Confessions of a managed behavioral health care physician

The author describes his early association with several pediatric practitioners in Rhode Island in the 1950s who were among the first to use stimulant drugs in the treatment of children with attentional problems. He also discusses some of the later applications of their work. Since the early 1970s there has been a great deal of public interest in and apprehension about the use of these medications in school children. Since the early 1990s there has been concern about the influence of mental health service delivery systems on the prescriptive practices of physicians. Carved-out behavioral health care systems have the potential to improve the standard of care in the pediatric populations they serve.