, Volume 51, Issue 5, pp 750–759 | Cite as

Pharmacological Treatment of Psychiatric Disorders in Children and Adolescents

Focus on Guidelines for the Primary Care Practitioner
  • Normand J. Carrey
  • Doreen M. Wiggins
  • Robert P. Milin
Disease Management


This article is a practical review of the current psychopharmacological agents used in the treatment of child and adolescent psychiatric disorders. Psychostimulants such as methylphenidate, dexamphetamine and pemoline are effective in the control of symptoms associated with attention deficit hyperactivity disorder. The controlled release preparations and the adjunctive use of clonidine are helpful to extend stimulant effects and control adverse effects. Tricyclic antidepressants are helpful in individual cases of child and adolescent depression, but adverse effects may limit their use. Clomipramine has been found to be effective for childhood obsessive-compulsive disorder. Selective serotonin (5-HT) reuptake inhibitors (SSRIs) appear to be safer for depression and are also useful in obsessive-compulsive disorder. Buspirone is effective for the treatment of anxiety disorders in children. Newer atypical antipsychotics such as risperidone may have less limiting adverse effects than older antiychotics in the treatment of psychosis and severe behaviour disorders, but the physician must be vigilant for the emergence of tardive dyskinesia. Drug treatment in children and adolescents must take into account the child’s environmental influences and be part of an overall treatment plan where individual, familial and cultural issues are addressed.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Institute of Medicine. Research on children and adolescents with mental, behavioral and developmental disorders. Washington (DC): National Academy Press, 1989Google Scholar
  2. 2.
    Offord DR, Boyle MH, Fleming JE, et al. Ontario Child Health Study: summary of selected results. Can J Psychiatry 1989; 34: 483–91PubMedGoogle Scholar
  3. 3.
    Koplewicz HS, Williams DT. Psychopharmacological treatment. In: Kestenbaum CJ, Williams DT, editors. Handbook of clinical assessment of children and adolescents. Vol. 2. New York (NY): New York University Press, 1988Google Scholar
  4. 4.
    Dulcan MK. Using psychostimulants to treat behavioral disorders of children and adolescents. J Child Adolesc Psychopharmacol 1990; 1: 7–20PubMedCrossRefGoogle Scholar
  5. 5.
    Simeon JG, Wiggins DM. Pharmacotherapy of attention-deficit hyperactivity disorder. Can J Psychiatry 1993; 38: 443–8PubMedGoogle Scholar
  6. 6.
    Gadow KD, Nolan EE, Sverd J, et al. Methylphenidate in aggressive-hyperactive boys: I. Effects on peer aggression in public school settings. J Am Acad Child Adolesc Psychiatry 1990; 29: 710–8PubMedCrossRefGoogle Scholar
  7. 7.
    Kaplan SL, Busner J, Kupietz S, et al. Effects of methylphenidate on adolescents with aggressive conduct disorder and ADHD: a preliminary report. J Am Acad Child Adolesc Psychiatry 1990; 29: 719–23PubMedCrossRefGoogle Scholar
  8. 8.
    Shekim WO. Diagnosis and treatment of attention deficit and conduct disorders in children and adolescents. In: Simeon JG, Ferguson HB, editors. Treatment strategies in child and adolescent psychiatry. New York (NY): Plenum Press, 1990Google Scholar
  9. 9.
    Ross RB, Licamele WL. Slow-release methylphenidate: problems when children chew tablets. J Clin Psychiatry 1984; 45: 525Google Scholar
  10. 10.
    Pelham WE, Greenslade KE, Vodde-Hamilton M, et al. Relative efficacy of long-acting stimulants on children with attention deficit-hyperactivity disorder: a comparison of standard methylphenidate, sustained-release methylphenidate, sustained-release dextroamphetamine and pemoline. Pediatrics 1990; 86: 226–37PubMedGoogle Scholar
  11. 11.
    Sallee FR, Stiller RL, Perel JM. Pharmacodynamics of pemoline in attention deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1992; 31: 244–51PubMedCrossRefGoogle Scholar
  12. 12.
    Nehra A, Mullick F, Ishak KG, et al. Pemoline-associated hepatic injury. Gastroenterol 1990; 99: 1517–9Google Scholar
  13. 13.
