Pediatric Psychopharmacology for Prepubertal Internalizing Disorders.

Abstract

Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological treatments were identified, along with safety concerns for drug treatments. Evidentiary support favored psychosocial treatment for non-OCD anxiety disorders and pharmacological treatments for OCD, with mixed results for depression. Cost-benefit considerations suggest psychosocial treatments should be considered the first choice for at least anxiety and depression, except in unusual cases where stabilization may require pharmacological intervention first.

The current state of empirical support for the pharmacological treatment of selective mutism.

“…In the past decade, considerable attention has been given to the significant gap that exists between the frequency with which physicians prescribe pharmacological treatments to children with selective mutism and the limited research that supports this practice (Carlson, Kratochwill, & Johnston, 1994). This gap is consistent with the treatment literature for many of the internalizing disorders (Kubiszyn, Carlson, & DeHay, 2005). Many researchers have called for additional studies to test whether pharmacological approaches are efficacious for anxiety-related disorders including selective mutism (e.g., Freeman, Garcia, Miller, Dow, & Leonard, 2004).…”

Individual Versus Group Family-Focused Cognitive–Behaviour Therapy for Childhood Anxiety: Pilot Randomized Controlled Trial

“…Cognitive–behaviour therapy (CBT) is currently recommended as the treatment of choice for anxiety disorders in children and adolescents [15], with demonstrated improvements on the target symptoms and sequelae [6, 16]. An essential question in this field is whether involving parents in treatment significantly improves outcomes for all anxious children.…”

Prescription Practices and Empirical Efficacy of Psychopharmacologic Treatments for Pediatric Major Depressive Disorder

“…With the exception of fluoxetine, which was approved by the FDA in 2003 for use with the pediatric population (ages 7 to 17) and in 1991 for use with adult populations, this trend occurs despite a lack of formal study of efficacy and safety or approval of their use. This practice of off‐label use of medications, based on adult responses, raises the issue of the possible neurodevelopmental effects of SSRIs on the developing brains of children; these potentially negative outcomes emphasize the need for additional longitudinal research (Kubiszyn et al., 2005).…”

“…The most common side effects from SSRIs include nausea, vomiting, agitation, headaches, insomnia, jitteriness, and tremor (Kutcher, 2002). However, more recently, additional concerns have been raised about the neurological effects (e.g., disinhibition, suicidal thinking) of SSRIs (see Kubiszyn, Carlson, & DeHay, 2005). Despite these newer concerns, the cardiovascular and gastrointestinal side effects are much less frequent and severe than those of TCAs.…”