There is an urgent need for more research on psychotropic drug use in very young children, said Leonard, who runs research trials of medications in children and adolescents. You want someone who is well trained and if that individual is prescribing medications, that they are specifically trained in that expertise, such as someone who has trained in child psychiatry. The fear is that this is not occurring and that psychosocial stresses in the homes of these children, which may underlie or complicate these cases, are not being addressed. In fact, no research results support psychotropic drug treatment in preschoolers. The JAMA findings also suggest a crisis in mental health services for children, Leonard said.
Budget cuts for health care can ration psychotherapy and force a focus on the quick fix.
The trend among third-party payers is to deny reimbursement for psychotherapy and for combined psychotherapy and drug treatments. This increases the chances that only drugs will be used. There have been dramatic changes in the health care world, such as severe time restrictions imposed on taking care of patients, which affects how we do a comprehensive evaluation and provide appropriate treatment. I have to write a 12-page treatment plan on why I want to talk with a child and family members or caretakers for 45 minutes. Leonard serves on the editorial board of the Journal of Child and Adolescent Psychopharmacology.