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A SURVEY OF SCHOOL PSYCHOLOGISTS’ KNOWLEDGE AND TRAINING
IN CHILD PSYCHOPHARMACOLOGY
JOHN S. CARLSON
Michigan State University
MICHELLE KILPATRICK DEMARAY
Northern Illinois University
SHANA HUNTER-OEHMKE
Michigan State University
A national sample of 320 school-based, practicing members of the NationalAssociation of School
Psychologists provided information on (a) their caseloads receiving medications, (b) types of
school psychopharmacology training opportunities available and perceptions of their current
training in child psychopharmacology, and (c) information about consultative efforts in moni-
toring medication effects on school functioning. Results indicated that almost one of every four
cases seen by survey participants were being treated with psychotropic medications; nearly all
respondents have engaged in consultation related to medication evaluations. Professional work-
shops and independent reading were the most utilized training opportunities, and participant
responses indicated an overwhelming need for basic educational training to improve knowledge
and consultation in this area. Implications of these findings on training in evidence-based inter-
ventions and current practice are discussed as school psychologists experience legislative pres-
sure to diminish their collaborative involvement in medication treatment consideration and
evaluation. © 2006 Wiley Periodicals, Inc.
Evaluating the effects of psychotropic medications in individual children is important given
the uniqueness of their biological systems (pharmacokinetics; what the body does to the drug), the
importance of contextual variables on medication response (pharmacodynamics; what the drug
does to the body), and the inability to translate pharmacological research findings from adult
populations to children (Riddle, Kastelic, & Frosch, 2001). Closely monitoring an individual’s
responsiveness to pharmacological treatments is essential to examination of associated costs and
benefits (MTA Cooperative Group, 1999; Phelps, Brown, & Power, 2002). This is especially true
given recent concerns of the potential for harmful effects of psychopharmacological treatments
highlighted within (a) the recent “black box” designation for selective serotonin reuptake inhibi-
tors in child and adolescent populations (Food and Drug Administration Public Health Advisory,
2004) and (b) a recent short-term ban of Adderall XR prescriptions within Canada (Health
Canada, 2005).
Changes in governmental policy likely will funnel hundreds of millions of dollars into the
business and research of child psychopharmacology in the coming decades (Budetti, 2003). An
example of this is the National Institute of Mental Health multi-million-dollar formation of a
group of university-based researchers dedicated to studying the safety and efficacy of psycho-
tropic medications in children and adolescents across multiple sites (e.g., Research Units of Pedi-
atric Psychopharmacology). In addition, a considerable portion of new funding is likely to be
directed toward the development of multisite collaborations to study the efficacy and safety of
combined psychosocial and psychopharmacological interventions for a number of internalizing
and externalizing disorders (Brown, 2005; Kubiszyn, Carlson, & DeHay, 2005). Training in evidence-
based biopsychosocial treatments may now be more important than ever for mental health pro-
fessionals working with school-aged populations.
Correspondence to: John S. Carlson, Department of Counseling, Educational Psychology, and Special Education, 432
Erickson Hall, Michigan State University, East Lansing, MI 48824–1034. E-mail: carlsoj@msu.edu
Psychology in the Schools, Vol. 43(5), 2006 © 2006 Wiley Periodicals, Inc.
Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pits.20168
623
Effective special education practice is contingent upon collaboration between schools, fam-
ilies, and physicians (Forness, Kavale, Sweeney, & Crenshaw, 1999). Yet, a number of legal
barriers have emerged in recent years to potentially limit the nature of these consultations. More
than 23 states have either introduced or enacted legislation related to children and psychotropic
drug use (National Conference on State Legislatures, 2004), and the Child Medication Safety Act
(i.e., not forcing or pressuring parents to medicate their children) was included within the Indi-
viduals with Disabilities Education Improvement Act of 2004 (IDEA, 2004) reauthorization bill
(Nealis, 2004). The role of school psychologists’ collaborative efforts associated with school-
based medication evaluations has a number of legal and ethical considerations (Carlson, Thaler, &
Hirsch, in press). The impact that legislative changes may have on children is implicit, yet the
importance or implications of these changes on current professional responsibilities of school
psychologists is unknown.
