[show abstract][hide abstract] ABSTRACT: The purpose of this practice parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication prescribing. The evidence base supporting the use of psychotropic medication for children and adolescents with psychiatric disorders has increased over the past 15-20 years as has their use. It is hoped that clinicians who implement the principles outlined in this parameter will be more likely to use medications with the potential for pharmacological benefit in children safely and to reduce the use of ineffective and inappropriate medications or medication combinations. The best practice principles covered in this parameter include (1) completing a psychiatric and medical evaluation, (2) developing a treatment and monitoring plan, (3) educating the patient and family regarding the child's disorder and the treatment and monitoring plan, (4) completing and documenting assent of the child and consent of the parent, (5) conducting an adequate medication treatment trial, (6) managing the patient who does not respond as expected, (7) establishing procedures to implement prior to using medication combinations, and (8) following principles for the discontinuation of medication.
Journal of The American Academy of Child and Adolescent Psychiatry - J AMER ACAD CHILD ADOLESC PSY. 01/2009; 48(9):961-973.
[show abstract][hide abstract] ABSTRACT: This practice parameter describes the assessment and treatment of children and adolescents with substance use disorders and is based on scientific evidence and clinical consensus regarding diagnosis and effective treatment as well as on the current state of clinical practice. This parameter considers risk factors for substance use and related problems, normative use of substances by adolescents, the comorbidity of substance use disorders with other psychiatric disorders, and treatment settings and modalities.
Journal of the American Academy of Child & Adolescent Psychiatry 07/2005; 44(6):609-21. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.
Journal of the American Academy of Child & Adolescent Psychiatry 01/2005; 43(12):1540-50. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.
Journal of the American Academy of Child & Adolescent Psychiatry 01/2005; 43(12):1521-39. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.
Journal of the American Academy of Child & Adolescent Psychiatry 03/2002; 41(2 Suppl):26S-49S. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.
Journal of the American Academy of Child & Adolescent Psychiatry 03/2002; 41(2 Suppl):4S-25S. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed salts of amphetamine, and pemoline. They carry U.S. Food and Drug Administration indications for the treatment of attention-deficit hyperactivity disorder.
Journal of the American Academy of Child & Adolescent Psychiatry 12/2001; 40(11):1352-5. · 6.97 Impact Factor
[show abstract][hide abstract] ABSTRACT: This practice parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Recommendations are based on the limited research available, the adult literature, and clinical experience. Early-onset schizophrenia is diagnosed using the same criteria as in adults, and appears to be continuous with the adult form of the disorder. Noted characteristics of youth with schizophrenia include predominance in males, high rates of premorbid abnormalities, and often poor outcome. Differential diagnosis includes psychotic mood disorders, developmental disorders, organic conditions, and nonpsychotic emotional/behavioral disorders. Treatment strategies incorporate antipsychotic medications with psychoeducational, psychotherapeutic, and social and educational support programs. The advent of atypical antipsychotic agents has enhanced the potential for effective treatment. Key Words: schizophrenia, children, adolescents, psychosis.
Journal of the American Academy of Child and Adolescent Psychiatry 01/2001; 40(7). · 4.98 Impact Factor
[show abstract][hide abstract] ABSTRACT: Mental retardation (MR) is a heterogeneous condition defined by significantly subaverage intellectual and adaptive functioning and onset before age 18 years. With an approach underscored by principles of normalization and the availability of appropriate education and habilitation, persons with MR generally live, are educated, and work in the community. Mental disorders occur more commonly in persons with MR than in the general population. However, the disorders themselves are essentially the same. Clinical presentations can be modified by poor language skills and by life circumstances, so a diagnosis might hinge more heavily upon observable behavioral symptoms. The diagnostic assessment considers and synthesizes the biological, psychological and psychosocial context of mental disorders. Comprehensive treatment integrating various approaches, including family counseling, pharmacological, educational, habilitative, and milieu interventions is the rule. Key Words: dual diagnosis, developmental disabilities, mental illness, psychiatry, mental health, practice parameters, guidelines, children, adolescents, adults.
Journal of The American Academy of Child and Adolescent Psychiatry - J AMER ACAD CHILD ADOLESC PSY. 01/1999; 38(12):1606-1610.
[show abstract][hide abstract] ABSTRACT: The assessment and treatment of children and adolescents with sexually abusive behavior requires an understanding of normal sexual development. A multiplicity of biological and psychosocial factors determines the child's sexual development, gender role, sexual orientation, patterns of sexual arousal, sexual cognitions, sexual socialization and the integration of sexual and aggressive patterns of behavior. The individual's sexuality evolves in concert and as a result of interaction with family, ethnic, social and cultural influences. These parameters summarize what we know about the epidemiology and phenomenology of sexually abusive youth and provide guidelines for the assessment and the selection of treatment interventions for these youths. Essential considerations in the assessment and treatment of sexually abusive youth, as well as the different categories of sexually abusive youth that should be recognized and which influence treatment decisions are presented. The spectrum of currently available psychosocial
Journal of The American Academy of Child and Adolescent Psychiatry - J AMER ACAD CHILD ADOLESC PSY. 01/1999; 38.