Psychopharmacology of Child and Adolescent Treatment

Week Nine Overview

  • Focus on children and adolescents and medication issues

  • Information broken down into two slide decks

  • Emphasis on general drug issues rather than specific medications

Importance of Child Mental Health

  • Child's mental health is as crucial as physical health

  • Children often lack the ability to articulate problems

    • Difficulty in understanding feelings

    • Adults also struggle to express their issues

  • Importance of recognizing non-verbal signs of distress in children

    • Problems can be overlooked for decades

    • Children may mask their feelings leading to long-term unhappiness

Developmental Considerations

  • Children and adolescents possess developing minds

  • Growth of the brain occurs till approximately ages 24-25, then gradually declines after age 55-60

  • Factors impacting brain development:

    • Genetic factors

    • Exposure to drugs and environment

  • Comparison of modern children’s resources versus previous generations

    • Increased access to gaming and online platforms

    • Debate on whether this increases children's stress and over-stimulation

Medication and Psychological Factors

  • Psychological factors occassionally overshadowed by chemical imbalance theories

    • Parents may resort to medication without exploring emotional needs

  • Example: ADHD medications may be prescribed without adequate psychological support

Biological Considerations

Kindling Effects and Neurodegeneration

  • Kindling effects: incremental increase of symptoms

  • Neurodevelopmental model: Individuals are born with developmental problems that emerge over time

  • Neurodegenerative model: Individuals start normal but lose functioning due to adverse experiences

  • Importance of recognizing both models in treatment

Liver Metabolism in Children

  • High metabolism in child livers until about age 13-14

  • Children may require higher doses of medication but monitored for effects

  • Factors influencing drug metabolism:

    • Gender, age, drug interactions, current diseases

Treatment Considerations

  • Children’s participation in medication discussions is essential to adherence

    • Children aged 7 or older should be included in treatment discussions

    • Considerations on how children perceive medication-related decisions

  • Fear among parents regarding treatment options and peer judgment

  • Behavioral control vs. emotional understanding in medication approaches

Refusal of Treatment

  • Children aged 14 and older can challenge medication decisions in court

    • Ries hearing: A judicial procedure to assess a child’s ability to refuse medication

  • De facto refusal: Passive resistance to taking medication, such as spitting or running away

Origin of Childhood Problems

  • Conditions like OCD or bipolar disorder may manifest early

    • Necessity of early intervention to prevent further complications

  • Medications can prevent deterioration and foster neurogenesis

Medication Efficacy and Research Challenges

  • High percentage (~80%) of medications for children are prescribed off-label

  • Need for understanding and monitoring children’s responses to medications through anecdotal reports

  • Difficulty in obtaining informed consent for pharmaceutical trials with children

Global Perspectives on Medication Use

  • US children have a higher rate of psychotropic medication prescriptions (7%) compared to other countries

    • Comparison to Netherlands and Germany where rates are significantly lower

  • Racial disparities in medication usage

    • Non-Hispanic whites are the highest consumers, followed by African Americans, then Hispanic Americans

ADHD Statistics

  • Approximately 8-10% of children diagnosed with ADHD

    • Many outgrow it by adulthood but around 50-60% do not

    • States with varying ADHD rates:

      • Kentucky has the highest, followed by Arkansas, Louisiana, with California at lower rates

  • Frontal lobe activity differences in ADHD vs. non-ADHD children

    • Dopaminergic activity in ADHD individuals is lower, while serotonergic activity in OCD is higher

Differential Diagnosis in ADHD

  • Importance of ruling out other factors before diagnosing ADHD

    • Signs may include boredom, hypomania, or brain damage

  • Behavior changes in children to teenagers transition

    • Hyperactivity decreases while risk-taking behaviors may increase

Effects of ADHD Treatment

  • Not treating ADHD can lead to substance abuse and other long-term issues

    • ADHD medication can reduce self-medication in adolescent years

  • Discussing alternative ADHD treatments (e.g., dietary changes, supplements)

Overdiagnosis Concerns

  • Increase in ADHD diagnoses and medication prescriptions from 1.8 million to 3 million over years

  • Potential risks of stimulants include triggering psychotic episodes if misdiagnosed

    • Importance of thorough assessment before prescribing stimulants

Recommendations for ADHD Treatment

  • Regular monitoring and adjusting dosages based on side effects

    • Awareness of potential rebound effects during medication holidays

  • Encourage non-medical interventions alongside medication

  • Importance of cultural competence and parental involvement in treatment decisions

Conclusion and Future Topics

  • Transition to next topics involving treatments for other childhood issues (e.g., depression, bipolar disorder)

  • Review materials and be prepared for upcoming quizzes