Training in child psychopharmacology would be essential to carry out the different roles and
responsibilities that school psychologists may assume when working with children treated with med-
ication. The American PsychologicalAssociation (APA; 1995) recommended three levels of train-
ing in psychopharmacology for doctoral-level psychologists: basic education for all psychologists
(Level 1), additional training for those who seek to engage in collaborative practice with physicians
(Level 2), and further intensive training and supervision for those who seek to independently prac-
tice clinical psychopharmacology (Level 3). It is currently recognized that many psychology pro-
grams are currently running beyond capacity, and little room exists to add Level 1 curriculum to training
programs (Kratochwill, 1994). To alleviate this potential barrier, some advocate for the integration
of a comprehensive training sequence in psychopharmacology within psychology internships (Dun-
ivin & Southwell, 2000) or through a more efficient integration of psychopharmacological-based cur-
riculum at the predoctoral level (Tulkin & Stock, 2004). In sum, professional psychology training
programs are moving toward increasing training in this area for the singular ethical purpose of afford-
ing the highest possible care to clients (Barnett & Neel, 2000).
The National Association of School Psychologists (NASP) does not currently provide rec-
ommendations or competencies related to child/school psychopharmacology; however, compe-
tencies in areas of data-based decision making and accountability, home/school/community
collaboration, research and program evaluation, and legal, ethical practice, and professional devel-
opment are quite relevant to this professional organization (Ysseldyke et al., 1997). These com-
petencies are closely aligned to assessment, consultation, and intervention responsibilities that
face school psychologists in their work with children experiencing mental health problems and the
impact such difficulties have on learning and social relations.
The purpose of this study was to examine school psychologists’ knowledge and training in
child psychopharmacology. In addition, the adequacy of professional training that school psychol-
ogists receive in psychopharmacology was explored. Specifically, this study was designed to (a)
gather information on the current role that school psychologists serve to children treated with
psychotropics and illuminate the scope of this responsibility within their service-delivery prac-
tices, (b) examine the opportunities and perceptions that school psychologists report related to
their training and knowledge of child psychopharmacology, and (c) understand the consultative
efforts school psychologists are engaged in with others, including physicians.
Method
Participants
Potential participants consisted of 1,000 randomly selected members (2000 –2001) of
NASP. Seven surveys (1%) were undeliverable due to an incorrect address. Of the 993 surveys
624 Carlson, Kilpatrick Demaray, and Hunter-Oehmke
Psychology in the Schools DOI: 10.1002/pits
sent, a total of 362 surveys were returned, for a response rate of 37%. Of the returned surveys, 42
(12%) were discarded because the respondents indicated that they were not currently practicing
within the schools (e.g., retired, private practice, student, administrator, trainer). Our return rate is
commensurate with other published research with this population, including the 29% rate found in
a pharmacological-related survey of American Psychological Association Division 16 members
(Kubiszyn & Carlson, 1995) and the 42 to 47% participation rate reported in recent school psy-
chology practitioner surveys utilizing multiple mailings (Fowler & Harrison, 2001; Pelco, Jacob-
son, Ries, & Melka, 2000). In summary, a total of 320 surveys were utilized in the data analyses.
The sample was compared to the demographic data provided to us by the NASP for the 1999
membership year as seen in Table 1. Data for 2000–2001 NASP members who were practicing
school psychologists were not available. The study participants appeared to be representative of
NASP members along dimensions of gender and type of degree. Distribution along ethnicity and
years of experience compared favorably to other recent practitioner samples (Curtis, Hunley,
Walker, & Baker, 1999). The age of the respondents ranged from 25 to 75 years (M⫽44.5, SD ⫽
10.1), and experience level ranged from 1 to 35 years (M⫽12.3, SD ⫽8.3).
