Psychopharmacology for children and adolescents: A paradigm shift

Abstract

Background: The introduction of psychoactive medications for children and adolescents has changed practice worldwide. Debate continues about the indications for such practice, in particular about the possibility of unnecessary or contraindicated prescription. Such a debate usually assumes that changes in practice follow advances in the knowledge base-new scientific knowledge, coupled with new medications; but practice responds to changes in other areas as well. These other areas include public attitudes, the conditions of practice, and the regulatory environment. All of these are affected by the relationship between clinicians and the psychopharmaceutical industry (aka Pharma). Methodology: This paper reviews changes in factors, along with changes in the evolving knowledge base, which are transforming medication practice with children and adolescents. Thesechanges, beginning in the United States, are affecting practice worldwide. Results: Changes in the knowledge base, public attitudes, the conditions of practice, and the regulatory environment amount to a paradigm shift. Conclusion: The implications of the emerging paradigm for practice and policy are reviewed.