LAUSR

In this issue of Current Problems in Pediatric and Adolescent Health Care, Dr. Jeffrey Strawn from Cincinnati Children’s Hospital and Medical Center and his colleagues have written a practical compendium of medications that help young patients with the symptoms of ADHD, depression/dysthymia, or anxiety. In the first paper (ref), they begin by reviewing the evidence for the effectiveness of selective serotonin (SSRI) and selective serotonin norepinephrine (SSNRI) reuptake inhibitors for depression. They review the results of several multicenter randomized trials, including a trial of the treatment of SSRIresistant depression in adolescents. This is followed by a review of similar medication for the treatment of pediatric anxiety disorders, including predictors of a response to the treatment (e.g., girls and older age both increase the likelihood of poor response to medication). The authors complete this section with a review of the safety and tolerability, including the risk of suicidality, of these medications for children and youth. The next section addresses the very important topic of stimulants for ADHD, the most prevalent behavioral disorder in children and adolescents. A similar pattern is followed for this section. The authors review the evidence for efficacy/effectiveness of stimulants for the symptoms of ADHD, predictors of response, as well as safety/tolerability. In short, stimulants for the symptoms of ADHD are effective and generally well tolerated with common side effects including decreased appetite, sleep difficulties, and rebound hyperactivity/irritability. A short section also reviews the role of non-stimulants in ADHD. The second paper in this issue summarizes the results of a very interesting mixed method study of 14 pediatricians and qualitative factors related to their levels of comfort with antidepressants and willingness to prescribe them for their young symptomatic patients (ref). The authors found that the pediatricians studied consider patient and family-specific challenges when choosing whether or not to prescribe antidepressants for their patients and are less likely to prescribe medication for patients with anxiety disorders compared to patients with depressive symptoms. The lower likelihood of prescribing medication for anxiety in their patients was not related to pediatricians’ perception of effectiveness or tolerability of the medication. The final paper in this issue is a commentary by Dr. Andrew Smith, a child psychiatrist at Dayton Children’s Hospital (ref). Dr. Smith’s comments are laudatory of the efforts made by Dr. Strawn’s team, and he emphasizes the high frequency of childhood behavioral health symptoms in the population and the “severe shortage” of child psychiatrists. He observes that primary care clinicians have an “ideal relationship” with children and their families to support families whose children present to the primary care clinician with behavioral health needs. He notes that there is a “wealth of data” that supports the effectiveness of pharmacotherapy for behavioral concerns; he reminds the reader that psychotherapy with