title: Alternative national guidelines for treating attention and depression problems in children: comparison of treatment approaches and prescribing rates in the United Kingdom and United States.
abstract: The use of psychotropic medications for children and adolescents with attention and depression problems continues to generate both attention in the news media and controversy within the field. Given that the United Kingdom has recently issued guidelines for its national health service that differ substantially from those in the United States, the time is ripe to reexamine the evidence. The purpose of this article is to describe the UK's new "stepped care" guidelines for treating attention and depression problems in children and to compare them to the US guidelines issued by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Our findings are that, despite many similarities, the UK guidelines are generally more conservative in their recommendations for medication use, especially for children experiencing only moderate impairment. Our article also compares prescription and diagnosis rates in the UK and the US, and reports evidence for lower rates of prescribing in the UK, despite some evidence that the rates of problems may not differ substantially. We conclude by noting that the existence of an alternative standard provides validation for clinicians or families who prefer to take a more conservative approach to medication use. The two different approaches to care also provide a valuable opportunity for research to determine whether the approaches result in different treatment outcomes.
authors.affiliation: From the Departments of Psychiatry (Drs. Murphy, Baer, and Jellinek) and Pediatrics (Dr. Jellinek), Harvard Medical School; Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Murphy, Baer, and Jellinek, and Ms. McCarthy); Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles (Dr. Zima).
authors.forename: J Michael
authors.initials: JM
authors.lastname: Murphy
authors.forename: Alyssa E
authors.initials: AE
authors.lastname: McCarthy
authors.forename: Lee
authors.initials: L
authors.lastname: Baer
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.forename: Michael S
authors.initials: MS
authors.lastname: Jellinek
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology