Psychotropic Medications

Important advances in psychotropic medications and significant developments in neuroscience have complemented our growing knowledge about the structural and functional differences of the central nervous system (CNS) in children diagnosed with learning disorders and emotional problems (Brown & Sammons, 2002). However, in spite of these recent advances, researchers and clinicians note that clinical use of psychotropic medications in children exceeds our knowledge about the efficacy and safety of these drugs. Unfortunately, no statistical database exists on how many children and adolescents are receiving psychotropic medications for specific disorders. However, some surveys with specific psychotropic drugs (i.e., stimulants) suggest increased use of these drugs (Safer & colleagues, 1999). The psychiatric disorders for which psychotropic medications have been most used include attention deficit hyperactivity disorder (ADHD), autism, enuresis, mental retardation, and Tourette's syndrome.

The rationale for distinguishing between adult and pediatric psychopharmacology includes the differences in medical and psychological practice between the two populations. These include physiological factors (e.g., differences in body weight, drug absorption, and drug interactions) and psychological factors (children and adolescents usually have a different cognitive framework from adults to describe positive and adverse effects of drugs) (Werry & Aman, 1998). Furthermore, children almost always rely on caregivers to administer medication and to report on the positive and negative effects of various medications. In addition, psychotropic medication is only one of many treatments children may receive.

Assessment of psychotropic drug effects in the pediatric population is monitored in the areas of learning, physical functioning, and psychosocial functioning. Therefore, assessment must be conducted from different informants (caregivers, teachers, clinicians) and in various settings (home, school) (Brown & Sawyer, 1998). Assessments usually include behavioral rating scales, direct observations of behavior, physical effects, structured interviews, and, sometimes, specific laboratory measures of psychological performance (e.g., continuous performance tasks of concentration and attention). While the search continues for ideal measurements to predict response to psychotropic drugs, so far no such instrument has been developed (Brown & Sammons, 2002).