Smyer et al. (1992) investigate that in modern times both practitioners and researchers in the field of psychiatry and psychology have become interested in the neurobiological foundations of behavioral, emotional and cognitive functioning. Baldessarini (1990) discovers that 20% of the prescriptions have an effect on psychological processes. De Leon, Fox & Graham (1991) include that this movement has brought interest in psychologists acquiring prescription privileges. American Psychological Association (APA) had many task forces that were managed by many groups. It was in response to interest in psychopharmacology.
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Barkley et al. (1990) recognized this issue and understood the need for its application and extension. Following this study, a task force on psychopharmacology hit the road. It was in charge of the following things: a) categorize important issues for using psychoactive medications with the children, b) review the literature particularly related to prescription privileges for psychologists and c) explain the implications of school psychology following the physician prescription of psychoactive medication for school children (Cindy Carlson & Tom Kubiszyn, 1994, p.1).
The task force has recommended the following things (Cindy Carlson & Tom Kubiszyn, 1994, p.1):
- Medical school training is not considered necessary for the proper prescription of psychoactive medications for adults. The trained psychologists can do it suitably.
- The prescription privileges for psychologists should explain it clearly that not much is known about the protection of the psychoactive formulations used with adults in comparison to what is used with children.
- School psychologists can develop and execute evaluation methodologies to review behavioral, cognitive, emotional, psychological, learning and developmental changes that can be influenced by psychoactive medications.
- School psychology can guide in the development of clinical psychopharmacological trials and protocols.
- A working group should be formed to develop the psychopharmacological research and evaluation methodologies.
- School psychologists should take predoctoral training in psychopharmacology.
- In the case of prescription privileges, the non-traditional psychopharmacological treatment protocols should be considered.
- School psychologists should not uncritically take into consideration postdoctoral training models for child psychologists.
- The Execution Committee encourages for prescription privileges to the school psychologists, which gives independent practitioner status instead of dependent one for psychologist prescribers (Cindy Carlson & Tom Kubiszyn, 1994, p.1).
Psychopharmacology can be related to the neuroscience model of mental disorders. Psychopharmacology of children who have learning and behavior problems has become very systematic in the present time (Steven R. Forness and Kenneth A. Kavale, 1988). The importance of drug effects associated with brain structure, genetics and biochemistry and the function of the central nervous system can be understood. Many psychoactive medicines affect clinically one or more neurotransmitters; these are the elements that are responsible for the conduction of impulses from one nerve cell to another or on the receptors for neurotransmitters (Steven Reiss, n.d.).
Psychoactive drugs create behavioral, emotional or cognitive influences. For the treatment of mental and behavioral disorders, psychoactive drugs are used and the use of these kinds of drugs is called clinical psychopharmacology. Neurologists, psychiatrists, pediatricians can recommend these drugs for curing mental illness, depression, anxiety, epilepsy, and substance abuse. Trichotillomania (TIM) is another common problem that occurs due to psychiatric disorder (Edore C. Adewuya et al, 2008).
The role of clinical psychologists and research psychologists differ from these clinical professionals. A clinical psychologist can provide behavioral, emotional or cognitive therapies to such patients who need them in addition to medication and a research psychologist study the effects of medication and increase scientific knowledge of the function of the brain (Steven Reiss, n.d.).
In the last decade, the growth of psychotropic medications can be observed which is to enhance behavioral and psychosocial interventions with children and adolescents. Phelps, Brown, and Power (2002) state that the importance of pediatric psychopharmacology is growing and that is the reason, it is receiving more concentration to respond the growing frequency of mental health difficulties that have been observed in 21 year old youngsters (Laura Abrams, Jillian Flood, and Leadelle Phelps, 2006, p.493).
The combination of medications with psychosocial interventions has shown pragmatic support with which the treatment provided to children, who have different kinds of psychiatric disorders, has given positive results. According to Laura Abrams et al. (2006), antidepressants and stimulations are some kinds of medications that are used to treat mental disorders. The problems like anxiety depression, attention deficit hyperactivity disorder (ADHD) put this review in order to give school psychologists an assessment of the usefulness and the side effects of prescribed medications.
