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In this single-case research study, we examined the efficacy and acceptability of sertraline treatment in children diagnosed with selective mutism. We utilized a double-blind, placebo-controlled trial of sertraline within a replicated multiple baseline/across participants research design (n = 2; n = 3). Multiple methods of assessment involving across-setting informants were completed repeatedly throughout the 16-week study. Follow-up data was collected at 4 and 20 weeks poststudy. Assessment measures failed to demonstrate group changes in mutism, anxiousness, and shyness. All individuals realized considerable improvement on some of these variables. Two of the five participants no longer met diagnostic criteria for selective mutism following less than 10 weeks of 100 mg sertraline treatment. A third participant was reported asymptomatic at 20 weeks poststudy. Treatment compliance was high. Parent treatment acceptability ratings were highly favorable. Single-case research methodology has considerable clinical utility in the medication treatment of selective mutism. Frequent and repeated measurement across phases helped to highlight varying levels of participant improvement across situationally specific settings. Additional investigation of the use of selective serotonin reuptake inhibitors in treating selective mutism is warranted.

Pemoline, a dopamine agonist, is effective in children with attention deficit hyperactivity disorder (ADHD), but its efficacy in adults is unknown. The authors studied the efficacy and safety of pemoline, using retrospective chart review of treated students with ADHD over a 2-year period. Forty students met diagnostic and treatment criteria; pemoline was associated with much improved or very much improved Clinical Global Impression symptoms scores in 70% of the students during a treatment period of 14 or more days. Severity of illness scores dropped from 4.11 to 3.01 between baseline and subsequent evaluation. Nine evaluable patients had adverse events, most commonly headaches, insomnia, and decreased appetite. Five additional students, who failed to meet the treatment-duration criterion, terminated because of severe initial insomnia. The authors concluded that pemoline is effective and safe in students with ADHD and has a lower abuse potential than methylphenidate and dextroamphetamine, the other two widely used, structurally dissimilar compounds, but controlled studies may be necessary before any final conclusions are reached.

This study investigates the use of medications by child and adolescent psychiatrists for treating selective mutism. In 1993, a one-page survey was mailed to 962 child and adolescent psychiatrists selected at random from approximately 2500 active members of the American Academy of Child and Adolescent Psychiatry. Of the 962 questionnaires sent, 411 were returned (return rate 43%) and 308 were completed (sample participation rate 32%). A prevalence estimate of selective mutism within a clinical sample was calculated to be 1 case of selective mutism per 936 new patients (0.11 %). Less than two-thirds (199/308) of the responding psychiatrists reported having treated a child with selective mutism in their practice. Of those who had treated a child with selective mutism, 36% (n = 71) reported having prescribed medication for this disorder. Antidepressants were the most frequently endorsed medication for being potentially beneficial in treating a hypothetical case example and, in addition, for being actually used by child psychiatrists in clinical practice for children diagnosed with selective mutism. Antianxiety agents were reported, at much lower rates, to be potentially useful in a hypothetical case and actually used in clinical practice for treating children with this disorder. These findings suggest that child psychiatrists may view selective mutism as being related to, having symptoms similar to, or often presenting comorbidly with depressive or anxiety disorders. However, a therapeutic program that includes pharmacotherapy was endorsed as the most effective treatment modality for selective mutism by only 14% of the reporting psychiatrists. Psychiatrists' impressions and observations cannot, even collectively, be used to make clinical inferences about the usefulness of treatments. This study did not examine treatment efficacy, since the outcomes of these open clinical trials were not judged by independent observers but were reported as observed and recollected by the clinicians involved. Moreover, these data on the treatment practices of sampled members of the American Academy of Child and Adolescent Psychiatry may not reflect the practices of other psychiatrists or pediatricians. The results indicate that child and adolescent psychiatrists are prescribing a variety of medications for selective mutism without the benefit of adequate efficacy studies. There is a significant need for further research and dissemination of information in this area.There is a paucity of research that has examined the actual or potential benefits of psychotropic medications as a treatment modality for selective mutism. Only three studies on the pharmacotherapy of

A 10-week double-blind, placebo-controlled design was employed to investigate the effectiveness of clomipramine (CMI) versus placebo in 16 outpatients (ages 10-18 years) with obsessive-compulsive disorder (OCD). While a trend favoring clomipramine was observed, the difference in efficacy between clomipramine (N=8) and placebo (N=8) did not reach statistical significance, partly due to small sample size (N = 6,8). Post-hoc exclusion of two clomipramine-resistant subjects with subtle neurological impairments did, however, yield a statistically significant improvement with drug treatment. Neurological impairments are commonly seen in children with OCD, and may be a risk factor for the disorder during childhood. Speculatively, subtle neurological impairments may also predict resistance to CMI therapy in some patients, and influence the outcome of clinical and research medication trials, depending on differences in neurological inclusion and exclusion criteria.

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In this article, we present a balanced view of the prescriptive authority debate in relation to five major issues and within the context of the practice of psychology in the schools: (a) appropriate training, (b) quality of care, (c) access to services, (d) continuity of care, and (e) professional identity. We also provide an analysis of the quality and relevance of each issue within the school practice context. Despite the increasing momentum of the prescriptive authority initiative at the state level, it seems unlikely that prescription privileges will be extended to psychologists working in school-based practice settings. Nevertheless, informed school psychologists have the opportunity to become involved in this issue at both the national and state levels. These efforts may take the form of supporting or opposing the initiative or of lobbying for extension of prescriptive authority into some school settings. At the individual level, informed school psychologists will have the opportunity to develop strong working relationships with prescribing psychologists in their communities and to exercise appropriate professional judgments when referring students or families for services in the community. C 2009 Wiley Periodicals, Inc.The issue of limited prescriptive privileges for professional psychologists has been a longstanding topic of debate both within and outside the field for nearly two decades. The American Psychological Association (APA) strongly supports the lobby for prescription privileges, and has invested significant time and financial resources to support advocacy efforts at the national and the state levels. New Mexico and Louisiana have passed legislation allowing psychologists who meet stringent training requirements to obtain limited prescription privileges, and similar efforts are underway in several other states. The U.S. Department of Defense has also conducted trials to assess the feasibility of training professional psychologists to prescribe psychotropic medication in military health care settings.Nevertheless, the effort on the part of psychologists to obtain limited prescription privileges is staunchly opposed by some members of the medical community, particularly persons in the field of psychiatry. Moreover, there is no clear consensus within the profession of psychology that the pursuit of prescription privileges is an appropriate goal. A plethora of opinion studies has been conducted, most of which reveal varying of degrees of disagreement on this issue. In general, researchers have found that psychologists have more favorable attitudes toward the issue of limited prescription privileges than do psychiatrists, pediatricians, and other primary care providers (Rae, Jensen-Doss, Bowden, Mendoza, & Banda, 2007). Walters (2001) conducted a meta-analysis of the opinion data and reported that, overall, slightly more than half (52%) of surveyed psychologists supported the prescription initiative, with slightly more than one third (35%) expressing opposition. Other studies have also found that opin...