Cambridge Textbook of Effective Treatments in Psychiatry: Drugs and other physical treatments

Editor's note This chapter reviews principles and issues that need to be considered in the prescribing of psychotropic medications to children and adolescents. The brain is still developing during this period, and pruning of neurons and synapses goes on during different periods of childhood and adolescence. Fat distribution and protein-binding of medications in this group is different from adults, and issues related to absorption rate and metabolism rate also reveal differences not only between this age grouping and adults but also within different periods of childhood and adolescence. All this suggests that even more caution needs to be taken when prescribing psychotropics to children, even though there are many studies, as revealed by the tables that accompany this chapter, that suggest effectiveness of pharmacologic treatment of psychiatric disorders during childhood and adolescence. General issues in paediatric psychopharmacology Currently, an estimated 6% of young people under the age of 20 years in the United States receive prescriptions for psychotropic medication. This number has increased two- to threefold over the past 15 years and now closely approximates rates found in adult populations (Zito et al ., 2003). Prescriptions for adolescents and preschoolers have particularly been on the rise in recent years (Martin & Leslie, 2003; Zito et al ., 2000). For preschoolers, a threefold increase in stimulant usage in the early 1990s is especially notable (Zito et al ., 2000). In the UK, use of medication is much less and has been less studied.