Instrumentation
A two-page survey was developed by the study investigators to gather information about
school psychologists’ caseloads pertaining to medication treatment, responsibilities associated
with evaluation and knowledge of medication, training experiences, and self-perceptions of need
and importance of this knowledge within their professional responsibilities. A pilot study of this
Table 1
Demographic Characteristics for National Association of School
Psychologists (NASP) Membership and Survey Respondents
Respondents (%)aNASP Membershipb(%)
Gender
Males 27.8 27.7
Females 72.2 72.3
Ethnicity
African American 1.3 2.1
Asian American 1.6 .9
Hispanic American 1.6 3.1
Native American .6 .4
Caucasian 94.3 92.1
Other .6 1.4
Years of Experience
1–10 years 52.1 46.8
11–20 years 27.8 32.8
20 years 20.1 20.4
Type of Degree
Nondoctoral 72.4 72.3c
Doctoral 27.6 27.7c
aSample size (N⫽320).
bNovember 1999 NASP membership information.
cExcludes B.A., B.S., and other degree type to match those included in this
study.
Child Psychopharmacology 625
Psychology in the Schools DOI: 10.1002/pits
instrument was conducted with 10 graduate students in school psychology who recently com-
pleted school practicum placements. Some modifications (e.g., item wording, item deletion) were
made to the survey with the feedback provided by respondents, and it was determined that the
survey took approximately 10 minutes to complete.
Data-Collection Procedures
The central office of NASP provided mailing labels for a random sample of 1,000 members.
A cover letter explaining the purpose of the study, the time estimated to complete the study, and
contact information along with the two-page survey instrument were mailed to these members in
February 2001. As an incentive for responding, participants were notified that their name would be
entered into a random drawing for one of five copies of the book Taking Charge of ADHD (Bark-
ley, 2000). Respondents were asked to complete the survey within 2 weeks. Returned question-
naires were indicative of the participants’ consent. A follow-up reminder postcard or additional
mailings were not utilized due to costs and the results of previous studies utilizing homogenous
professional samples that failed to demonstrate substantial differences between first- and second-
mailing respondents (Carlson, Kratochwill, & Johnston, 1994; Pelco et al., 2000). Others have
indicated that if respondents match the population from which they were selected along dimen-
sions including years of experience, age, gender, and ethnicity, respondents would not signifi-
cantly differ from nonrespondents (e.g., Green, 1991).
Results
Descriptive statistics and frequencies for school psychologists’ responses to specific survey
items can found in Table 2. A summary of the major findings is presented next.
Roles and Responsibilities Associated With Child Psychopharmacology
The first issue addressed within this study was the frequency with which school psychologists
face psychopharmacological issues within their daily practice. Nearly one of every four cases
(M⫽23.27, SD ⫽20.68) seen by school psychologists is reportedly receiving psychotropic treat-
ment. Asecond area investigated in this study was the involvement of school psychologists in cases
who were diagnosed with attention deficit hyperactivity disorder (ADHD). When averaged across
respondents, one of every five children (M⫽21.38, SD ⫽18.08) was reported by school psychol-
ogists to have a diagnosis of ADHD. Of theADHD cases seen by school psychologists, it was repor ted
that two of every five children (M⫽40.46, SD ⫽33.39) were being treated with medication. A
final area in which data was gathered regarding school psychologists’ roles and responsibilities
related to child psychopharmacology included information about discussions of psychotropic med-
ications within case-management activities. Almost every surveyed school psychologist had been
involved in cases in which there had been discussion around medication treatment issues. It is
noted that evaluations “often” involve “any discussion” of psychotropic medication more fre-
quently within evaluation cases (41%) as compared to consultation/intervention cases (29%).
Types and Perceptions of Current Training Related to Child Psychopharmacology
A second area of investigation within this study was on the types of child psychopharmacol-
ogy training opportunities that exist for school psychologists. The majority of survey respondents
(81%) had not taken a child and adolescent psychopharmacology course. The primary means by
which school psychologists acquired knowledge in this area was reported to occur through work-
shops (88%) and independent reading (96%). With respect to training in associated areas of child
psychopharmacology, it was found that half of the respondents indicated having taken a biological
bases of psychological disorders course, yet this decreased substantially when the course focus was
626 Carlson, Kilpatrick Demaray, and Hunter-Oehmke
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Table 2
Survey Results for Respondents’ Caseloads, Training, and Practice
Survey Question Participant Response
Caseload Information
1. What percent of children/adolescents that you work with are currently on psychotropic
(e.g., psychostimulants, antidepressants) medication (approximately)?
