Pediatric Psychopharmacology for Primary Care, 3rd Edition

Visit the link below to download the full version of this book:

https://medidownload.com/product/pediatric-psychopharmacology-for-primary-care-3
rd-edition/

Click Download Now

 American Academy of Pediatrics Publishing Staff
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, and Publishing
Mark Grimes, Vice President, Publishing
Carrie Peters, Editor, Professional/Clinical Publishing
Theresa Wiener, Production Manager, Clinical and Professional Publications
Mary Louise Carr, Marketing Manager, Clinical Publications
Published by the American Academy of Pediatrics
345 Park Blvd
Itasca, IL 60143
Telephone: 630/626-6000
Facsimile: 847/434-8000
www.aap.org
The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians,
pediatric medical subspecialists, and pediatric surgical specialists dedicated to the health, safety,
and well-being of all infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment
or serve as a standard of medical care. Variations, taking into account individual circumstances,
may be appropriate.
Statements and opinions expressed are those of the authors and not necessarily those
of the American Academy of Pediatrics.
Any websites, brand names, products, or manufacturers are mentioned for informational and
identification purposes only and do not imply an endorsement by the American Academy of
Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information
was current at the time of publication.
This publication has been developed by the American Academy of Pediatrics. The contributors
are expert authorities in the field of pediatrics. No commercial involvement of any kind has been
solicited or accepted in development of the content of this publication. Disclosures: Dr Cori Green
disclosed a relationship with The REACH Institute.
Every effort has been made to ensure that the drug selection and dosage set forth in this text are
in accordance with the current recommendations and practice at the time of publication.
It is the responsibility of the health care professional to check the package insert of each drug for
any change in indications and dosage and for added warnings and precautions.
Some drugs and medical devices presented in this publication have US Food and Drug
Administration (FDA) clearance for limited use in restricted research settings. It is the
responsibility of health care professionals to ascertain the FDA status of each drug or device
planned for use in their clinical practice.
Every effort is made to keep Pediatric Psychopharmacology for Primary Care consistent with the
most recent advice and information available from the American Academy of Pediatrics.
Please visit www.aap.org/errata for an up-to-date list of any applicable errata for this publication.
Special discounts are available for bulk purchases of this publication. E-mail Special Sales at
[email protected] for more information.
© 2022 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means—electronic, mechanical, photocopying, recording,
or otherwise—without prior permission from the publisher (locate title at http://ebooks.
aappublications.org and click on © Get Permissions; you may also fax the permissions editor at
847/434-8780 or e-mail [email protected]). First edition published 2016; second 2019.
Printed in the United States of America
9-468/1021 1 2 3 4 5 6 7 8 9 10
MA1027
ISBN: 978-1-61002-546-1
eISBN: 978-1-61002-547-8
Cover and publication design by LSD DESIGN LLC
Library of Congress Control Number: 2021900633

00b_Psychopharmacology_FM_3ed.indd 2 7/29/21 8:32 AM

 What People Are Saying

Third Edition
Pediatric Psychopharmacology for Primary Care is a valuable resource for
every pediatric clinician and should be part of every pediatric office’s library.
It offers a comprehensive overview of the diagnosis and management of
common pediatric mental health disorders in a concise and organized
fashion, providing readily accessible information about the common classes
of psychotropic medications. It clears the murky waters of mental health
drugs and allows for a rational decision-making process in choosing among
stimulants, SSRIs, and associated drugs.
The volume is organized extremely well, offering sections on overview con-
siderations, specific diagnostic implications, and a full discussion of each of
the classes of psychotropic medications. I found the final 2 sections, “After
Prescribing: Midcourse Corrections” and the Appendixes, especially helpful
in addressing information that is often not readily available.
Publication of the third edition could not have come at a more opportune
time. On the heels of the COVID-19 pandemic when children and adoles-
cents were faced with 18 months of quarantine, virtual school, and social
isolation, the incidence of depression and anxiety disorders has skyrocketed.
On a daily basis, primary care clinicians are asked to address mental health
issues with limited access to an already overburdened mental health system.
This text offers them diagnostic tools to accurately assess the condition and
then management strategies to begin psychotropic medication as part of a
comprehensive treatment plan.
David Bromberg, MD, FAAP
The Pediatric Center of Frederick
Former District III Chair and Former Member of the Board of Directors,
American Academy of Pediatrics

