G. Wilkinson
Jan 26, 1991
Citations
1
Influential Citations
15
Citations
Quality indicators
Journal
British Medical Journal
Abstract
such as trimeprazine tartrate are only moderately effective in helping to re-establish a normal sleep pattern in infants and toddlers, whereas behavioural methods are highly effective.9 10 The use of drugs to control physically aggressive and self mutilating behaviours, especially in mentally handicapped children, is more controversial, as is the use of psychotropic drugs to treat anxiety in children. The concern is that we will resort to drugs as a form of social control rather than attempting to alter the conditions that produce the behaviour. Few controlled trials have been conducted of drug treatments for aggressive, non-hyperactive children with conduct disorder. A recent review concluded that both haloperidol and lithium carbonate were useful in resistant cases," 12 and antidepressants may be effective for any accompanying depressive symptoms. The authors emphasise that, as with all childhood psychiatric disorders, "there is virtually no situation in which an aggressive child or adolescent should be treated only pharmacologically."" Imipramine in high dosage was found to be better than placebo for school phobia in one controlled study,'3 but a trial ofclomipramine in lower dosage for the same condition found that it was effective only when depressive symptoms were present and then only for a short period. 14 Emotional and conduct disorders, which between them account for 90% of the psychiatric disorders seen in childhood, are best treated by a comprehensive approach based on family and individual psychotherapy and behaviour therapy with drugs used sparingly and judiciously only as adjuncts. The authors of one recent review of drugs for problem children reinforced Eisenberg's earlier principles'5 that there should be a firm indication for use, the drug should be a well tried one, its dose should be tailored for each child, and it should be used only for a limited time with frequent monitoring.'6 In our present state of knowledge psychotropic drugs should be prescribed sparingly and under the supervision of specialists. While these drugs have a definite role in treating some childhood psychiatric disorders, we need more and better quality research to break the current cycle of "limited data, limited use, potential misuse, and limited benefits."'7 DORA BLACK Consultant Child and Adolescent Psychiatrist, Royal Free Hospital, London NW3 2QG