Barkley (1976, 1977) investigate that the literature on the topic of stimulant drugs for children with learning and behavior problems is proliferating (Howard S Adelman and Bruce E. Compas, 2001). Freeman (1966) and Sprague & Werry (1971) mention that these studies are being centered on diagnosis and treatment. The investigations have been done on various functions like motoric, cognitive, perceptual, language and socioemotional. The present interesting areas in the research are memory, attention, cognitive style, learning, expectancy, and informal acknowledgments
Classes of Medication
Laura Abrams, Jillian Flood, and Leadelle Phelps (2006, p.493) discover that there have been separate classes for psychotropic medications which depend upon either, the biochemical system like selective serotonin reuptake inhibitor, the disorder like antipsychotic, or both tricyclic antidepressants.
Laura Abrams, Jillian Flood, and Leadelle Phelps (2006, p.493) further mention that tricyclic medications are such kinds of medications, which consist of a three-ring antihistaminic structure. The tricyclic antidepressant performance is dependant upon the development of the brain’s supply of norepinephrine and serotonin levels, which permits the course of nerve impulses to return to normal levels. The brain’s all three neurotransmitters like serotonin, norepinephrine and dopamine are influenced by the monanine oxidaseinhibitors (MAOIs).
The medications are called as MAOI where the neurotransmitters are referred to as monoamines and the enzyme which is related to monoamines is called oxidase. The intensity of serotonin, norepinephrine, and dopamine is augmented by reducing oxidase. Selective serotonin reuptake inhibitors (SSRIs) perform after augmenting the intensity of serotonin where the intensity of norepinephrine and dopamine is not influenced (Laura Abrams, Jillian Flood, and Leadelle Phelps, 2006, p.493)
There are total six classes of drugs: Antisychotics, Antidepressants, Anxiolytics, Sedatives and Hypnotics, Stimulants, Mood Stabilizers (Steven Reiss, n.d., p.437).
Antisychotics: 1952 is the period when Psychopharmacology was recognized by Delay, Deniker and Harl when they reported that Thorazine was affected by antipsychotic and these effects are different from the effects of the simple sedative. Antipsychotics’ others names are neuroleptics and major tranquilizer. These drugs are used for schizophrenia and some other psychotic conditions. These drugs minimize the intensity of psychotic conditions and disorders like withdrawal, hallucinations and delusions.
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As these drugs just minimize the intensity of the symptoms and they are not cured, the drugs are used for a longer period. It is considerable how each person is responding to these medications. Kinon (1993) discovers that most of the people’s response is positive which can be noticed within the six weeks of the treatment. Schatzberg, Cole, & Debattista (1997) notice that relapse may happen within 1-2 year and rate can go up to 50% though the medicines are continued (Steven Reiss, n.d., p.437).
These drugs can treat the disorders like aggression or irritability. The extensive use of these drugs can be seen in curing mentally retarded or autism people. Reiss & Aman (1998) argue that many people believe in trying antidepressants instead of using antipsychotics. Steven Reiss, (n.d., p.438) mention that the first generation antipsychotics are phenothiazines, butyrophenone, thioxanthene, and dihydroindolone.
He further mentions that the second generation involves dibenzodiazepine, thienobenzodiazepine, benzisocazole (risperidone), and phenolindole (sertindole). The second generation drugs are accepted widely as they do not have many side effects. A very common antipsychotics drugs are Haldol, Mellaril, Navane, and Thorazine, which are all first generation drugs and Clozaril and Risperda, which are second generation drugs. Dopamine antagonism is that mechanism which maintains effects of antipsychotic.
Antipsychotics do not make anyone dependant physically. These drugs become the reason of sedation which can affect day to day learning and functioning (Steven Reiss, n.d., p.438).
Antidepressants: Crane (1957) & Kuhn (1957) state that these medicines came into existence in 1957. The use of antidepressants is widely made for curing the problems like panic disorder, attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive disorder, depressive episodes and up to some extent aggression. Half of the depress patients respond to these drugs. Its effectiveness in children is not much seen still its use is increasing.
Steven Reiss (n.d., p.438) mentions that antidepressants take account of the tricyclics and other concerned compounds like monoamine, selective serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs) and second generation agents. Previously MAOIs came into contact with tyramine that is found in food and beverages like salami, fruits, beer, cheese etc which caused life-threatening hypertensive reactions.
The new MAOIs like maclobemide and brofaromine have fewer side effects and also they do not have any restrictions on diet. The tricyclic and heterocyclic elements like amitriptyline, clomipramine and imipramine that are effective in depression but can be the reason of cardiovascular complications at the same time, have been taken over by SSRIs like fluoxetine and sertraline which are very effective and do not cause any cardiovascular problems and are very safe while taking overdose (Steven Reiss, n.d., p.438).