00b_Psychopharmacology_FM_3ed.indd 3 7/29/21 8:32 AM

 iv What People Are Saying

Second Edition
This concise, practical, informative, and easy-to-read primer on pediatric
psychopharmacology in the primary care setting could not have come at a
better time. I read the entire book and already applied some of its contents to
a recent case.
A significant new morbidity in the practice of pediatrics is the rising prev-
alence of mental health disorders in our children and adolescents, coupled
with the increasing limited access to mental health specialists and the limited
training in behavioral and mental health in primary care residencies. One
answer to these issues is for us currently practicing clinicians to read and use
this book. Pediatric Psychopharmacology for Primary Care is organized in
such a way that a quick perusal of its contents delivers much-needed guid-
ance for the initial treatment and eventual management of common and
not-so-common psychiatric disorders in children and adolescents. Rationale
and resources for initial screening, referral, nonpharmacologic therapy, and
pharmacologic therapy are prominently provided. Even better, the book
offers advice on how to handle the FDA’s Black Box warnings and how to
provide behavioral therapy and to prescribe medications when experts in
psychiatry and behavioral counseling are not readily available. After reading
this book on treating children and adolescents with mental health issues, one
should feel more confident in treating this vulnerable population.
Pediatric Psychopharmacology for Primary Care, with its short chapters,
tables, appendixes, and links to online resources, provides crucial informa-
tion for medical students, primary care residents, and practicing primary
care clinicians who desire to care for children and adolescents with common
psychiatric disorders, who deal with shortages in mental health resources,
and who seek reassurance that successful caring for such children and ado-
lescents in the primary care setting is achievable.
Joseph A. Zenel, MD, FAAP
Editor in Chief, Pediatrics in Review
Professor, Pediatrics, and Director,
Pediatric Residency, at Sanford Children’s Hospital,
University of South Dakota Sanford School of Medicine

00b_Psychopharmacology_FM_3ed.indd 4 7/29/21 8:32 AM

 What People Are Saying v

First Edition
This clear and well-organized volume provides an excellent and useful
compendium of advice on the use of psychotropic medications in pediatric
primary care. Building on strong work by the AAP over the past 15 to
20 years to develop clinical practice guidelines for primary care management
of attention-deficit/hyperactivity disorder and the work of the AAP Task
Force on Mental Health, this book offers clear guidance on when to use
psychotropics, which to use, and what coexisting conditions and side effects
the clinician should monitor.
James M. Perrin, MD, FAAP
John C. Robinson Chair in Pediatrics
Massachusetts General Hospital for Children
President (2014), American Academy of Pediatrics

This guide to pediatric psychopharmacology provides pediatric primary

care clinicians, and specialists working with them, with a practical clinical
resource that concisely integrates relevant current literature and significant
experience. Within a helpful framework that emphasizes safety and efficacy,
this book provides clear guidance on dosing, monitoring, and potential
adverse reactions. It makes access to and use of the information simple, yet
incredibly valuable, for the busy clinician.
Christopher J. Kratochvil, MD
Professor of Psychiatry and Pediatrics
Anna O. Stake Professor of Child Psychiatry
Associate Vice Chancellor for Clinical Research
University of Nebraska Medical Center
Vice President for Research, Nebraska Medicine
Chief Medical Officer, UNeHealth

00b_Psychopharmacology_FM_3ed.indd 5 7/29/21 8:32 AM

00b_Psychopharmacology_FM_3ed.indd 6 7/29/21 8:32 AM
 Contributors
Author
Mark A. Riddle, MD
Professor of Psychiatry and Pediatrics
Johns Hopkins University School of Medicine
Baltimore, MD

Contributing Editors
Emily Frosch, MD
Associate Professor of Psychiatry and Behavioral Sciences
Johns Hopkins University School of Medicine
Baltimore, MD

