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Expert Opin Pharmacother. 2018 Apr;19(6):547-560. doi: 10.1080/14656566.2018.1445720. Epub 2018 Mar 29.

Psychotropic medications for highly vulnerable children.

Author information

1
a Department of Psychiatry , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
2
b Dartmouth Hitchcock Medical Center , Lebanon , NH , USA.
3
c Vulnerable Children Research Group , The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
4
d Dartmouth Trauma Interventions Research Center , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
5
e Department of Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
6
f Department of Community & Family Medicine , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.
7
g Medicine and the Media Programs , Geisel School of Medicine at Dartmouth , Lebanon , NH , USA.

Abstract

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.

KEYWORDS:

Psychotropic medication; behavior problems; child welfare; children; developmental disabilities; mental health; off-label; polypharmacy; trauma

PMID:
29596008
DOI:
10.1080/14656566.2018.1445720
[Indexed for MEDLINE]

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