on who made the initial recommendation to treat with medication. Other factors may include the family’s ambivalence to the use of medications and everyone’s ability and willingness to follow through on it.
• Medications reduce symptoms and may improve the child’s receptivity to other treatment options.

An integrated diagnosis involving a team of professionals and caregivers is the best course of action for helping children with behavioral problems or learning disorders. Medication can be an important part of treatment, but success is most likely when medication is coupled with individual counseling, family therapy, and/or appropriate school intervention, such as gifted or special education classes.

Medication	Use	Concerns/findings for children
Stimulants (Ritalin, Ritalin-SR, Concerta, Dexadrine, Cylert, Adderall)	attention deficit hyperactive disorder (ADHD)	Research needed on long-term physiological effects. No greater risks for drug dependence. Increases academic productivity.
Tricyclic Antidepressants	depression	Should not be used commonly because of dangerous side effects and unproven effectiveness.
Selective Serotonin reuptake inhibitors ( SSRI) antidepressants (Prozac, Zoloft, Paxil, Celexa, Luvox)	depression	Preliminary studies show promise. Not enough research to make usage recommendations. Only Zoloft is approved by the FDA. Luvox is appoved only for obsessive-compulsive disorder.
Atypical antidepressants (Wellbutrin, Wellbutrin-SR)	ADHD in children	Favored for use when stimulant medication hasn't worked and for hereditary tics.
Antianxiety medications and sedatives (Anafranil, Klonopin)	anxiety and obsessive-compulsive disorder	Because of usage dangers and harmful side effects, should be tried only after therapy has failed.
Antipsychotics (Haldol, Orap, Zyprexa, Risperdal, Geodon, Seroquel)	Schizophrenia	Can be effective, but proof of safe use is lacking.
Mood Stabilizers (lithium)	bipolar and conduct disorder	Used widely and can be effective in adolescents. No studies have been done on use in young children.

—Bobbie Collins-Perry

Bobbie Collins-Perry is managing editor for the Duke Gifted Letter.

This article references “Pediatric Psychopharmacology: A Review of New Developments and Recent Research,” by Dr. Ronald T. Brown, Medical University of South Carolina, and Dr. Morgan T. Sammons, Naval Medical Clinic, Professional Psychology: Research and Practice , 2002, Vol. 33, No. 2.