The Art and Science of Prescribing: Different Perspectives in Child and Adolescent Psychiatry

Abstract

This understanding of the patient should provide treatment guidance and monitoring and with flexibility to adapt to change. Treatment, based on this information, should be comprehensive enough to adequately address relevant factors but reasonable enough to be implemented and maintained. Learning to practice as a child and adolescent psychiatrist (CAP) is intrinsically challenging because one needs to become skilled at learning about and managing multiple factors and individuals (AACAP, 2009; Carandang, Kratochvil, Scahill, & Martin, 2011; Pruett, Joshi, & Martin, 2011; Vitiello, 2013). Effectively prescribing psychotropic medications is an integral part of care. Even the treatment of “simple” psychiatric disorders generally requires multiple, nuanced decisions, often not clearly answered by the literature or textbooks. CAPs must know and understand the basics of psychopharmacology as well as develop the proficiency to use individual and disease characteristics to guide medication, dosing and scheduling choices. And, practitioners must acquire the skills to update their knowledge and skills on an ongoing basis (Salzman, 2005; Zisook et al., 2008). This article discusses the challenges of learning to effectively prescribe psychotropic medications to psychiatrically ill children and adolescents using the example of the treatment of Attention Deficit Hyperactivity Disorder (ADHD) from the perspectives of a fellowship program director, faculty member and CAP fellows.