M⫽23.27, SD ⫽20.68
(Range ⫽1–95)
2. What percent of the children/adolescents you work with have ADHD (approximately)? M⫽21.38, SD ⫽18.08
(Range ⫽1–90)
2b. What percent of these children/adolescents are on medication for ADHD? M⫽40.46, SD ⫽33.39
(Range ⫽0 –100)
3. How often does an evaluation include any discussion of psychotropic medication (e.g.,
the child is currently on medication or has been in the past, etc.):
Never Sometimes Often
1 (1%) 2 (4%) 3 (28%) 4 (25%) 5 (41%)
4. How often does an intervention or consultation case include any discussion of psychotropic
medication (e.g., intervention includes medication treatment, etc.):
Never Sometimes Often
1 (1%) 2 (9%) 3 (35%) 4 (26%) 5 (29%)
Training
1. What training have you had in the area of child and adolescent psychopharmacology?
a. Entire course(s) Yes (19%) No (81%)
b. Portions of a course(s) Yes (55%) No (45%)
c. Workshop(s) Yes (88%) No (12%)
d. Independent reading Yes (96%) No (4%)
2. Have you ever taken a biological basis of psychological disorders class? Yes (50%) No (50%)
3. Have you ever taken a university-based course on psychopharmacology? Yes (20%) No (80%)
4. Was a course on psychopharmacology available to you at your school? Yes (24%) No (76%)
5. Have you ever attended a professional workshop for Continuing Education Units (CEUs)
on psychopharmacology?
Yes (61%) No (39%)
6. Should school psychologists receive training in the area of child psychopharmacology? Yes (97%) No (3%)
7. Should school psychologists seek prescription privileges? Yes (10%) No (90%)
8. How well trained do you feel in psychopharmacology?
Not well trained Somewhat well trained Very well trained
1 (22%) 2 (33%) 3 (35%) 4 (10%) 5 (⬍1%)
9. How much additional training in psychopharmacology do you wish you had?
None Some A lot
1(⬍1%) 2 (4%) 3 (37%) 4 (34%) 5 (24%)
10. How important is it for you to have knowledge about psychotropic medications in order
to perform your main roles in assessment, treatment, and consultation?
Not important Somewhat important Very important
1(⬍1%) 2 (7%) 3 (33%) 4 (36%) 5 (24%)
Practice
1. For children who are being placed on medication for ADHD, how often do you work
with the students’ physicians to collaborate on medication treatment (e.g., monitor side
effects, monitor improvement)?
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
(16%) (32%) (14%) (8%) (7%) (6%) (4%) (4%) (4%) (4%) (1%)
2. Do you work with physicians and/or parents to evaluate medication trials? Yes (62%) No (38%)
3. If you were a parent of a child with ADHD, would you seek medication treatment for
them?
Yes (87%) No (13%)
Child Psychopharmacology 627
Psychology in the Schools DOI: 10.1002/pits
on psychopharmacology (20%). The majority of respondents (76%) reported that such a course was
not offered at their university. Instead, it appears that most formal training, as indicated by
Continuing Education Units (CEU) credits, is being done through professional workshops (61%).
Perceptions related to school psychologists’ training in child psychopharmacology were
obtained via a number of different questions. Almost all of the respondents (97%) indicated that
there was a need for training in child psychopharmacology, yet it was clear that they (90%) were
not at all interested in having the profession move toward seeking prescription privileges. Data
also revealed a perceived need for additional training in child psychopharmacology, as nearly 1 in
4 respondents indicated that it was “very important” to have knowledge of psychotropic medica-
tions to perform their roles and jobs. Very few (⬍1%) indicated that knowledge in this area is “not
important” for their work.