The second generation antidepressants are trazodone, buproprion, venlafaxine, and nefazodone. Their chemical composition is different from other antidepressant drugs and they react against depressive symptoms that are as same as the tricyclics. They have very less side effects. All these classes are very important as each has its own individual effect to which a patient may respond or not. A patient may respond to one better than other. The SSRI and the tricycles antidepressants like Clomipramine and fluvoxamine are used to treat obsessive compulsive disorder. The effect of antidepressants can be observed on norepinephrine, serotonin and dopamine (Steven Reiss, n.d., p.438).
Anxiolytics: These drugs help in recovering anxiety or anxiety disorders. In 1960s the Benzodiazepines, which are diazepam, lorazepam, and alprazolam, were initiated. As these drugs are very effective and safe in overdose, they are recommended extensively but they become the reason of physical dependency. They have side effect like daytime drowsiness. Benzodiazepines’ business names are Ativan, Xanax and Valium (Steven Reiss, n.d., p.439).
Buspirone was initiated as the first nonbenzodiazepine anxiolytic in the United States in 1987. It is the short term treatment of anxiety disorder. It is very effective in comparison to benzodiazepines and it has very less withdrawal symptoms in case it is discontinued. Beta blockers and alpha-2 agonists perform as anti anxiety agents. They can reduce anxiety aggression (Steven Reiss, n.d., p.439).
Sedatives and Hypnotic: Steven Reiss (n.d., p.439) mention that these drugs are very useful for insomnia treatment. They are also very effective for extremely agitated patients to make them sleep quickly. In early 1965 Phenobarbital was extensively used for sedation but currently it is used for epilepsy treatment. Trazodone is being understood very useful for bedtime sedation (Steven Reiss, n.d., p.439).
Stimulants: Bradley. Molitch (1937) & Eccles (1937) reported that amphetamines were considered as minimizing disruptive behavior and hyperactivity. They were also understood very important for improving academic performances in children. Presently, approximately 3% of the school children use this drug for treating ADHD. Approximately 70% of the children showed improvement being more attentive, decreasing disruptive behavior and improving academic performance after taking these drugs. These drugs are very safe but their use should go for many years. Children who use these drugs have not been found physically dependent when they take these drugs for ADHD. They are used by adults too for ADHD and obesity treatment. For business purposes these stimulants are called Dexedrine, Ritalin, and Cylert (Steven Reiss, n.d., p.439).
Mood Stabilizers: Cade initiated the use of lithium salts for treating mania in 1949 but till 1970s there was no technique to control their toxic effects which could promote them widely. In case of mania lithium is used at priority basis. Carbamazepine and valproic acid that are anticonvulsant drugs have a preference among children. Carbainazepine or valproate are used by impulsive patients or those who have episodic, the uncontrolled violent behavior. It is also been observed that Verapamil is very good for the treatment of mania. For the business purposes the mood stabilizers are called Eskalith and Lithane; anticonvulsants are called Tegretol, Depakene and Depakote (Steven Reiss, n.d., p.439).
A recent study, which has been controversial whether antidepressants become the reason of suicide in some children, has created the confusion in clinicians, patients and parents. Brent et al. (1999); Pfeffer et al. (1991) discover that suicide is the main reason of death in adolescents and it has been the first aim for the nation and the state to minimize its rate (Florida, 2005). Olfson et al. (2003); Shaffer et al. (1996) discover that depression is the main cause of suicide in adolescents (Wayne K. Goodman et al., 2006).
Socioenvironmental, substance abuse and psychiatric possessions can also be associated with suicide risk in children and adolescents. The main solution for minimizing the risks of suicidal cases is to recognize the factors associated with it. The antidepressants are expected o play an important role in giving effective treatment for anxiety disorder, prevention of suicidal thinking or act (Wayne K. Goodman et al., 2006).
Wayne K. Goodman et al., 2006 further mention that the efficiency of antidepressants is considered to be doubtful in treating depressed children and adolescents. The selective serotonin reuptake inhibitor (SSRI) has been found out very effective for pediatric depression. Some surveys have been conducted with selective serotonin reuptake inhibitor (SSRI) induced enuresis. Tonini and Candura (1996) discover that enuresis is intervened by the activation of neuronal 5-HT4 receptors in the detrusor muscle. (Sabri Hergüner et al., 2007).
