Practical and Ethical Issues in Pediatric Psychopharmacology: Introductory Considerations

The increase in the use of psychiatric medications among children and adolescents has brought attention to the overall safety of these medications and the evidence-based data for their use in this population. This review focuses on the ethical aspects of pediatric psychopharmacology and general guidelines for practice, especially for medical residents. Ethical issues, such as (1) the lack of a sound database on tong-term efficacy and safety due to a limited number of clinical trials in this population, (2) the lack of knowledge about adverse events related to the off-label use of drugs, (3) an extensive level of complexity in prescription management for the pediatric population, and (4) challenges in decision-making regarding diagnosis and prescription due to difficulties in gathering and incorporating information from multiple sources, are discussed. This article also reviews clinical guidelines for pharmacological interventions and relevant landmark research projects (Treatment for Adolescents with Depression Study, Multimodal Treatment Study of Children with ADHD, and Treatment of Severe Childhood Aggression Study). The authors conclude that, in light of the continued shortage of child and adolescent psychiatrists, research and training policies as well as goals should focus on preparing clinicians and building mental health care systems that can deliver optimal services in this new reality.