Developing rational protocols for paediatric psychopharmacological prescribing

The number of child psychiatrists, paediatricians and general practitioners prescribing psychotropic medication for children in the UK is increasing. Medication is being used not just to treat children of normal intelligence with hyperkinetic disorder or depression, but also to modify behavioural pr oblems in children with developmental disorders and severe learning difficu lties. Literature reviews highlight the lack of robust randomized controlle d drug trials on which to base clinical practice and the authors have found no appropriate existing protocols to help develop a systematized approach. Against such a background the authors have developed a comprehensive set of protocols covering prescribing details for individual drugs, and also addr essing issues such as informed consent, long-term monitoring and school lia ison. All children referred to the authors' clinics go through a standardiz ed decision-making process. This article describes both the protocols thems elves and the philosophies that guided their development. The authors descr ibe how such a system benefits the children, their families, general practi tioners and schools, whilst also facilitating audit and research.