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Pediatric mental health care relies too much on medication, not enough on psychosocial approaches


The American Psychological Association (APA) has released a report blaming limited access to pediatric mental health services for what it calls "inadequate care and treatment based on insufficient scientific evidence of safety and effectiveness." The "inadequate care" to which APA refers is primarily the practice of treating children's mental and behavioral disorders with psychotropic medication, in the absence of studies demonstrating the safety and efficacy of these medications in the pediatric age group. Such an over-reliance on medication is, in turn, the result of gaps in scientific knowledge, shortages of clinicians trained to work with children, cuts in Medicaid funding, and poor reimbursement for mental health services.

According to Ronald T. Brown, PhD, chair of the APA Working Group on Psychotropic Medications for Children and Adolescents, psychosocial treatments aren't sufficiently utilized because they are labor-intensive and costly-even though many such therapies have been found to be effective and some have a better risk profile than medication.

In addition to calling for development of a solid evidence base, appropriately trained providers, and better access to care, the report came to specific, evidence-based conclusions about treatment practices for a number of mental health disorders that affect children:

Oppositional-defiant disorder and conduct disorder. Psychosocial interventions have shown better results than medication and should be the first-line treatment.

Obsessive-compulsive disorder. Cognitive behavioral therapy (CBT) should be first-line therapy, supplemented with medication if necessary.

Anxiety disorder. CBT is first-line treatment, with a selective serotonin reuptake inhibitor (SSRI) a "viable choice" for children unable to work with CBT.

Depression and suicidality. Start with psychosocial interventions and close monitoring; follow with medication for children and adolescents who do not respond. Inform parents fully of potential risks and benefits of medication.

The full text of the report is available at http://www.apa.org/releases/PsychotropicMedicationsReport.pdf.

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