Limited access to services for children and adolescents with behavioral problems or mental illness often leads to inadequate care and treatment based on insufficient scientific evidence of safety and effectiveness, concludes a report by the American Psychological Association (APA).
According to the report, a product of the APA Working Group on Psychotropic Medications for Children and Adolescents, gaps in the scientific knowledge concerning which treatments work best for specific diagnoses and patients, a dearth of clinicians specifically trained to work with children, cuts in Medicaid funding, and poor reimbursement for mental health services leads to many children being treated with medication despite limited efficacy and safety for their use particularly with children.
Research published earlier this year showed a five-fold increase in the use of antipsychotic drugs to treat behavioral and emotional problems in children and adolescents from 1993 to 2002.
"This entire state of affairs is in part related to our health care system's failure to provide sufficiently for children, particularly in the area of pediatric mental health care," states Ronald T. Brown, PhD, chair of the APA Working Group and Professor of Public Health and Dean at Temple University. "As a result, much of the care provided to children for mental health issues has been limited to medication even though many psychosocial treatments have been found to be effective and some with better risk profiles. Psychosocial treatments, however, can be more labor intensive and more expensive."
The Working Group's report identifies and calls attention to several "notable gaps" in the knowledge base upon which psychotropics are currently being prescribed, including anti-depressants and anti-psychotics. The report furthermore notes that existing evidence for both psychosocial and psychopharmacologcial treatments are "uneven across disorders, age groups, and other defining characteristics of race, ethnicity, and socioeconomic status".
"Furthermore," the report states, "data are lacking concerning the long-term effects of the majority of treatments, both psychosocial and psychopharmacological, as well as their effects on functional outcomes" such as academic achievement and peer relationships.
Finally, the report notes that the lack of availability of all pharmaceutical data on psychotropics and their effects prevents the news media and the public from a full understanding of which treatments work, which do not, and the possible adverse side effects of some medications.
The report recommends that decisions about first line of treatment options should be guided by the need to balance the anticipated benefits of the treatment with its possible harms, including the absence of treatment. Safer treatments with demonstrated efficacy should be considered first before any use of other treatments with less favorable risk profiles.
Contact: Eryn Jelesiewicz
dobeck@temple.edu
215-707-0730
Temple University
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