Movig et al. (2002) discover that researches have shown that the patients who take SSRIs have more chances for developing urinary incontinence. SSRIs are becoming very common drugs to be prescribed in pediatric population and it is required to keep an eye on the possibility of enuresis (Sabri Hergüner et al., 2007).
Laura Abrams et al. (2006) discover that the importance of five medications have been understood very well by double blind studies for using them for the purpose of childhood anxiety disorders. They are
- clonazepam (Klonopin),
- clomipramine (Anafranil),
- fluvoxamine (Luvox),
- fluoxetine (Prozac)
- Sertraline (Zoloft).
In 1990 clomipramine (Anafranil) was first used in the United States. It is a tricyclic antidepressant which is used for treating childhood obsessive-compulsive disorder (OCD). Compton, Burns, Egger, & Robertson, 2002; Williams & Miller, 2003 investigate that double blind studies with the involvement of children have recognized major changes in symptoms which are related with OCD when they are compared with placebo. Its bad effect is the risk of convulsion if is used for more than a year. (Laura Abrams et al., 2006, p.494).
The following chart reflects that some medications have been promoted by open studies for the pediatric population suffering with anxiety and mood disorders (Laura Abrams et al. 2006, p.495):
GAD generalized anxiety disorder; PTSD_posttraumatic stress disorder; OCD_obsessive compulsive disorder (Laura Abrams et al. 2006, p.495).
In addition to this, dizziness, tremors, fatigue, dry mouth and drowsiness have been described. Insomnia can cause many difficulties in coping with daily work (Niciletta et al, 2000). Velosa & Riddle (2000) discover that clomipramine are needed to do some assessment with all tricyclic related to blood levels, liver functioning, cardiac functioning and vital signs. Klonopin adds that pediatric research community has not paid much attention towards benzodiazepine and clonazepam.
Graae, Milner, Rizzotto,& Klein (1994) mention that clonazepam has been compared with placebo by two double blind cross studies and remarkable changes the symptoms of children suffering with anxiety disorder. The symptoms were reduced. Kutcher, Reiter, Gardner, & Klein (1992) also noticed the same kind of changes in adolescent patients suffering with panic disorder. There were very less side effects like ataxia, dizziness and drowsiness (Laura Abrams et al., 2006, p.495).
SSRI has discovered that Fluoxetine (Prozac) is very safe and effective for children. It is mentioned in open studies and a few double blind studies as well. Compton et al., 2002; Varley & Smith, 2003; Whittington et al., 2004 discover that SSRI have been understood very important and have been kept as a fist line defense for the children suffering with anxiety disorders and are recommended generally for such kinds of children.
The result of such SSRIs and fluoxetine is commonly positive where less and reducing symptoms can be observed with a few side effects after minimum four weeks of treatment. Birmaher and colleagues (2003) performed some tests over 74 adolescents with the age range of 7 -17 who were suffering from functional impairment because of generalized anxiety disorders, social phobia and separation anxiety disorder. When the placebo controlled and random trials were applied on them, the researchers found fluoxetine very effective and well tolerated (Laura Abrams et al., 2006, p.497).
Fluvoxamine (Luvox) is clinically promoted in controlled and open trials. The Research Unit on Pediatric Psychopharmacology Anxiety Study Group (2001) made researches by doing multicenter, double blind, placebo controlled and on random basis study where 128 children in the age range of 6 to 17 years were assessed. They were all taken according to the decisive factor like separation anxiety disorder, social phobia or generalized anxiety disorder.
An eight week study showed remarkable reduction of symptoms in the assessed group of those children. Research Unit on Pediatric Psychopharmacology Anxiety Study Group (2002) further reported that this study was extended for six more months and then the researchers found that original fluvoxamine responders started showing a trim down in anxiety symptoms which was upto 94% and from the 14 original fluvoxamine nonresponders those who moved to fluoxetine (Prozac), 71% were found having less anxiety symptoms (Laura Abrams et al., 2006, p.497).
Sertraline (Zoloft) has been found giving positive results in a few double blind studies. March and colleagues (1998) mentioned that a multicenter, controlled trial where sertraline has been put side by side placebo was applied on the group of 187 children in the age range of 6-17 years who were suffering from OCD. This medication was found very effective with less side effects. Rynn, Siqueland, and Rickels (2001) also did a double blind placebo controlled research about sertraline for treating the children with generalized anxiety disorder. This trial was conducted on the group of 22 children in the age range of 5-17 years. They reported remarkable symptoms of reduction when compared with placebo group (Laura Abrams et al., 2006, p.497).