Collaborative Practices in School Psychopharmacology
The final section of the two-page survey focused on three questions pertaining to collabora-
tive consultation surrounding medication issues. One question related to issues of acceptance (i.e.,
comfort level) of medication as a treatment option by school psychologists. In other words, how
did participants personally perceive medication as a treatment for ADHD? Only about 1 of every
10 (13%) school psychologists who “hypothetically speaking” had a child with ADHD would not
seek out medication treatment for them. Additionally, data were gathered on treatment-consultation
and medication-evaluation practices. Almost two thirds (62%) of school psychologists reported
that they had worked with physicians and/or parents to evaluate medication trials for children, yet
collaborative monitoring occurred infrequently in those cases where children were being placed
on medication to treat ADHD symptoms.
Discussion
To our knowledge, this is the first study to examine the training and practices of school
psychologists in the area of child psychopharmacology. Results of this survey of practicing school
psychologists, who are members of NASP, indicated that medication treatment of emotional and
behavioral problems is highly prevalent within their caseloads. Almost one in four of cases seen by
school psychologists were reported as being treated with medications. Combined with previous
research indicating that more than one half of special education students have been treated with a
psychotropic medication in the past 3 years (Mattison, 1999), this appears to be a fairly common
treatment approach used with school-aged children seen within the delivery of school psycholog-
ical services. For those students diagnosed with ADHD, medication treatment appears to be even
more common, as results have indicated that 40% of children are reported to be receiving this
treatment modality. This data may support the controversial notion that there remains a large
percentage of children who are currently being undertreated, given that data in the literature have
strongly implicated the importance of both medication and behavior-management approaches for
this condition (Jensen et al., 1999; MTA Cooperative Group, 1999). Alternatively, if 60% of
ADHD children in schools are being managed appropriately through nonmedication approaches
(e.g., behavior management), further questions pertaining to diagnostic reliability of this disorder
may be raised. In sum, interpretations regarding the frequency with which school-aged children
are being treated “appropriately” for symptoms associated with ADHD cannot be ascertained by
this study and are important for future study.
Many school psychologists are providing services to students for which discussions of med-
ication treatment are warranted as part of evaluations, consultation, and intervention activities. In
addition, very few (⬍1%) cases were reported by school psychologists to “never” involve medi-
cation discussions. Discussion of treatment history along with a need to discuss future interventions
628 Carlson, Kilpatrick Demaray, and Hunter-Oehmke
Psychology in the Schools DOI: 10.1002/pits
that are multidimensional (i.e., biopsychosocial) may be an important part of the special education
service-delivery responsibilities of currently practicing school psychologists. Legislating these
discussions and considerations may significantly alter current practices within the field, and future
study of these implications are needed.
School psychologists’ caseloads and responsibilities pertaining to medication treatments appear
to be commensurate with reports from other treatment providers including doctoral-level school
psychologists and licensed psychologists. For example, many clients/cases are currently receiving
medication, and the impact of treatment histories on effective service delivery is an important part
of current case-management responsibilities (Kubiszyn & Carlson, 1995; VandenBos & Williams,
2000). Basic education in psychopharmacology or Level 1 training as recommended by APA
(1995) would appear to be essential for effective service delivery by school psychologists, irrespec-
tive of master’s- or doctoral-level training goals. Training models to improve school psycholo-
gists’ knowledge in child psychopharmacology should be developed, implemented, and evaluated.
In addition, a focus on the specific types of activities that school psychologists might engage in
related to child psychopharmacology (e.g., progress monitoring, using treatment-sensitive rating
scales, collaborating with physicians/psychiatrists, parent and teacher consultation, professional
inservice or other knowledge dissemination efforts) is an important area for discussion and future
consideration within the field (DuPaul & Carlson, 2005).
