Abstract
This will be Dr. Wayne Hugo Green's last issue as senior editor for the Journal. Wayne has been the senior editor of the Journal of Child and Adolescent Psychopharmacology since March of 1998. It has always been a great pleasure and an advantage to be able to depend on Wayne's friendship, wit, and vast knowledge of pediatric psychopharmacology. As the author of one of the field's bibles, Child and Adolescent Clinical Psychopharmacology, Wayne has for 30 years been following every twist and turn as we continually improve our treatment approaches and broaden our knowledge of pharmacokinetics and the developing brain. We have been so fortunate to have him on our team. He is a preeminent expert on child and adolescent psychopharmacology. I wish Wayne the best of luck in his future endeavors.
I am pleased to announce that Dr. Ron Steingard, a child and adolescent psychiatrist, has accepted the position of senior editor. He arrives with a wealth of experience in all aspects of child and adolescent psychopharmacology and psychopathology. In addition to his many clinical and policy successes, Ron has authored over 75 publications, has held academic positions at Harvard, Tufts, and the University of Massachusetts, and is now Senior Pediatric Psychopharmacologist at the Child Mind Institute. He also served as Chief Medical Officer of the Executive Office of Health and Human Services in Massachusetts during Governor Romney's administration. In addition, Ron has been an investigator on 28 federally funded research projects. He was on the editorial board and served as web editor for the Archives of General Psychiatry and is a past president of the New England Council of Child and Adolescent Psychiatry. I enthusiastically welcome Ron to the Journal.
In these pages, Findling et al. bring rigorous techniques and solid study design to the already widespread practice of antipsychotic prescribing in the adolescent schizophrenia population. Their investigation of the efficacy and side effects of quetiapine provides a solid evidence base for the benefits of antipsychotic therapy in patients ages 13 to 17. Shang et al. bring different questions to bear on the effects of atomoxetine in a male adolescent attention-deficit/hyperactivity disorder (ADHD) cohort in Taiwan, assessing cognitive measures of improvement instead of Diagnostic Statistical Manual symptomology. This investigation of the global effects of relatively novel medications is a welcome addition to the literature.
Hong et al. take a fascinating and potentially pioneering look at the “independent and interaction effects of selected polymorphisms at four major candidate genes for ADHD” on response to methylphenidate treatment. It appears that clusters of genetic abnormalities are implicated in neurotransmitter dysregulation, and these results offer a tantalizing view of the brain using genetics and clinical experience. This investigation of the interactions between the noradrenergic and dopamine systems may herald a critical area of study into the etiology of ADHD and also the prediction of treatment response.
Leslie et al.'s report on a survey of child and adolescent psychiatrist's cardiac screening practices when prescribing stimulant medication is further evidence of some long-held opinions and systemic problems in child psychiatry. In short, perhaps because of clinical experience, most of us do not perform physical examinations and very few order electrocardiograms depending on but not necessarily communicating with the patient's primary care physicians. This survey highlights the need for greater interaction between primary care and psychiatry in managing complex cases, particularly since the literature and clinical experience suggests sudden cardiac events in children arise from a constellation of risk factors.
As a sort of meta-critique of the articles surrounding it, I highly recommend Almirall et al.'s explication of sequential multiple assignment randomized trials (SMARTs), adaptive treatment strategies (ATSs), and the wisdom of maximizing the amount of data derived from the all-too-limited studies that account for research in child and adolescent psychiatry. Alternatives to classic discontinuation trials have been around for a while, as have efforts to create treatment algorithms that reflect real-life clinical situations and best practices. But Almirall et al. suggest that these goals and research conventions be more widely adopted and embraced, particularly given the hurdles our field already faces. “This innovative trial design is ultimately more efficient and less costly than the standard discontinuation trial,” they write, “and may result in more representative comparisons between treatments.” With the cards effectively stacked against research in pediatric psychiatric illness and treatment, taking this advice seems like a sound suggestion.