Clinical issues in child and adolescent psychopharmacology.

Abstract

During the past two decades psychopharmacologists have made considerable strides in establishing the safety and efficacy of psychotropic drug therapy for childhood behavior disorders. Most of the research has focused on children with disruptive behavior disorders, autism, or mental retardation, but more recently other disorders such as depression, obsessive compulsive disorder, separation anxiety (school refusal), and Tourette syndrome are also receiving attention. Psychopharmacotherapy has often been a matter of controversy, with most issues pertaining to either the appropriateness of medication (e.g., rationales for treatment, alternative interventions, toxicity, iatrogenic effects) or inadequacies of clinical management (e.g., availability of services, drug assessment procedures, limitations of research). This article presents a brief overview of the safety and efficacy of psychotropic drugs and the issues associated with their use in clinical settings.

Prevalence and Treatment of Selective Mutism in Clinical Practice: A Survey of Child and Adolescent Psychiatrists

“…In addition, it is reasonable to infer that child and adolescent psychiatrists may have viewed the disorder of selective mutism as frequently complicated by symptoms of anxiety or depression. Such an interpretation is consistent with the notion that psychotropic drugs are often prescribed based on symptom suppression (Gadow 1991). It is also possible that child and adolescent psychiatrists have been keeping up with the recent literature on the possible use of antidepressants for treating selective mutism.…”

Part 2: Interventions With Children After Disasters

“…These interthese symptoms, along with research on chilidren and views have sometimes been called debriefing interadolescents' responses to treatments for simi1,ar sympviews, taking as a model procedures used with relief toms that may or may not ble precipitated by traumatic workers exposed to horrific events (Dyregrov, 1988; events (for a recent review of psychoactive drugs cur- Mitchell, 1983). Others have been developed from rently being studied for use in treating children and clinical experience with children exposed to criminal adolescents, see Gadow, 1991). violence (Pynoos & Eth, 1986) or from cognitivebehavioral formulations of posttraumatic reactions Individaal psychotherapy.…”

Pediatric Bipolar Disorder: Underdiagnosed or Fiction?

“…In many cases, psychotherapy has been found to be more effective than medication alone or a combination of psychotherapy with medication (Antonuccio, Danton, & DeNelsky, 1995;Gadow, 1991;Klerman et al, 1994;Leichsenring & Leibing, 2007;Luborsky et al, 2002;Luborsky et al, 2003;Manning, Markowitz, & Frances, 1992;Smith, Glass, & Miller, 1980;Weisz, Jensen-Doss, & Hawley, 2006;Wexler & Chiccheti, 1992). To get the process started, clinicians must build a solid therapeutic relationship with the child through the use of play therapy, some lighthearted humor, getting to know and understand the child, and thus making the child more comfortable talking with the clinician (Axline, 1969;Maalouf et al, 2006).…”

“…Children diagnosed with ADHD are often prescribed a psychostimulant medication such as Ritalin (Gadow, 1991;Maalouf, Ziegler, Schlozman, & Prince, 2006;Seitler, 2006). The effects and side effects of Ritalin or similar drugs can result in a series of iatrogenically induced symptoms resembling cycles of mania and depression ("Bipolar Disorder in Children," 2007;Koehler-Troy, Strober, & Malenbaum, 1986;Olfman, 2007;Singh, DelBello, Kowatch, & Strakowski, 2006).…”