Results from this survey indicate that school psychologists are aware of the gap between their
limited formal training and their frequent responsibilities related to medication treatments. The
majority of school psychologists reported training in this area via independent reading (96%) and
through workshop participation (88%). As indicated within the school psychology literature, there
appear to be limited opportunities for formalized training in child psychopharmacology at the
predoctoral level (Carlson, 2001). More than 75% of respondents indicated that courses on this
topic were not available as part of graduate course offerings. In addition, there may be limited
links between the more frequently taken related courses, such as biological-basis courses (taken
by 50% of respondents) offered by universities, and the types of pragmatic skills and responsibil-
ities associated with school psychopharmacology (DuPaul & Carlson, 2005). One example of
these skills is training in school-based medication-monitoring practices. Arecent survey (Gureasko-
Moore, DuPaul, & Power, 2005) on this specific topic found that the majority of school psychol-
ogists (58%) had not received formal training in this area. This decreased even further (⬍20%)
when considering graduate-school training in medication monitoring and is consistent with the
percentage of responding school psychologists (20%) in this study who had taken a graduate
course in psychopharmacology. Results from these two survey studies indicate that a gap appears
to exist between school psychology program training opportunities in child psychopharmacology
and practices associated with this knowledge base. Additional training appears warranted, and the
value that school psychologists place on this knowledge supports this conclusion.
A number of school psychologists (24%) believe that knowledge of psychotropic medications
is “very important” for their roles and functions. An equal percentage reported the need for “a lot”
more training in this area due to insufficient knowledge and training. It is unknown whether
postdegree training is the most appropriate avenue for acquiring the knowledge needed within
current roles, yet this is the predominant method currently being reported by school psychologists.
The importance of child psychopharmacology training for school psychologists was clearly indi-
cated by 97% of the participants in this study. When this question was altered to represent a greater
level of competence for the purpose of prescription privileges, respondents almost uniformly
(90%) were opposed to this idea for school psychologists. This contrasts with previous reports
from doctoral school psychologists and other professional psychologists who are more supportive
of seeking prescription privileges (Kubiszyn & Carlson, 1995; Sammons, Gorny, Zinner, &Allen,
Child Psychopharmacology 629
Psychology in the Schools DOI: 10.1002/pits
2000). Practicing members of NASP, which is heavily represented by nondoctoral clinicians, do
not appear to be interested in seeking prescription privileges, and this response appears to be
consistent with ethical issues of competence and training espoused by NASP ethical and practice
guidelines.
Most respondents indicated a favorable opinion of medication treatment for children diag-
nosed with ADHD, as indicated by their willingness to seek medication treatment for a child of
their own who was diagnosed with this condition; however, linking one’s attitudes toward a med-
ication approach for their own personal situation and bringing these beliefs into practice are not
one in the same. Maintaining an objective, balanced approach to working with families who may
have a different belief and value system is an important consideration for service delivery.
The findings from this study indicate that the professional responsibilities of practicing school
psychologists include significant involvement in medication-monitoring practices; 62% of respon-
dents indicated working with physicians and/or parents to monitor response to medication treat-
ment. This report is slightly higher than the 55% of ADHD monitoring practices reported from a
survey of school psychologists. Both findings should be interpreted in the context of the average
time (⬍2 hr per week) that school psychologists engage in these activities (Gureasko-Moore et al.,
2005). Involvement differentials between these studies may indicate that school psychologists
also are active in evaluating symptom reduction of medications for other psychological conditions.
The consistent and/or active engagement in medication treatment activities (e.g., medication
monitoring), however, appears limited within school psychologists’ responsibilities. The majority
of school psychologists reported being involved in less than 20% of the potential cases who begin
a trial of medication for treating symptoms of ADHD. In addition, school psychologists reported
being engaged collaboratively with physicians in less than one third of ADHD cases being treated
with medications. Given the importance of closely monitoring the medication treatment response
of children and other issues of helping parents to make decisions regarding the data-based costs
and benefits of this treatment modality, this may be an important area of responsibility within
future practices. Such a role also would support the need that physicians have expressed for more
school-based information when considering treatment selection and responsiveness (Haile-
Mariam, Bradley-Johnson, & Johnson, 2002; Kainz, 2002).
School-aged children are being treated with psychotropic medications at an increasing rate,
and a considerable percentage of cases seen by school psychologists indirectly implicates the need
for training in child psychopharmacology. Psychologists, specifically those working in the schools,
theoretically are in a good position to assist parents in critically considering the costs and benefits
of potential interventions (Phelps et al., 2002). Pragmatically speaking, issues of medication treat-
ment are currently being addressed by school psychologists within their roles and responsibilities
as treatment evaluators and consultants (DuPaul & Carlson, 2005; Gureasko-Moore et al., 2005).