Rebecca A. Baum, MD, FAAP

Mission Health | HCA Healthcare
Asheville, NC

Susan dosReis, PhD

Professor of Pharmacy
University of Maryland School of Pharmacy
Baltimore, MD

Jane Meschan Foy, MD, FAAP

Professor of Pediatrics
Wake Forest University School of Medicine
Winston-Salem, NC
Chair, AAP Task Force on Mental Health, 2004–2010
Member, AAP Mental Health Leadership Work Group, 2011–present

Cori Green, MD, FAAP

Associate Professor of Clinical Pediatrics
Director, Behavioral Health Education and Integration
Weill Cornell Medicine
New York, NY

Lynne C. Huffman, MD, FAAP

Associate Professor of Pediatrics
Stanford University School of Medicine
Stanford, CA

00b_Psychopharmacology_FM_3ed.indd 7 7/29/21 8:32 AM

 viii Contributors

David B. Pruitt, MD
Professor of Clinical Psychiatry
Division of Child and Adolescent Psychiatry
University of Maryland School of Medicine
Baltimore, MD
Gloria M. Reeves, MD
Associate Professor
Division of Child and Adolescent Psychiatry
University of Maryland School of Medicine
Baltimore, MD
Lawrence S. Wissow, MD, MPH, FAAP
Professor of Psychiatry and Behavioral Sciences
Division of Child and Adolescent Psychiatry
University of Washington
Seattle, WA

00b_Psychopharmacology_FM_3ed.indd 8 7/29/21 8:32 AM

 A heartfelt thank you to my wife, Emily Frosch, for her invaluable
contributions to this edition. She not only played a major role in
the reorganization of this edition with her usual clarity of thinking
and precision of writing but also provided ongoing support and
encouragement throughout the process.

00b_Psychopharmacology_FM_3ed.indd 9 7/29/21 8:32 AM

 Equity, Diversity, and Inclusion Statement
The American Academy of Pediatrics is committed to principles of equity,
diversity, and inclusion in its publishing program. Editorial boards, author
selections, and author transitions (publication succession plans) are designed
to include diverse voices that reflect society as a whole. Editor and author
teams are encouraged to actively seek out diverse authors and reviewers at all
stages of the editorial process. Publishing staff are committed to promoting
equity, diversity, and inclusion in all aspects of publication writing, review,
and production.

00b_Psychopharmacology_FM_3ed.indd 10 7/29/21 8:32 AM

 Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Target Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Why Now? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
What Does This Book Contribute? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii

Part 1— Before Prescribing

Chapter 1—Getting Started . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Guiding Psychopharmacology Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Additional Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Organization and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Selected Changes and Updates in Third Edition . . . . . . . . . . . . . . . . . . . . . . . 6
Chapter 2—Conceptual Framework for Prescribing Psychotropic
Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Rationale for the Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Group 1 Medications for Attention-Deficit/Hyperactivity Disorder,
Anxiety, and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Group 2 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Group 3 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Chapter 3—Making a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Diagnosis of Common Disorders: ADHD, Anxiety Disorders,
and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Diagnosis of Common Comorbidities of ADHD, Anxiety Disorders,
and Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Recognizing Other Psychiatric Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Determine if Medication Is Indicated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Recognize Need for Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

00b_Psychopharmacology_FM_3ed.indd 11 7/29/21 8:32 AM

 xii Contents

Chapter 4—Laying the Groundwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Formulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Feedback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Nonmedication Interventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Specific Consent Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Off-label Prescribing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
US Food and Drug Administration Boxed Warnings . . . . . . . . . . . . . . . . . 58
Triage for Psychiatric and Social Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 60
Important Considerations for Safe and Effective Prescribing . . . . . . . . . . . 60
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

Part 2 — Group 1 Medications for Specific Diagnoses:

Attention-Deficit/Hyperactivity Disorder, Anxiety, and Depression
Chapter 5—Group 1 Medications for Attention-Deficit/Hyperactivity
Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
General Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Methylphenidate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
Amphetamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
Guanfacine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Clonidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Atomoxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
Viloxazine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Chapter 6—Group 1 Medications for Anxiety and Depression . . . . . . 113
General Guidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Group 1 Selective Serotonin Reuptake Inhibitors . . . . . . . . . . . . . . . . . . . . 117
Group 1 Serotonin and Norepinephrine Reuptake Inhibitor:
Duloxetine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