    Jaffe SL. Pemoline and liver function [letter]. J Am Acad Child Adolesc Psychiatry 1989; 28: 457–8PubMedCrossRefGoogle Scholar
  14. 14.
    Greenhill LL. Treatment issues in children with attention-deficit hyperactivity disorder. Psychiatr Ann 1989; 119: 604–13Google Scholar
  15. 15.
    Satterfield JH, Cantwell DP, Schell A, et al. Growth of hyperactive children treated with methylphenidate. Arch Gen Psychiatry 1982; 39: 486–7Google Scholar
  16. 16.
    Mattes J, Gittelman R. Growth of hyperactive children on maintenance methylphenidate. Arch Gen Psychiatry 1983; 30: 317–21CrossRefGoogle Scholar
  17. 17.
    Wilens TE, Biederman J. The stimulants. Psychiatr Clin North Am 1992; 15: 191–222PubMedGoogle Scholar
  18. 18.
    Waters BG. Psychopharmacology of the psychiatric disorders of childhood and adolescence. Med J Aust 1990; 152: 32–9PubMedGoogle Scholar
  19. 19.
    Fulton AI, Yates WR. Family abuse of methylphenidate. Am Fam Physician 1988; 38: 143–5PubMedGoogle Scholar
  20. 20.
    Lowe TL, Cohen DJ, Friedhoff AJ, et al. Stimulant medication precipitates Tourette’s syndrome. JAMA 1982; 247: 1729–31PubMedCrossRefGoogle Scholar
  21. 21.
    Calis KA, Grothe DR, Elia J. Attention deficit hyperactivity disorder. Clin Pharmacol 1990; 9: 632–42Google Scholar
  22. 22.
    Comings DE, Comings BG. A controlled study of Tourette syndrome: I. Attention deficit disorder, learning disorders and school problems. Am J Hum Genet 1987; 41: 701–41PubMedGoogle Scholar
  23. 23.
    Konkol RJ, Fischer M, Newby RF. Double-blind, placebo-controlled stimulant trial in children with Tourette’s syndrome and attention-deficit hyperactivity disorder. Ann Neurol 1990; 28: 424Google Scholar
  24. 24.
    Gadow KD, Nolan EE, Sverd J. Methylphenidate in hyperactive boys with comorbid tic disorder: II. Short-term behavioral effects in school settings. J Am Acad Child Adolesc Psychiatry 1992; 31: 462–70PubMedCrossRefGoogle Scholar
  25. 25.
    Rapoport JL, Castellanos FX. Stimulant drug treatment in children with Tourette’s syndrome and attention deficit hyperactivity disorder. Clin Neuropharmacol 1992; 15 Suppl. 1: 226ACrossRefGoogle Scholar
  26. 26.
    Wilens TE, Biederman J, Spencer T. Clonidine for sleep disturbances associated with attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1994; 33: 424–6PubMedCrossRefGoogle Scholar
  27. 27.
    Ambrosini P, Bianchi M, Rabinovitch H, et al. Antidepressant treatments in children and adolescents. J Child Adolesc Psychiatry 1993; 32: 1–6CrossRefGoogle Scholar
  28. 28.
    Biederman J, Baldessarini R, Wright V, et al. A double-blind placebo controlled study of desipramine in the treatment of ADD: II. Serum drug levels and cardiovascular findings. J Am Acad Child Adolesc Psychiatry 1989; 28: 903–11PubMedCrossRefGoogle Scholar
  29. 29.
    Ryan ND. Heterocyclic antidepressants in children and adolescents. J Child Adolesc Psychopharmacol 1990; 1: 2CrossRefGoogle Scholar
  30. 30.
    Riddle MA, Geller B, Ryan N. Case study. Another sudden death in a child treated with desipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 792–7PubMedCrossRefGoogle Scholar
  31. 31.
    Popper C. Balancing knowledge and judgement: a clinician looks at new developments in child and adolescent psychopharmacology. Child Adolesc Clin North Am 1995; 4(2): 487Google Scholar
  32. 32.
    Biederman J, Baldessarini RJ, Goldblatt A, et al. A naturalistic study of 24-hour electrocardiographic recordings and echocardiographic findings in children and adolescents treated with desipramine. J Am Acad Child Adolesc Psychiatry 1993; 32: 805–13PubMedCrossRefGoogle Scholar
  33. 33.
