Adequacy of Children’s Psychopharmacology Services: Variations by Race and Clinical Characteristics
Abstract
Objective:
An expert consensus approach was used to determine the adequacy of children’s psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics.
Methods:
Data were from the baseline interview of 601 children, ages 6–12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child’s psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children’s psychotropic medication treatment.
Results:
Black children (compared with White children; OR=1.84, 95% CI=1.53–2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08–2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor’s degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61–0.89) were less likely to receive inadequate pharmacotherapy.
Conclusions:
The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.
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History
Received: 19 July 2022
Revision received: 21 February 2023
Accepted: 28 March 2023
Published online: 8 June 2023
Published in print: December 01, 2023
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Competing Interests
Dr. Young reports receiving research support from the Brain and Behavior Research Foundation, Supernus Pharmaceuticals, and PsychNostics, has served as a consultant to the Patient-Centered Outcomes Research Institute (PCORI), and served on the board of directors for Helping Give Away Psychological Science. Dr. Findling reports receiving research support, acted as a consultant, or has received honoraria from Abbvie, Acadia, Adamas, Aevi, Afecta, Akili, Alkermes, Allergan, American Academy of Child and Adolescent Psychiatry, American Psychiatric Association Press, Arbor, Axsome, Daiichi-Sankyo, Emelex, Gedeon Richter, Genentech, Idorsia, Intracellular Therapies, IQVIA, Kempharm, Luminopia, Lundbeck, MedAvante-ProPhase, Merck, MJH Life Sciences, Neurim, NIH, Novartis, Otsuka Pharmaceutical, PaxMedica, PCORI, Pfizer, Physicians Postgraduate Press, Q BioMed, Radius, Receptor Life Sciences, Roche, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Syneurx, Takeda, Teva, Tris, Validus, and Viatris. Dr. Youngstrom is the cofounder and executive director of Helping Give Away Psychological Science, has received royalties from Guilford Press and the American Psychological Association, and has consulted with Signant Health, Lundbeck, Janssen, and Western Psychological Services. Dr. Fristad reports receiving research funding from Janssen; royalties from American Psychiatric Association Publishing, Guilford Press, and J&K Seminars; and stipend and travel support from the Society of Clinical Child and Adolescent Psychology. Dr. Arnold reports receiving research funding from Supernus Pharmaceuticals, Roche/Genentech, Otsuka Pharmaceutical, Axial, Yamo, and Young Living Essential Oils; has consulted with Pfizer Pharmaceuticals and Children and Adults With Attention-Deficit/Hyperactivity Disorder; and has served on advisory boards for Otsuka Pharmaceutical and Roche/Genentech. Dr. Horwitz reports receiving royalties from American Psychiatric Association Publishing. The other authors report no financial relationships with commercial interests.
Funding Information
This research was supported by National Institute on Drug Abuse grant K23 DA-044288 and NIMH grants R01 MH-073967, R01 MH-073801, R01 MH-73953, and R01 MH-073816. Dr. Riehm was supported by a Ruth L. Kirschstein National Research Service Award (1F31 MH-124330-01) from NIMH, by a Doctoral Foreign Study Award from the Canadian Institutes of Health Research, and by grant 5T32 MH-013043-50 from the NIMH Psychiatric Epidemiology Training Program at Columbia University.The views in this article represent the opinions of the authors and not necessarily those of the NIH.
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