AACAP Releases New Practice Parameter to Guide Psychotropic Medication Use in Kids
By Caroline Cassels
Medscape Medical News
September 18, 2009 — A new practice parameter to guide the use of psychotropic medications in children has been released by the American Academy of Child and Adolescent Psychiatry.
"The reason for the parameter was to ground prescribers of psychotropic medication in the best practice principles. This is not a standard of care document and is not meant to reduce prescribing. Rather it is a call for action to create a systematic and comprehensive approach to using medications in children safely and effectively," principal author John Walkup, MD, from Baltimore, Maryland, said in a statement.
The full parameter is published in the September issue of the Journal of the American Academy of Child Adolescent Psychiatry.
According to the article, there has been a marked increase in the understanding of childhood psychiatric disorders and a developing evidence base supporting the use of psychotropic medications in this patient population.
The authors note that psychiatric disorders in children are common and, without treatment, can have negative short- and long-term consequences. Yet despite this, they say, the vast majority of children with mental health problems do not receive appropriate evaluation and treatment.
Although psychotropics are an important element of treatment, the increased use of these drugs has led to concerns that "some children and adolescents are being overdiagnosed with psychiatric disorders and are being treated with medication/s that are not appropriate for them," the authors write.
They add that strategies to reduce inappropriate use, including the US Food and Drug Administration's black box warning for antidepressants, may have the unintended effect of creating barriers to care and subsequent negative outcomes.
"Rather than advocating for restricting access to medication treatment, this parameter advocates for high-quality assessment and prescribing practices to enhance outcomes for children and to address societal concerns about how children with psychiatric disorders are treated," the investigators write.
In developing the parameter, the researchers, led by Dr. Walkup, undertook an extensive literature review that included published articles pertaining to psychopharmacology in children and adults. They also reviewed textbooks on pediatric psychopharmacology, as well as their reference lists.
Finally, as background for the parameter, the researchers conducted a PubMed search on quality medical care and the overuse of medical testing and other medical procedures considered to be used excessively, such as routine laboratory or radiological testing and caesarean section. In addition, they did an analysis of any other medical conditions that have historically been overdiagnosed or misdiagnosed and treated inappropriately.
The parameter contains 13 principles to help guide clinicians in their treatment strategy for their young patients. These include best practices for psychiatric and medical assessment, development of the treatment and monitoring plan, education of both the patient and the family about the disorder and treatment, implementation of the treatment plan, and management of medication modification plans.
Dr. Walkup has disclosed that he receives or has received research support from Eli Lilly Company, Pfizer, and Abbott Laboratories; acted as a consultant and/or served on an advisory board for Eli Lilly & Company, GlaxoSmithKline, and Cliffs communities; and receives or has received honoraria from CME. Dr. Walkup's spouse serves as a consultant to Abbott Laboratories. Dr. Bukstein receives or has received research support, acted as a consultant, and/or served on the speaker's bureaus of McNeil Pediatrics and Novartis Pharmaceuticals. Dr. Bernet and Dr. Walter have disclosed no relevant financial relationships.
J Am Acad Child Adolesc Psychiatry. 2009;48:961–973.