Commentary of Psychopharmacology for Children and Adolescents
Feb 9, 2019
By Abimbola Farinde, PhD.,PharmD – CareerSmart® Learning Contributor
There is a growing concern with the increased use of psychotropic medication for treatment of mental disorders, anxiety disorder, obsessive disorders, and depressive disorders in children and adolescents. In one study, the percentage of psychotropic medication prescribed to youths was reported to be as high as 6.3%, rivaling adult rates, and between 1995-1999, the use of antidepressant increased 151% in the 7-12 age group and 580% in age group 6 and under (Sparks & Duncan, 2004). The increase awareness of mental health problems in young children may be one of the contributing factors to the increased psychotropic drug prescriptions. In 2012, The National Institute of Mental Health reported that approximately 13% of children ages 8 to 15 had a mental disorder diagnosis, with attention deficit hyperactivity disorder being most common (Magellan Health, 2017). However, the scientific basis of drug treatment for the mental health condition of children and adolescents is still in its infancy. Unlike studies that have been performed on adults, there is not enough evidence-based information on children to support the efficacy of certain psychotropic drugs.
Researchers and providers attempt to extrapolate or generalize the data obtained from studies that consist of adult participants and apply the results of the study to children without considering the potential consequences. When it comes to prescribing psychotropic medications to children, there are conditions such as obsessive compulsive disorder, tic disorder, and attention deficit hyperactivity disorder that require a moderate degree of skill and knowledge in pharmacological management. For management of other mental conditions such as anxiety disorder, depression, and aggressive behavior associated with autism and intellectual disability, more advanced pharmaceutical skill is required. Some clinicians are of the mindset that they meet the requirements to prescribe these medications to children and adolescents, although they are not expertly trained to do so (Hazell, 2005). Typically, general practitioners or family physicians are the first one to prescribe treatment, yet, they have limited exposure to child and adolescent psychiatric problems during their undergraduate and postgraduate training. Many primary care physicians can be observed prescribing a significant number of psychotropic medications to children, when in most cases it is out of the scope of their practice (Hazell, 2005). Practitioners are expected to operate within the boundaries of their competence and practices, as well as their education, training, and supervised experience. When a primary care provider is prescribing psychotropic medications rather than a psychiatrist, this violates a critical ethical principle of medical practice (American Psychological Association, 2010).
In order to fully understand the impact that psychopharmacology can have on the treatment of mental disorder or psychological disorders for children and adolescents, medical providers must continue their professional practice through additional training and staying abreast of the latest developments in drug therapies. Issuing a prescription for psychotropic medication without a formal mental or psychiatric evaluation is also risky. There may be overlapping symptoms or dual diagnoses that may be missed by an untrained professional. Pharmacological therapy should also be used as part of a more comprehensive treatment plan. In order to prevent underprescribing, overprescribing, or inappropriate prescribing, one of the best approaches for any practitioner treating a child or adolescent with a suspected mental illness or psychiatric disorder is to refer them to an expert in the field of child psychiatry or other mental health specialist.
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American Psychological Association. (2010). Ethical Principles of Psychologists and Code of Conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx
Hazell, P. (2005). Prescribing psychotropic medication to children in general practice. Aust Prescr, 28,116-8.
Magellan Health. Appropriate Use of Psychotropic Drugs in Children and Adolescents: A Clinical Monograph. April 2017. Retrieved on 1/25/19 from https://www.magellanprovider.com/media/55579/psychotropicdrugsinkids.pdf
Sparks J.A., & Duncan, B.L. (2004). The Ethics and Science of Medicating Children. Ethical Human Psychology and Psychiatry, 6( 1),25-39