    Wilens TE, Biederman J, Geist DE, et al. Nortriptyline in the treatment of ADHD: a chart review of 58 cases. J Am Acad Child Adolesc Psychiatry 1993; 32: 343–9PubMedCrossRefGoogle Scholar
  34. 34.
    Garfinkel B, Wender P, Sloman L, et al. Tricyclic antidepressant and methylphenidate treatment of attention deficit disorder in children. J Am Acad Child Adolesc Psychiatry 1983; 22: 343–8CrossRefGoogle Scholar
  35. 35.
    Flament MF, Rapoport JL, Berg CZ, et al. Clomipramine treatment of childhood obsessive-compulsive disorder: a double-blind controlled study. Arch Gen Psychiatry 1985; 42: 977–83PubMedCrossRefGoogle Scholar
  36. 36.
    Simeon JG, Ferguson HB, DiNicola VF, et al. Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up. Prog Neuropsychopharmacpl Biol Psychiatry 1990; 14: 791–5CrossRefGoogle Scholar
  37. 37.
    Emslie G. The AACAP News. J Am Acad Child Adolesc Psychiatry 1996; Jan-Feb: 15Google Scholar
  38. 38.
    Barrickman L, Noyes R, Kuperman S, et al. Treatment of ADHD with fluoxetine: a preliminary trial. J Am Acad Child Adolesc Psychiatry 1991; 30: 762–7PubMedGoogle Scholar
  39. 39.
    Gammon G, Brown T. Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. J Child Adolesc Psychopharm 1993; 3(1): 1–10CrossRefGoogle Scholar
  40. 40.
    Riddle MA, Scahill L, King RA, et al. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1992; 31: 1062–9PubMedCrossRefGoogle Scholar
  41. 41.
    King RA, Riddle MA, Chapell PB, et al. Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment. J Am Acad Child Adolesc Psychiatry 1991; 30: 179–86PubMedCrossRefGoogle Scholar
  42. 42.
    Apter A, Ratzoni G, King RA, et al. Fluvoxamine open-label treatment of adolescent inpatients with obsessive-compulsive disorder or depression. J Am Acad Child Adolesc Psychiatry 1994; 33: 342–8PubMedCrossRefGoogle Scholar
  43. 43.
    Preskorn SH. Antidepressant drug selection: criteria and options. J Clin Psychiatry 1994; 55 Suppl. A: 6–22PubMedGoogle Scholar
  44. 44.
    Barrickman LL, Perry PJ, Allen AJ, et al. Bupropion versus methylphenidate in the treatment of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1995; 34: 649–57PubMedCrossRefGoogle Scholar
  45. 45.
    Simeon JG, Ferguson HB, Van Wyck Fleet V. Bupropion effects in attention deficit and conduct disorders. Can J Psychiatry 1986; 31: 581–5PubMedGoogle Scholar
  46. 46.
    Trott GE, Friese HJ, Menzel M, et al. Use of moclobemide in children with attention deficit hyperactivity disorder. Psychopharmacol 1992; 106: S134–6CrossRefGoogle Scholar
  47. 47.
    Reiter S, Kutcher S, Gardner D. Anxiety disorders in children and adolescents: clinical and related issues in pharmacological treatment. Can J Psychiatry 1992; 37: 432–8PubMedGoogle Scholar
  48. 48.
    Realmuto GL, August GJ, Garfinkel BD. Clinical effect of buspirone in autistic children. J Clin Psychopharmacol 1989; 9: 122–5PubMedCrossRefGoogle Scholar
  49. 49.
    Kutcher SP, Reiter S, Gardner DM, et al. The pharmacotherapy of anxiety disorders in children and adolescents. Psychiatr Clin North Am 1992; 15: 41–67PubMedGoogle Scholar
  50. 50.
    Kranzler HR. Use of buspirone in an adolescent with overanxious disorder. J Am Acad Child Adolesc Psychiatry 1988; 27: 789–90PubMedCrossRefGoogle Scholar
  51. 51.
    Simeon JG. Buspirone effects in adolescent psychiatric disorders. Eur Neuropsychopharmacol 1991; 1: 421CrossRefGoogle Scholar
  52. 52.
