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Psychiatrists lay down the rules for prescribing to kids*

September 17, 2009 |  5:14 pm

A psychiatrist contemplating the prescription of psychotropic medications to a kid should open communications to the child's pediatrician. He should ensure that the child and her family grasp the objectives, side effects and benefits of the proposed medication, and agree it's needed. The psychiatrist should have a detailed plan to monitor the effects of the medication and change or discontinue the drug if it's not getting the job done or has untoward side effects.

A psychiatrist should precede any prescription-writing with a full psychiatric work-up and medical history, ruling out the possibility that behavioral or emotional symptoms are the result of underlying physical illness, or that drugs could do harm. And she should be wary of prescribing medication in cases where a child's home situation is so chaotic that a medicine's ill effects might be missed or an improper dose could be taken.

All are reasonable enough principles, and doubtless widely practiced already. But against the backdrop of steep increases in the pediatric use of psychiatric medication, all are principles that the American Academy of Child & Adolescent Psychiatry  today saw fit to enshrine in a new "Practice Parameter on the Use of Psychotropic Medications in Children and Adolescents," and to publish in the September issue of the academy's official journal.

The document "is not meant to reduce prescribing," said Johns Hopkins University psychiatrist John Walkup, the lead author of the "practice parameter" document. "Rather," he said in a news release accompanying the article's release, "it is a call to action to create a systematic and comprehensive approach to using medications in children safely and effectively."

The AACAP's to-do list for psychiatrists comes as many health professionals express concerns that--stretched thin by the needs of kids with behavioral, emotional and academic problems--physicians may be too quick to diagnose and medicate problem behaviors. The AACAP's "work group on quality issues," wrote that health insurers' reluctance to reimburse for time-consuming psychotherapy--which for many pediatric conditions is the preferred first treatment--has driven some of the increased reliance on drugs to treat kids. And though the drafters cautioned that "it is difficult to quantify and to prove conclusively," they allowed that the extensive marketing of psychiatric medications to physicians, patients and insurance administrators may have helped fuel the dramatic rise in prescriptions for kids.

When physicians fail to practice a "rigorous consistent approach to assessment and treatment," the document states, children and their families grow discouraged by treatments that don't work or come with unacceptable risks. "It is also possible that poor quality of psychiatric care may affect the public's perception of prescribers of psychotropic medications and lead to a loss of public support for psychiatric treatment services."

-- Melissa Healy

*Editing changes have been made in this post