Use of Psychotropic Medications among Youth in Treatment Foster Care

We describe the use of psychotropic medications among youth in treatment foster care (TFC). Data from 240 youth were coded to examine rates of medication use, including polypharmacy and an indicator of "questionable polypharmacy." Fifty-nine percent of youth in TFC had taken a psychotropic medication within the past two months. Of the youth taking psychotropics, 61% took two or more and 22% met criteria for questionable polypharmacy. The majority of youth taking psychotropics also received psychosocial mental health services and were more likely to receive such services than youth not taking medication. Use of psychotropic medication use was not significantly related to demographic factors, maltreatment history, or custody. However, youth with more severe symptoms were more likely to be on medications and to be on multiple medications. Youth with "questionable polypharmacy" were less likely than other youth on multiple medications to have a recent visit to a psychiatrist.

Ameliorating attention problems in children with sickle cell disease: a pilot study of methylphenidate

OBJECTIVE

This pilot study examined whether methylphenidate (MPH) was effective in enhancing cognitive performance and attention for children with sickle cell disease (SCD) with cerebrovascular complications who evidence attention problems.

METHODS

In this multisite, pilot study, we evaluated 2 separate double-blind controlled clinical trials, including a laboratory trial of the short-term efficacy of MPH, with the second study a 3-week home/school crossover trial evaluating the efficacy of MPH. The laboratory trial included 14 participants between the age of 7 and 16 years. Assessments included measures of sustained attention, reaction time, executive functions, and verbal memory. The home/school trial included 20 participants. The outcome measures were parent and teacher ratings of attention. The first study compared MPH with placebo, while the second trial compared placebo, low-dose (LD) MPH, and moderate-dose MPH.

RESULTS

In the laboratory trial, significant effects were revealed for measures of memory and inhibitory control. Parent and teacher reports from the home/school trial indicate that moderate-dose MPH produced superior improvement in attention relative to the placebo and LD MPH.

CONCLUSIONS

Stimulant medication positively impacted select measures of memory and inhibitory control in some children with SCD. Attention, as rated by parent and teachers, was improved for a greater number of children and adolescents on higher doses of MPH relative to LD MPH and placebo. Stimulant medication may provide an effective intervention for some children with SCD and cerebrovascular complications who demonstrate attention problems.

A pilot investigation of teachers' perceptions of psychotropic drug use in schools

OBJECTIVE

Children's behavior at school often leads to parental interest in seeking physician treatment. This study examines teachers' knowledge and perceptions of psychotropic drug use in schools.

METHOD

Structured interviews were conducted with 27 general education teachers from a diverse representation of elementary schools within central Michigan. Information on (a) current use of psychotropic medications by their students, (b) consultation and collaboration with parents and mental health professionals, and (c) knowledge of the properties and side effects of Ritalin was gathered.

RESULTS

Teachers report limited knowledge of how and why medication treatment works despite reporting that 11.5% of their students were currently being prescribed a psychotropic medication. Teachers indicate little communication with parents or professionals regarding medication use or the side effects associated with their use.

CONCLUSION

Issues related to the amount of knowledge that school professionals should have about this increasingly used treatment remain unresolved and warrant further research.

A meta-analysis of combined treatments for children diagnosed with ADHD

OBJECTIVE

Meta-analytic procedures are used to review the literature of combined treatments of psychosocial and pharmacological treatments for children diagnosed with ADHD.

METHOD

Eight combined treatment studies meet specific inclusion and exclusion criteria regarding the core and peripheral features of the disorder.

RESULTS

The results of this study highlight the individual and average effect sizes within the categories of inattention, hyperactivity, impulsivity, social skills, and academics. These findings are compared with the effect sizes of meta-analytic findings previously reported in the pharmacological literature.

CONCLUSION

The results reveal large effect sizes for the core features of the disorder and the peripheral feature of social skills. A small effect size is found for the peripheral feature of academics. Findings are discussed in light of the paucity of included studies focused on combined treatments for ADHD.

Atomoxetine in the management of children with ADHD: effects on quality of life and school functioning

The purpose of this study was to examine in a controlled trial the effects of atomoxetine on the management of attention deficit-hyperactivity disorder (ADHD) symptoms and functional impairments at school and at home. Participants were 153 children (age 8 to 12 years) diagnosed with attention-deficit hyperactivity disorder who were randomized to double-blind treatment with either atomoxetine (n = 101) or placebo (n = 52). Findings revealed significant improvements both for parent and teacher ratings of behavior for children receiving atomoxetine therapy. Children also were reported to evidence a trend toward better response to active medication than to placebo for health-related quality of life as rated by parents. No significant effects were revealed for the teacher ratings of academic productivity. Data were interpreted to provide support for the efficacy of atomoxetine on the symptoms associated with ADHD. The effects of atomoxetine on other functional outcomes including academic performance and health-related outcomes are of interest, albeit less compelling for this particular investigation, than for the effects on overt symptom display.

Teamwork: the therapeutic alliance in pediatric pharmacotherapy

All child psychiatrists' interactions with patients and families have important potential meanings, and the act of prescribing medication is no exception. As psychopharmacologic practice has increased in child psychiatry, facility with psychotherapeutic skills, such as establishing an alliance, identifying and treating symptoms, and promoting adherence must follow to enhance clinical outcomes. This article addresses the role of the therapeutic alliance in pediatric work, the psychologic implications of administering medications, developmental issues altering psychopharmacologic efforts, the role of the dual alliance (allying both patients and parents), and recommendations for clinical practice and further research.

Nature, assessment, and treatment of generalized anxiety disorder in children

GAD in children is characterized by excessive and uncontrollable worry about a number of events and activities in daily life. GAD is a prevalent and chronic disorder that is highly comorbid with other psychiatric disorders and has a significant affect on a child's life. Reliable and valid methods are available with which to assess childhood anxiety (eg, structured interviews and questionnaires). Furthermore, efficacious treatments for anxious children have emerged, with CBT the treatment of choice. In recent years, our understanding of childhood anxiety disorders has grown exponentially. Much of our understanding of GAD, however, is still reliant on studies of children with a range of anxiety disorders. Future research is needed that specifically examines children with GAD compared to anxious, depressed children without GAD. Such research would aid in the identification of factors unique to GAD, improve assessment methods and potentially enhance treatments for children with GAD.