Abstract
The articles in this issue pursue diverse questions with wide-ranging implications, all while addressing issues in pediatric psychopharmacology that are central to research and to clinical practice.
Spence et al. present a valuable investigation of the factors preceding antipsychotic treatment initiation in youth in foster care. The authors can distinguish subgroups of youth starting antipsychotic treatment, most clearly between those in whom antipsychotics are prescribed to augment an existing regimen and those medication-naive youth who are prescribed antipsychotics “following a first episode crisis.”
Spence et al. also make an observation concerning foster placement stability that is crucially important for any clinician treating this population. “In this cohort, youth had on average 3 foster care placement changes in the year before antipsychotic initiation,” the authors write. “Placement instability results in disruptions in the child's environment and may increase the likelihood of behavioral problems.” Clinicians should be aware that in this population, an antipsychotic prescription may be an attempt to correct the child's response to his or her environment rather than any psychopathology.
Schoenfelder et al. present a fascinating and thorough account of a study using medication and behavioral treatments for mothers with attention-deficit/hyperactivity disorder (ADHD) to target child ADHD symptoms and impairment in multiplex ADHD families. The authors deploy a sequential, multiple assignment, randomized trial (SMART) pilot design. In SMART, the authors write, participants “are initially randomized to receive a treatment and then are rerandomized to either intensified or augmented treatment or a different intervention modality during a second phase of treatment (i.e., the second randomization). SMART trials allow for an investigation of whether treatments should be sequenced in a particular order, as well as how to tailor treatment sequences.”
Ultimately, Schoenfelder et al. conclude that “maternal stimulant medication and behavioral parent training are acceptable and feasible interventions for families in which both the mother and child have ADHD symptoms.”
Elsewhere, Schneider et al. present results of large analyses (n = 47,910 and 41,248) of weight and height outcomes of stimulant and guanfacine treatment for ADHD. This large-scale study enabled by U.S. Department of Defense Military Health System records is the “first to assess the impact of pharmacotherapy with guanfacine on weight and height in children and adolescents with ADHD as observed retrospectively in a real-world clinical setting,” the authors write. This welcome investigation confirms some anecdotal clinical experience that “guanfacine monotherapy is not associated with marked deviations from normal growth” in children with ADHD.
Elsewhere, Singh et al. report on their study using guanfacine in the management of behavioral disturbances in youth with Prader–Willi syndrome aged 6–26 years. The authors found that guanfacine treatment had an effect on symptoms of aggression and agitation, but no impact on reducing the psychosis or agitation related to psychotic symptoms often found with this patient population.