Should our children be taking psychotropics?

An APA working group is taking a serious look at one of the most controversial areas in children's mental health: prescribing psychoactive medications to children and adolescents. The group first met shortly after the Food and Drug Administration (FDA) issued a "black box" warning--its strongest safety alert--linking antidepressants to increased suicidal thoughts and behavior in children and teens.

The Working Group on Psychoactive Medications for Children and Adolescents, chaired by Ronald T. Brown, PhD, an expert in pediatric psychology and dean of Temple University's College of Health Professions, will review the scientific literature in the area. The group, established by APA's Board of Directors in March, housed in APA's Public Interest Directorate and appointed by APA President Diane Halpern, PhD, met for the first time Nov. 19-21 and will continue their work in 2005.

"The bottom line is there's more use of psychotropic medication with children than there is research data on it," says Brown, author of several books on the topic, including one in progress, "Medications for Children: A Guide for the Practitioner" (Guilford Press). "Our purpose is to come up with the state of the art about what is known and to advocate for the best interests of the child."

The eight-member group--which includes experts on childhood depression, anxiety, attention-deficit hyperactivity disorder (ADHD) and regulatory issues, as well as a child psychiatrist--will focus and write a report on the bigger picture of what is and isn't known about the effects of such medications on children--and how to best apply that knowledge in practice, says Brown.

"The question is, how do we best treat these kids, and do these psychotropic medications that have routinely been used to treat kids meet the scrutiny of science?" he says.

At least one class of psychotropic medications used with children, antidepressants, is under strong scrutiny after British studies showed they cause suicidal tendencies in 2 percent to 3 percent of child users, the impetus for the Oct. 15 FDA action on the matter. At present, more than 6 percent of American children and adolescents are estimated to take some kind of psychiatric medication. With the exception of ADHD drugs, many of those medications are not yet approved by the FDA for use with children, but prescribed by medical practitioners based on their judgment and experience.

Two child experts--the University of Puget Sound's Barry Anton, PhD, an APA Board of Directors and Council of Representatives member, and the University of Kansas's Michael C. Roberts, PhD, an APA council member--conceived of the group in response to public concern over a 2003 Archives of Pediatrics and Adolescent Medicine study (Vol. 157, No. 1) reporting a two- to three-fold increase in psychiatric drug use among children and teens between 1987 and 1996. (In 2000, the study's principal investigator, Julie Magno Zito, PhD, of the University of Maryland, re-evaluated one of the health plans investigated in the study and found that usage rates had continued to rise.)

Anton and Roberts also wanted the working group to discuss psychologists' current and future roles in the area, both as health-care consultants and as potential future prescribers, Anton says. Many psychologists already inform family practitioners and pediatricians on the state of the science on psychotropics for children, so there is good reason, he explains, to create consensus on what psychologists know and what they are communicating to other practitioners. In addition, as psychologists continue to gain prescription privileges, including for children, it is important their knowledge base is solid, Anton notes.

The group's aim is not to demonize psychotropics, adds Brown, but rather to take a scientifically open stance toward the use of these medications and acknowledge the good that drugs can do when used appropriately. For instance, despite their potential for misuse or overuse, ADHD medications such as Ritalin have been well-researched and proven very helpful in treating the condition, he notes. (Two major ongoing National Institute of Mental Health-funded studies of ADHD--the Multimodal Treatment Study of ADHD and the Preschool ADHD Treatment Study--promise more information in the near future on positive and side effects of these medications, as well as on the efficacy of nonpharmacological behavior treatments.)

Task force members are David Antonuccio, PhD, of the University of Nevada; George DuPaul, PhD, of Lehigh University; Mary Fristad, PhD, of Ohio State University; Cheryl King, PhD, of the University of Michigan; William Pelham, PhD, of the State University of New York at Buffalo; John Carl Piacentini, PhD, of the University of California, Los Angeles; and Benedetto Vitiello, MD, of the National Institute of Mental Health.

Tori DeAngelis is a writer in Syracuse, N.Y.