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Psychotropic medications for highly vulnerable children
Jennifer L McLaren1,2,3, Erin R Barnett1,2,3,4, Milangel T Concepcion Zayas1
1a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
Insights
Many vulnerable children receive psychotropic medications without sufficient evidence. Future research should focus on long-term effectiveness and integrated psychosocial treatments for improved outcomes.
Area of Science:
- Child Psychiatry
- Pediatric Psychopharmacology
- Vulnerable Populations
Background:
- Over 20% of US children face vulnerability due to lack of healthcare and protection.
- Factors contributing to vulnerability include trauma, poverty, and developmental disabilities.
- These children are frequently prescribed psychotropic medications, raising significant concerns.
Purpose of the Study:
- To review the effectiveness and side effects of psychotropic medications in highly vulnerable children.
- To examine current prescribing trends, including polypharmacy and off-label use.
- To identify gaps in research and propose future directions for treatment.
Main Methods:
- Systematic review of the highest-quality evidence.
- Description of the population of highly vulnerable children.
- Analysis of psychotropic medication use for common diagnoses in this population.
Main Results:
- Highly vulnerable children exhibit high rates of psychotropic medication use, including polypharmacy, off-label prescribing, and long-term treatment.
- These medication practices often occur without concurrent psychosocial interventions.
- Current evidence does not support these widespread prescribing trends.
Conclusions:
- Evidence contraindicates current trends in psychotropic medication use for vulnerable children.
- Future research must prioritize long-term effectiveness trials and polypharmacy studies.
- Integrating evidence-based, family-centered psychosocial treatments with psychotropic medication is crucial.
Introduction:
At least 20% of children in the U.S. are highly vulnerable because they lack healthcare and protection. Several factors produce vulnerability: trauma, disruptions of parenting, poverty, involvement in the juvenile justice and/or child welfare systems, residence in restrictive settings, and problems related to developmental disabilities. These children receive psychotropic medications at high rates, raising numerous concerns.
Areas Covered:
The authors begin this review with a description of the population of highly vulnerable children. They then follow this with a review of the effectiveness and side effects of psychotropic medications for their most common diagnoses, using the highest-quality systematic reviews identified by multiple database searches.
Expert Opinion:
Highly vulnerable children receive numerous psychotropic medications with high rates of polypharmacy, off-label use, and long-term use, typically in the absence of adjunctive psychosocial interventions. The current evidence contravenes these trends. Future studies of psychotropic medications in vulnerable children should include long-term effectiveness trials and polypharmacy in conjunction with evidence-based, family-centered, psychosocial treatments.
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