The chief of the Child and Adolescent Treatment and Preventive Intervention Research Branch at the National Institute of Mental Health, Mr. Benedetto Vitiello mentions that in the period of 1937 the therapeutic effects of amphetamines in hyperactive children was noticed considerably which paved the way for the adults to use antidepressants, lithium and neuroleptics and the growth in pediatric psychopharmacology fall behind the adults (Christopher J. McDougle & John H. Krystal, 2007).
From the past decade, The National Institutes of Health is trying to innovate important resources to make them available to set up the Pediatric Pharmacology Research Units (PPRU) and Research Units on Pediatric Psychopharmacology (RUPP). They are conducting not only important pharmacokinetic studies but also they are trying effective measures of off- label psychotropics among the children. Boylan and colleagues review the pharmacological treatment of severe depressive disorder.
Olfson et al. (2006) discover that antidepressants are very well suited to the children. Smarty and Findling evaluate the pharmacotherapy of bipolar disorder (BPD) in children and adolescents. They argue that BPD is conflict-ridden when diagnosing and treating this problem as there is not any mutual agreement among experts related to its clinical expressions, diagnostic symptoms criteria and its course. Still pediatric BPD is understood a chronic disease. Some anticonvulsants, lithium and second generation antisychotics can be very advantageous for the severe monotherapy in the adolescents who have mixed and or maniac conditions.
Christopher J. McDougle & John H. Krystal (2007) stresses upon the requirement of increased meticulous study of combination pharmacotherapy which is due to very less response to the acute monotherapy. They further suggest that future researches are also required to check bipolar depression in adolescents. There should also be some studies related to the treatment of co-morbidities and maintenance/relapse prevention. Goodman and his colleagues review and offer a challenging summary of the orientation of the suicidal behavior in adolescents who get the treatment through antidepressants (Christopher J. McDougle & John H. Krystal, 2007).
Krystal et al. (2002) focused on the researches of Lee and his colleagues regarding the growing body of evidence that glutamate dysfunction can grow the exposure to many psychiatric disorders, which involves depression too. The prior results of their studies which were done on rates show that taking glutamate with the amyglada can minimize social exploratory behavior and it also influence symptoms of mood disorders. Various studies have been done to check the effectiveness of the drug treatment in many anxiety disorders in comparison to pediatric mood disorders.
Lots of studies have been done and their results are introductory. These results confirm that organic markers with impending treatment response for pediatric anxiety disorders will be recognized soon (Christopher J. McDougle & John H. Krystal, 2007).
Laura Abrams et al., (2006, p.497) discuss that Media has brought into notice a recent controversy about the pharmacological treatment of pediatric depression. The Food and Drug Administration’s joint advisory committee suggested that all pediatric antidepressant drugs should maintain a ‘black box’ warning label. This incident happened on 14 September, 2004. It was to point out the growing risk of suicidal thinking and behavior in the children under the age of 18 Food and Drug Administration (2004).
Brent (2004) stated that the committee has taken too lightly the importance of pediatric antidepressants drugs rather it has overvalued the risks occur due to it. Food and Drug Administration (20040) reported that of the 4,400 patients who went through the evaluation, 78 children were selected randomly for active drug treatment and showed self harm behavior. American Academy of Child and Adolescent Psychiatry (2004) assess that this ratio is 2 to 3 of 100 patients.
Brent (2004) further added that the active drug conditions reduced the symptoms of depression. It happened four times and it was as frequent as suicidality increased (Laura Abrams et al., 2006, p.497). The American Academy of Child and Adolescent Psychiatry (2004) came upon a conclusion that these statistics do not give this warning that antidepressants become the reason for committing suicide among the children and adolescents (Laura Abrams et al., 2006, p.497).
