Abstract
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Contemporary research with psychedelic therapeutics such as psilocybin, lysergic acid diethylamide, and 3,4-methylenedioxymethamphetamine is rapidly advancing. There has been recent interest and ongoing dialogue focused on how best to initiate rigorous and ethical studies of psychedelics therapeutics for youth with refractory psychiatric disorders. Although there have been no recent clinical trials of psychedelics therapeutic in youth, experts in our field have advocated for commencing this work in a cautious and rigorous fashion (Jeffrey et al., 2024). There are many unanswered questions, limited consensus, and no well-developed guidelines on how best to proceed with research protocols for youth. This month, Sutherland and colleagues address this gap in the literature with a review of prior work and an initial description of essential considerations (Sutherland et al., 2025).
Jacobs and Insua-Summerhays enhance the discussion regarding psychedelic therapeutics with a thoughtful letter to the editor. This letter recalibrates the discussion with a nuanced emphasis on a potential adolescent participant’s developmental and existing psychosocial milieu. A comprehensive understanding of the family system with empathic interventions is indeed a critical consideration for ensuring safety and maximizing therapeutic potential during treatment with psychedelic therapeutics (Jacobs and Insua-Summerhays, 2025). We are grateful for this contribution, agree with its importance in psychedelic therapeutics, and look forward to future contributions from Jacobs and Insua-Summerhays. We also wonder if our field would do well to emphasize an enhanced psychosocial perspective more broadly in clinical trials with all pharmacologic and neurotherapeutic agents.
This month, Kholer and colleagues provide an exhaustive review of Comprehensive Behavioral Intervention for Tics (CBIT). Conventional practice often utilizes CBIT as a safe, tolerable, and clinically effective intervention for tics. The authors note that two large randomized controlled trials with over 200 patients provide support for CBIT as a first-line approach for tics (Kohler et al., 2025). Ongoing efforts are studying the integration of CBIT with other pharmacologic and neurotherapeutic treatments.
Bupropion is an effective and safe antidepressant that is commonly used but less commonly studied in children and adolescents with depression. To date, there is limited evidence to support its safety and clinical effects in children and adolescents. To address this need, Bushnell and colleagues present data from patients aged 6–64 years who started treatment with bupropion. This sample included 39,833 children and 177,710 young adults. The most common potential indication was depression, followed by attention-deficit/hyperactivity disorder (ADHD) (Bushnell et al., 2024). This article is an important advance but underscores the necessity of further safety and effectiveness studies of bupropion in children and adolescents.
Optimal adherence is an important and often unaddressed challenge in child and adolescent psychopharmacology research and clinical practice. This month, Strawn and colleagues examine adherence patterns using electronic monitoring in an ongoing prospective study of escitalopram for the treatment of anxiety disorders in youth. The research team employed qualitative, unsupervised clustering and regression models to examine adherence patterns and predictors. Four adherence patterns were identified, and patients diagnosed with separation and social anxiety had a decreased likelihood of adherence. Older age, anxiety severity, and irritability were associated with lower adherence, while female sex and positive treatment efficacy expectancy appeared to improve adherence (Strawn et al., 2025).
Viloxazine extended-release capsules are an FDA-approved nonstimulant medication increasingly considered for the treatment of ADHD in children, adolescents, and adults (Baweja et al., 2024). In this issue, Childress and colleagues report on a phase 4, open-label study that examined the safety, tolerability, and efficacy of viloxazine with a concurrent psychostimulant for the treatment of children and adolescents aged 6–17 years with symptoms of ADHD that did not respond to psychostimulant monotherapy. Viloxazine combined with a psychostimulant appeared to be safe, tolerable, and clinically effective for the treatment of ADHD. The most common adverse events were headaches and a decreased appetite. The timing of the viloxazine dose, whether in the morning or evening did not impact sleep, tolerability, or clinical effects (Childress et al., 2025).
We round out this issue with a fascinating case series from Ishimuro, Rynn, and colleagues. The evidence base, precision dosing research, and treatment algorithm development with ketamine treatment of adolescents with refractory psychiatric disorders continue to advance (Lineham et al., 2024). Ketamine treatment studies of adults with obsessive-compulsive disorder (OCD) have demonstrated promising findings, and preclinical work suggests that glutamatergic dysregulation in cortico-striato-thalamo-cortical neurocircuitry underpins the clinical symptoms of OCD. This case series demonstrated that one ketamine infusion in adolescents with OCD was tolerable and had a positive clinical impact (Ishimuro et al., 2025). This study provides an important foundation for future randomized controlled trials of ketamine treatment for adolescents with OCD.
We hope you enjoy this issue of Journal of Child and Adolescent Psychopharmacology.