Ethical concerns
In most child and adolescent cases, a combination of various methods is necessary to deliver a multidimensional treatment plan. The three primary broad modes of treatment in child and adolescent psychiatry are physical, psychological, and social treatments. Within these modes are medication treatments that spark controversy due to the limited, controlled research on adolescents and children.
Therefore, the use of medication is largely based on clinical experience rather than controlled experimentation (Ebert, Loosen, Nurcombe, & Leckman, 2008). It is of upmost importance that the treating prescriber exhaust all other methods of treatment prior to recommending and seeking parental consent for the use of psychotropic medication.
Principles prior to medication treatment
Prior to prescribing medication to children and adolescents, the clinician should first obtain a detailed medical and medication history that includes illicit drug use. Second, the medication and treatment should be linked to a larger treatment modality that is consistent with the diagnostic formulation.
Third, the family should be involved in the treatment plan with full parental consent prior to beginning a medication treatment. Fourth, the decision to prescribe medication should be directed at treating symptoms rather than disorders.
Fifth, the clinician should communicate with school representatives to ascertain a thorough perspective of symptoms and behavior while at school. Sixth, a detailed physical exam, including laboratory tests, should be obtained prior to starting prescribed medication to rule out organic causes and contraindicated conditions. And seventh, the prescriber should document a risk to benefit analysis that is peer-reviewed (Ebert, Loosen, Nurcombe, & Leckman, 2008).
Medication guidelines
If medication is started, the drug with the least threat of danger, as well as, the best evidence of effectiveness should be utilized. Combination therapy should only be utilized when a suitable trial is unsuccessful. When medication begins, the dosage should be low, and increased gradually.
When discontinuing medication, the process should include a steady taper unless no risk is noted with abrupt discontinuation. It is imperative that the clinician quantify goals and monitor progress, including checking for side effects while on medication, regularly. In addition, the medication should be prescribed for as short a time as possible, with consideration of “drug holidays” where applicable (Ebert, Loosen, Nurcombe, & Leckman, 2008).
Conclusion
Pediatric psychotropic utilization rates are high globally with about 20% of the children taking more than one kind of psychotropic drug. These drugs are taken for various problems involving emotions, cognitive functioning and behavior. Studies on the appropriate pharmacological treatments for pediatric psychological health disorders are limited mostly due to the high costs and ethical issues. Caregivers are unwilling to enroll their children in these researches since there do not see the direct impact of such studies.
The few existing studies have focused on the short-term effects of using psychotropic drugs on children by examining the symptoms. Additional research is necessary to determine the long-term impact of these drugs on the functional properties of children. Clinicians prescribe psychotropic drugs with limited information regarding their impact as the children age. Hence, further studies should be conducted in order to provide more information about the safety of psychotropic treatment strategies.
These studies will also be beneficial in helping physicians to come up with effective psychotropic treatment plans. Due to the concerns involved in studies involving children, the researchers should consider various ethical aspects in the trials including justice, respect and beneficence.
References
Ebert, M. H., Loosen, P. T., Nurcombe, B., & Leckman, J. F. (2008). Current diagnosis and treatment psychiatry (2nd ed.). New York, NY: McGraw-Hill Companies Inc.