00b_Psychopharmacology_FM_3ed.indd 12 7/29/21 8:32 AM

 Contents xiii

Part 3 — Group 2 and Group 3 Medications

Chapter 7—Group 2 Medications: FDA-Approved Antipsychotics
and Mood Stabilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Rationale . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
The Mood Stabilizer Lithium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Chapter 8—Group 3 Medications: Others Commonly Prescribed . . . . . 155
Other Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Other Antipsychotics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Other Mood Stabilizers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Anxiolytics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Sleep Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Future Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165

Part 4—After Prescribing: Midcourse Corrections

Chapter 9—Fine Tuning Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Reevaluate Therapies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Reevaluate Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
Discontinuing Group 1 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Switching Group 1 Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172
When to Consider Group 2 Antipsychotics or Lithium . . . . . . . . . . . . . . . 173
When to Consider Group 3 Medications Without FDA Approval
for Use in Youth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
When to Consider Drug Levels or Genetic Testing . . . . . . . . . . . . . . . . . . 174
Can Genotyping Improve Medication Response? . . . . . . . . . . . . . . . . . . . . 176
When to Consider Consultation or a Second Opinion . . . . . . . . . . . . . . . 176
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Chapter 10—Managing Treatment Impasses . . . . . . . . . . . . . . . . . . . . . . . . 179
Reassess Diagnoses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Complex Psychosocial Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Expert Consultation or Referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

00b_Psychopharmacology_FM_3ed.indd 13 7/29/21 8:32 AM

 xiv Contents

Appendixes
Appendix A–Assessment and Symptom Monitoring Tools . . . . . . . . . . . . 187
Appendix B–Resources for Clinicians . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Appendix C–Training Resources for Clinicians . . . . . . . . . . . . . . . . . . . . . 195
Appendix D–Quality Ratings for Psychotherapies and Efficacy Data
for Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Appendix E–Resources for Caregivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Appendix F–Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition, Complete Criteria of Select Diagnoses . . . . . . . . . . . . . . . 205
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

00b_Psychopharmacology_FM_3ed.indd 14 7/29/21 8:32 AM

 Introduction

Target Audience
This book is written for pediatric primary care clinicians (PCCs) who care
for children and adolescents with common psychiatric disorders in their out-
patient practices and who prescribe and monitor medications. This audience
includes primary care pediatricians, family physicians, pediatric and family
nurse practitioners, and pediatric and family physician assistants.
Secondary audiences include specialists who provide consultation to pedi-
atric PCCs in performing these roles, including developmental-behavioral
pediatricians, specialists in neurodevelopmental disabilities, child and ado-
lescent psychiatrists, psychiatric nurse practitioners, specialists in adolescent
medicine, pediatric neurologists, and some psychiatrists with training in
adolescent care. A third audience includes allied mental health professionals
who collaborate with medication prescribers and who can provide evidence-­
based psychotherapies and other care for children and adolescents, including
psychologists, social workers, nurses, and counselors.

Why Now?
The need for a conceptual framework with practical guidance for pediatric
psychopharmacology is critical. The National Survey of Children’s Health
(2016-2017) provides estimates of specific diagnoses based on parental
reports that their child (ages 3–17 years) had received a formal diagnosis
of a mental disorder. According to this survey, 9.4% of children in the
United States (about 6.1 million) had received a diagnosis of attention-
deficit/hyperactivity disorder (ADHD), 7.1% of children (4.4 million) had
been diagnosed with anxiety, and 3.2% of children (1.9 million) had received
a diagnosis of depression. These data show that these 3 common mental
health disorders account for a large proportion of affected youth.1
A persistent critical shortage of mental health specialists limits the ability of
these youth to access care for their mental health needs. Most children with
common disorders do not receive a mental health evaluation, and many do
not receive treatment. In 2016–2017, only about 60% of youth with ADHD
were treated with medication. Similarly, only about 60% of youth with an

00b_Psychopharmacology_FM_3ed.indd 15 7/29/21 8:32 AM