From the Editor-in-Chief's Desk

This issue of the journal offers worthwhile investigations of the effectiveness of routine and novel compounds alike in pediatric populations. However, while all of these articles are worthy of your attention, I will draw your attention to a handful that amplify this focus in intriguing ways and point towards fertile new areas of study as well as concerning trends in the field of child and adolescent psychiatry.

Betts et al. turn a sharp eye towards the practice of polypharmacy in prescribing for pediatric patients diagnosed with attention-deficit/hyperactivity disorder (ADHD), a trend with which I am sure many readers are familiar. Their basic results would not surprise an experienced clinician: 12.6% of children with only ADHD diagnoses are prescribed another medication in addition to a psychostimulant, and 41.7% of ADHD patients with comorbid disorders receive an additional prescription. However, the details are intriguing and well worth scrutiny. Betts et al. recruited commercial insurance study subjects, and it should not go un-noted that the most prescribed adjunct in this study—selective serotonin reuptake inhibitors—differs markedly from the atypical antipsychotics widely prescribed to children with ADHD in Medicaid scenarios, as per the recent article by Zito et al. in this journal.

Another medication frequently prescribed alongside stimulants for the management of ADHD and mentioned in Betts et al. is guanfacine, the subject of a study in this issue from Findling et al. The authors took specific interest in the adjunct drug's effect on oppositional behavior, a common rationale for polypharmacy in complex cases. Their positive results are heartening for the clinician but also underscore our need to continue to question the constructs of common disorders and develop standardized treatments.

This work is well underway as exemplified by Stein et al.'s investigation of the role of DAT1 polymorphisms in both treatment response and side effect profiles in ADHD youth treated with stimulant medication. I extend a rare “kudos” to this group of authors, and particularly to Jeffrey Newcorn, whose dogged pursuit of the mechanisms of action of stimulant and non-stimulant medication for ADHD is revolutionizing not only treatment but our basic understanding of the disorder.

Please read the work of Stein et al. carefully, and note the primary conclusion: Genotyping can, in some instances, suggest an initial approach to treatment that differs from treatment as usual. Read deeper and see that biological psychiatry is swiftly moving from a concept to an actionable and clinical reality. As evidenced by the articles in this issue, we will soon be bringing the laboratory bench to the office in many more areas of pediatric psychiatry.