Research on Child and Adolescent Mental Health

Few data about effective treatments for
schizophrenia and related conditions in children
and adolescents are available. With the exception
of two small studies (Findling et al., 2000; Kumra
et al., 1996), there are no controlled data about the
use of new-generation antipsychotics in youths.
Only modest amounts of short-term treatment data
are available for children and adolescents with
autistic disorder/pervasive developmental disorder.
An acute and maintenance trial for young people
with this condition is currently being undertaken by
the RUPP’s, and new models have been developed
to examine the effectiveness of medications in this
population.
Yet, as with other disorders, combination
pharmacotherapy and long-term safety studies with
large numbers of patients are still lacking. Further
studies are needed to assess how these
scientifically proven treatments can be successfully
transported and sustained in real-world practices.
There is a need to better understand the factors
contributing to the use or lack of use of efficacious
treatments in the real world, including individual,
familial, provider/organizational, systemic, and
societal factors.
CROSSING THE BOUNDARIES
To date, most pharmacologic drugs have been
studied in open trials. The limitations of available
safety data from randomized controlled trials
(RCT’s), and the difficulties of mounting sizable
trials in children and adolescents, suggest the need
to augment our knowledge in other ways.
Knowledge from several areas of basic science is
particularly relevant. Longitudinal
pharmacoepidemiological studies in children are
needed to better understand the long-term risks or
benefits associated with psychotropics.
Experimental data garnered through the
development of animal models can be important in
examining the developmental impact of both
psychotropic drugs and illness during sensitive
periods of neurodevelopment. Fundamental
research on the mechanisms underlying and
influencing brain development, neuronal signaling,
synaptic plasticity, signal transduction pathways,
and the biochemical and behavioral actions of
therapeutic agents in animals and humans have
important implications for the understanding of
individual differences in treatment response.
Knowledge about the mechanisms of action of
therapeutic interventions can also have important
implications for the development of new
medications for treatment of childhood disorders.
OBSTACLES AND GAPS
Pediatric psychopharmacology is no longer in its
infancy; it is taking the small, tentative steps of a
toddler. Yet, several issues continue to impede
progress in this area. The safety of psychotropic
drugs is a concern—children are growing and
developing and, hence, are perceived to be more
vulnerable to drug effects. Current assessment
methods are not well developed, and preclinical
models to assess possibly subtle developmental
effects are inadequate. Moreover, the
ascertainment of adverse events is a particular
challenge, especially in young children. Optimal
approaches for studying the safety of psychotropics
in children are needed. Another difficulty relates to
diagnosing young children. Debate continues
around whether or not diagnoses such as ADHD,
major depressive disorder, and other psychiatric
diagnoses that are well accepted in older children
are meaningful in younger children. An alternative
view is that much of the prescribing of
psychotropics in preschoolers, especially for
conditions other than ADHD, represents treatment
of nonspecific symptoms such as aggression or selfinjurious
behavior. If so, are these nonspecific
symptoms reasonable targets for research
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