    Simeon JG, Knott VJ, Dubois C, et al. Buspirone therapy of mixed anxiety disorders in childhood and adolescence: a pilot study. J Child Adolesc Psychopharmacol 1994; 4: 159–70CrossRefGoogle Scholar
  53. 53.
    Kutcher SP, Mackenzie S. Successful clonazepam treatment of adolescents with panic disorder. J Clin Psychopharmacol 1988; 8: 229CrossRefGoogle Scholar
  54. 54.
    Coffey BJ. Anxiolytics for children and adolescents: traditional and new drugs. J Child Adolesc Psychopharmacol 1990; 1: 57–83PubMedCrossRefGoogle Scholar
  55. 55.
    Simeon JG. Use of anxiolytics in children. Encephale 1993; 9: 71–4Google Scholar
  56. 56.
    Simeon JG. Pediatric psychopharmacology. Can J Psychiatry 1989; 34: 115–22PubMedGoogle Scholar
  57. 57.
    Campbell M, Gonzalez NM, Ernst M, et al. Antipsychotics. In: Werry JS, Aman GA, editors. Practitioner’s guide to psychoactive drugs for children and adolescents. New York (NY): Plenum Press, 1993: 269–96CrossRefGoogle Scholar
  58. 58.
    Gualtieri CT, Quade D, Hicks RE, et al. Tardive dyskinesia and other clinical consequences of neuroleptic treatment in children and adolescents. Am J Psychiatry 1984; 141: 20–3PubMedGoogle Scholar
  59. 59.
    Sloman L. Use of medication in pervasive developmental disorders. Psych Clin North Am 1991; 14(1): 165–82Google Scholar
  60. 60.
    Cohen D, Riddle M, Leckman J. Pharmacotherapy of Tourette’s disorder. Psychiatr Clin North Am 1992 Mar; 15: 1Google Scholar
  61. 61.
    Simeon JG, Carrey NJ, Wiggins DM, et al. Risperidone effects in treatment-resistant adolescents: preliminary case reports. J Child Adolesc Psychiatry 1995; 5: 69–79Google Scholar
  62. 62.
    Mandoki MW. Risperidone treatment of children and adolescents: increased risk of extrapyramidal side effects? J Child Adolesc Psychopharmacol 1995; 5: 49–67CrossRefGoogle Scholar
  63. 63.
    Birmaher B, Baker R, Kapur S, et al. Clozapine for the treatment of adolescents with schizophrenia. J Am Acad Child Adolesc Psychiatry 1992; 31: 160–4PubMedCrossRefGoogle Scholar
  64. 64.
    Frazier JA, Gordon CT, McKenna K, et al. An open trial of clozapine in 11 adolescents with childhood-onset schizophrenia. J Am Acad Child Adolesc Psychiatry 1994; 33: 658–63PubMedCrossRefGoogle Scholar
  65. 65.
    Carlson GA. Bipolar disorders in children and adolescents. In: Garfinkel B, Carlson G, Weller E, editors. Psychiatric disorders in children and adolescents. Philadelphia (PA): WB Saunders, 1990Google Scholar
  66. 66.
    Alessi N, Naylor M, Ghaziuddin M, et al. Update on lithium carbonate therapy in children and adolescents. J Am Acad Child Adolesc Psychiatry 1994; 33: 291–304PubMedCrossRefGoogle Scholar
  67. 67.
    Campbell M, Small AM, Green WH, et al. Behavioral efficacy of haloperidol and lithium carbonate. Arch Gen Psychiatry 1984; 41: 650–6PubMedCrossRefGoogle Scholar
  68. 68.
    Papatheodorou G, Kutcher S, Katic M, et al. The efficacy and safety of divalproex sodium in the treatment of acute mania in adolescents and young adults: an open clinical trial. J Clin Psychopharmacol 1995 Apr; 15: 110–6PubMedCrossRefGoogle Scholar
  69. 69.
    Popper C. Introduction: therapeutic empiricism and therapeutic basics. J Child Adolesc Psychopharmacol 1990; 1: 3–5PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1996

Authors and Affiliations

  • Normand J. Carrey
    • 1
  • Doreen M. Wiggins
    • 1
  • Robert P. Milin
    • 1
  1. 1.Institute of Mental Health Research and Children’s Regional Mental Health CenterRoyal Ottawa HospitalOttawaCanada

Personalised recommendations