From the Editor-in-Chief’s Desk

TO OUR READERS: A Call for More Research Focused on Discontinuation of Treatment.

Serotonin-dopamine activity modulators (SDAMs) such as risperidone are frequently used to address symptoms of irritability, aggression, and mood lability in children and adolescents (Zhang et al., 2024). SDAMs are often helpful adjuncts to a treatment plan when impairing symptoms have not improved with family therapy, behavioral therapy, and other interventions. As with many pharmacological interventions for children and adults, research typically focuses on acute treatment. Long-term studies of the clinical effects, side effect burden, and risks are rare (Strawn and Geracioti, 2023). In clinical practice, risperidone is commonly prescribed for 12 months or more. This decision is based on complex considerations regarding the risks and benefits of treatment in the context of symptoms that confer substantial functional impairment for children (Dinnissen et al., 2024). This situation is not unique to risperidone as long-term studies of the clinical effects, tolerability, safety, and discontinuation of psychotropic medications in children and adolescents are lacking.

In this issue, Dinnissen and colleagues address knowledge gaps related to the long-term use and discontinuation of risperidone in children and adolescents. The study enrolled patients who had been treated with risperidone for at least 1 year in clinical practice. All patients in the study had 2 weeks of open-label treatment with risperidone. Patients were randomized to 16 weeks of continuation treatment or discontinuation of risperidone with continuation for 2 weeks followed by a steady taper for 6 weeks and then 8 weeks of placebo. Primary outcome measures focused on disruptive behaviors were collected at baseline (after 2 weeks of open-label treatment) and 16 weeks. Secondary measures focused on behavioral, emotional, and social outcomes with parent, child, and teacher ratings. Side effects, adverse events, vital signs, and laboratory tests were collects at both assessment visits. There were no significant increases in parent reported disruptive behavior in the patients with discontinuation. However, the patients in the discontinuation group had worsening verbal aggression, behavioral, and general functioning with additional outcome measures. The discontinuation group had significant benefits with respect to weight, BMI, waist circumference, glucose, insulin, and prolactin. Notwithstanding mixed findings, the study by Dinnissen and colleagues highlights the importance of consistent, clinical consideration of endpoints for pharmacological interventions in children (Dinnissen et al., 2024). Future research focused on treatment discontinuation plans and related outcomes in children and adolescents is critical.

This issue also includes a fascinating study by Tebbett-Mock and colleagues (Tebbett-Mock et al., 2024). Emerging literature continues to advance our understanding of the impact of the COVID-19 pandemic on children and related practice patterns in our field (Harris et al., 2024). Tebbett-Mock and colleagues examined electronic health record data focused on intensive interventions in large samples of adolescents hospitalized before and during the COVID-19 pandemic. During the pandemic, hospitalized adolescents had a greater frequency of restraint and increased observation status. The increased level of acuity, patient symptom severity, as well as diminished resources during the pandemic may have been underlying factors (Tebbett-Mock et al., 2024). Ongoing study of psychiatric care delivery during the COVID-19 pandemic will assist with future service delivery in the event of future international crises.

We round out this issue with three letters. The first letter by Nagy and colleagues focuses on a presentation of paradoxical sedation with methylphenidate (Naguy et al., 2024). Stimulant medications are the mainstay of treatment planning for Attention-Deficit/Hyperactivity Disorder and have well-known side effects (Baweja et al., 2024). Nagy and colleagues note the importance of considering this rare side effect of paradoxical sedation with a stimulant and although counterintuitive, suggest that dosage increases may be a consideration (Naguy et al., 2024). Another letter from Lkamel and Assermouh examined data and developed a model suggesting that low self-esteem and high perceived stress in high school students are risk factors for smart phone addiction (Lkamel and Assermouh, 2024). There are ongoing advances in understanding optimal treatment planning for patients with neurodevelopmental disorders and autism spectrum disorder (Berloffa et al., 2024). A key challenge for meeting the needs of patients with autism is nuanced early identification in the context of social determinants of health. In this issue, Valicenti-McDermott and colleagues highlight the need for more research focused on ethnically diverse samples of patients with autism (Valicenti-McDermott et al., 2024).

On this final note please consider submitting your work for our forthcoming special issue focused on neurodevelopmental disorders.

We hope you enjoy this issue of Journal of Child and Adolescent Psychopharmacology.