Laura Abrams et al. (2006, p.497) discuss that the pediatric population has shown many positive changes after receiving three clinical medications: (a) paroxetine (Paxil), (b) fluoxetine (Prozac), and (c) clomipramine (Anafranil). Clomipramine (Anafranil) is the most demanding antidepressant, which is a tricyclic antidepressant. Though it is mainly recommended for OCD, still it is very effective in treating pediatric depression. Laura Abrams et al. (2006, p.497) mention that Sallee, Vrindavanam, Deas-Nesmith, Carson, and Sethuraman (1997), Sallee, Hilial, Dougherty, Beach, and Nesbitt (1998), and Braconnier, Le Coent, and Cohen (2003) all have done randomized, double blind studies where clomipramine has been found very helping for the treatment of pediatric depression (Laura Abrams et al., 2006, p.497).
Laura Abrams et al. (2006, p.498) mention that Fluoxetine (Prozac) has been proved a very effective SSRI for the treatment of pediatric depression. Emslie and colleagues (2002) cured a group of 122 children and 97 adolescents who had severe depressive disorder. During the treatment they were given either placebo or Fluoxetine 20 mg/day for eight weeks. Similarly, the Study team for the Treatment for Adolescents with Depression detected that only Fluoxetine and Fluoxetine combined with cognitive behavior therapy (CBT) were very effective for the treatment of adolescents who had sever depressive disorder. Laura Abrams et al. (2006, p.498) further mentions that Only Fluoxetine could be considered to be the important and effective treatment for CBT but the combination Fluoxetine was the most effective.
Laura Abrams et al. (2006, p.498) discover that Paroxetine (Paxil) is another SSRI which is beneficial for treating pediatric mood disorders. Braconnier et al. (2003) investigated that Paroxetine is very effective which has very less side effects when it was applied on the group of 121 children who had major depression. Keller and colleagues also tested 275 adolescents who had severe depression.
These children were under the treatment of either double-blind paroxetine that was given to them for eight weeks or placebo or imipramine. Keller et al., 2001further mentions that the adolescents who were under the treatment of paroxetine showed major reductions in the symptoms of depression which had higher rating in comparison to those who were given placebo or imipramine. It was also noticed that imipramine was found to be as same effective as placebo (Laura Abrams et al. 2006, p.498).
Attention Deficit/Hyperactivity Disorder
ADHD is managed by stimulants which are the most extensive researched medications. Researches have shown the advantageous sides of the stimulants for treating the symptoms related to ADHD that includes impulsivity, hyperactivity and inattention. Phelps et al., 2002 sates that these researches are based on the laboratory tests, observing the behavior directly in a classroom setting and some behavioral tests which are based on rating of the parents and caregivers (Laura Abrams et al. 2006, p.498).
W. Burleson Daviss et al. (2008) mention in their study that Birmaher et al. (1996) investigate that MDD that is major depressive disorder which happen in 2.5% children and 8.3 adolescents and they are so severe that they can create high level of suicidal risk. Guevara, Lozano, Wickizer, Mell, & Gephart (2002) talk about stimulants which are advantageous in recovering oppositionality, peer relationships and aggression. Pelham et al. (2002) discover some more advantageous effects of stimulant medication which takes account of class work, parent interactions and classroom behavior (Laura Abrams et al. 2006, p.498).
As stimulant medication is being practiced from the past 60 years, lots of researches have been made for knowing its side effects as well. The short term effects which are common also contain headache, delayed sleep inception, stomachache, less appetite and restlessness. These side effects are due to the dose of medication and can be in charge of scheduling adjustments (Laura Abrams et al. 2006, p.498). Laura Abrams et al. (2006, p.498) discuss that Wilens, Faraone, and Biederman (2003) investigate that stimulants for ADHD affect safely against the development of substance abuse in adolescence and they do not give any substance use disorder.
Physicians who prescribe these stimulants should be aware of its potential abuse (Christiane Poulin, 2001).
Role of the School Psychologist
School psychologists play an important role in supervising children and adolescents who are in need of medication. Their firstly important role is to evaluate behavioral and emotional apprehensions to decide if the medication is really necessary. They should evaluate the severity and depth of behavioral difficulties.
Child’s functions in the school, playground, classroom and after school activities should be assessed. It should be based on their relationship with different adults like father, mother, coach and teacher to observe environmental pressure on their behavior. School psychologists should be very good in evaluating contextual variables which govern the family, school and the community and which actually affect the child (Laura Abrams et al. 2006, p.499). They should offer to the parents a school based and multiple method assessment that should include a detailed history interview having questions in the context of school that will better explain their symptoms related to their learning difficulties and other disorders (George J. Du Paul, 2005).