As a whole, curriculum in this area has been limited within training programs, and practitioners
instead seek knowledge through independent readings and continuing-education opportunities.
Limitations
There are a number of limitations to the current study. First, response-rate bias may have
impacted the results of this study. Specifically, those who responded may have greater familiarity,
interest, or experience in child psychopharmacological practices than those individuals who did
not respond to the study. Thus, medication treatment rates of caseloads, actual practices, training
opportunities, and interest level in these training efforts may be overestimated by the study results.
An additional consideration related to the generalizability of study results to other NASP members
is whether the homogeneity of the members of this professional organization and the close link
between survey participants and the overall membership characteristics may help to overcome the
630 Carlson, Kilpatrick Demaray, and Hunter-Oehmke
Psychology in the Schools DOI: 10.1002/pits
low response rate, as has been reported by some survey researchers (e.g., Green, 1991). In other
words, not only are there questions about the generalizability of study results to NASP members
but there also are uncertainties regarding how well these data would represent those practicing
school psychologists who are not NASP members. Given the progressive nature of this organization’s
practice guidelines and emphasis on interventions, it is likely that study results may not align with
efforts of the profession as a whole.
The use of survey responses as a means of data collection also limits the interpretation of
study results. Self-report data may not be reflective of actual training, knowledge, or perceptions
of school psychologists. We are unable to determine the accuracy of responding, and there is no
way for these responses to be verified. Future research should target student records and files as a
means of data collection. Such an approach would be consistent with medication prevalence rates
that have been determined from insurance and practice data. Future research examining which
professionals within the school setting may be in the best position in terms of knowledge and
training to complete school-based medication evaluations is warranted, given the importance of
close monitoring to the beneficial outcomes of this treatment approach.
Implications for Training, Practice, and Research
The results of this study indicate a need for a working-knowledge base of psychotropic
medications, given the frequency with which school psychologists work with children receiving
these treatments during the school day. In addition, as a profession, we need greater accountability
for the utility of our knowledge as outside pressures attempt to limit our role in collaborative
treatment decision-making activities. Medication treatment for childhood disorders will continue
to receive increased attention in the 21st century due to factors involving societal pressures on
time, money, and resources. School psychologists, given their scientist–practitioner training in the
areas of assessment, consultation, and intervention, are in a unique position to impact the research
and physician use of medications with school-aged youth (Kubiszyn, 1994). Training in school
psychopharmacology should not overshadow training in school-based prevention and intervention
efforts. It is a field of study that complements current initiatives being undertaken by training
programs related to developing course work to provide exposure to child-based psychosocial
treatments that demonstrate empirical support. Children’s mental health conditions are complex
and due to a multitude of ecological, biological, and psychological variables. Intervention curric-
ulum within training programs should parallel the theoretical and empirical support that exists for
treating psychological disorders. Alternatively, interdisciplinary collaboration may effectively alle-
viate difficulties in attempting to do too much within our professional training programs (DuPaul
& Carlson, 2005).
There are a number of important directions for future research in school psychopharmacol-
ogy. Limited attention has been given to the types of training opportunities present within gradu-
ate programs in school psychology. A comparison of doctoral and specialist/master’s training via
a survey of program directors and/or a survey of program curricula would provide additional
information about how the field is addressing the increased emergence of medication issues within
school psychological practice. Alternatively, a survey of recent graduates might provide informa-
tion on the current efforts of training programs to add child psychopharmacology knowledge into
curricular requirements. Medication evaluation issues including the need, importance, and benefit
of intensively monitoring response to pharmacological interventions within the school context are
unresolved and important for future study. One specific area of research that has received limited
attention within the child psychopharmacology and school psychology literature is the impact that
medication treatments may have on indirectly altering classroom and other ecological variables
such as instructional time, social support, and/or teacher–student relationships. This biopsychosocial
Child Psychopharmacology 631
Psychology in the Schools DOI: 10.1002/pits
erspective is an important one as the profession continues to look for ways to contribute to effec-
tive outcomes for school-aged populations.
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