Laura Abrams et al (2006, p.499) state that school psychologists perform like a bridge among medical personnel, parents and teachers. The school psychologists should make sure that all the participating people, who actually intervene, should be well informed. School psychologists can settle a joint relationship with all the members of that intervening team. They can coordinate with the information which is helpful in assessing intervention usefulness (Laura Abrams et al. 2006, p.499).
Quality Psychopharmacology Access for Students
Psychopharmacologic medications are bringing revolutionary changes in treatment of mental health. This change has been observed very actual in caring children with mental disorder. This transformation has given lots of concerns about safe and effective psychopharmacologic treatment. The changing prototypes of psychotropic
use, the limited access to specialized providers and the increasing demand of the interface between the primary and specialty care settings have affected access to safe and effective medications for youth who suffer with mental disorder (Abigail Boden Schlesinger, 2007).
Abigail Boden Schlesinger (2007) mention Since 1990s the role of medication in treating youth with mental disorder has changes drastically. There has been observed some changes in the use of antidepressants which can be due to reduction in wrong recommendations, excessive weariness and a growth in specialized providers for adolescents. There has been a growth in the use of antipsychotic. It is always obvious that the use of antipsychotic is always a troublesome topic. Medical community should make sure that safe and appropriate practices of psychotropic should always be there and they should not support unsafe practices of such medications rather they should be discouraged (Abigail Boden Schlesinger, 2007).
To meet the requirements of the youths and family the role of all the collaborative people like psychologists, pediatricians, neurologists, nurses and social workers should be reexamined. Primary care takers are the foundation of the health system. Their skills should not be neglected when trying suitable methods for improving quality of psychopharmacologic treatment.Physicians, pediatricians, child and adolescent psychiatrists all should make mutual efforts to make better the services of psychopharmacologic treatments (Abigail Boden Schlesinger, 2007).
New Developments and Recent Research
Thomas L Murray (2006) tells that there are various challenges in understanding psychopharmacology researches. CACREP, 2001; Ingersoll, 2000 investigate that Behavioral neuroscience education should allow counselors to understand the biological implications of psychopharmacology research (Thomas L Murray, 2006). It has also been discovered that pharmaceutical industries’ role is very important in delivering the pharmacological information to the physicians.
Wazana (2000) mentions that the information are generally provided with many gifts, free seminars and lunches, which actually put impact on the practices of the physicians. Another challenge is to find the literature on the benefits of psychopharmacology is unproblematic. Pharmaceuticals advertisements can be found in many magazines, newspapers, television, internet, journals and pamphlets from a doctor’s office. So now the counselor has to make efforts to read these materials on psychopharmacology for gaining depth knowledge.
Thomas L Murray (2006) states that Jackson (2005) mentions that psychopharmacological material has some confusing methodologies which if once understood can be perceived easily after reviewing such literature. Daniel Safer (2002) of John Hopkins University has detailed that the pharmaceutical findings are modified for gaining financial benefits. Thomas L Murray (2006) discusses that Perlias and colleagues (2005) have found in a recent study of clinical medication trials related to psychiatry that the randomized double blind, placebo controlled studies were conducted 4.9 times and it was to give positive results when there was a conflict of interest (a pharmaceutical industry funded this research) according to Perils and colleagues that the existing literature on pharmacology favors the pharmaceutical industry (Thomas L Murray, 2006).
School psychologists who are school based mental health practitioner are combining ideally with medical personnel for treating mental health disorders in children and adolescents. The combined efforts of psychosocial and pharmacological involvements are giving proper support for the well being of the children and adolescents. The behavioral, academic, social and cognitive effects of the medication can be noticed presently.
George J. Du Paul (2005) mentions that the pharmacotherapy has effect on school performance, school based professionals like school psychologists and there should be a mutual decision on effective treatment of this problem. He further tells that there are some limitations for the school psychologists to participate in this but they have many roles to perform related to psychopharmacology like a) diagnosing the problem and deciding the need for medication; b) helping physicians in assessing medication effects and deciding dosages on the basis of it; c) putting together psychosocial, educational and medical interventions.
To fit in this role, some training experiences are required. The properly rained school professionals in pharmacotherapy can give the positive results in the treatment of the children where they can experience medication and combined treatment protocols (George J. Du Paul, 2005).
With very good knowledge of psychopharmacogical agents and by maintaining combined relationship with clinicians, school psychologists can apply their interferences with the population of children (Laura Abrams et al. 2006, p.500).
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