Copyright @ 2009 American Academy of Child and Adolescent Psychiatry. Unauthorized reproduction of this article is prohibited. Practice Parameter on the Use of Psychotropic Medication in Children and Adolescents ABSTRACT The purpose of this practice parameter is to promote the appropriate and safe use of psychotropic medications in children and adolescents with psychiatric disorders by emphasizing the best practice principles that underlie medication pre- scribing. The evidence base supporting the use of psychotropic medication for children and adolescents with psychiatric disorders has increased for the past 15 to 20 years, as has their use. It is hoped that clinicians who implement the principles outlined in this parameter will be more likely to use medications with the potential for pharmacological benefit in children safely and to reduce the use of ineffective and inappropriate medications or medication combinations. The best practice principles covered in this parameter include completing a psychiatric and medical evaluation, developing a treatment and monitoring plan, educating the patient and family regarding the child’s disorder and the treatment and monitoring plan, completing and documenting assent of the child and consent of the parent, conducting an adequate medication treatment trial, managing the patient who does not respond as expected, establishing procedures to implement before using medication combinations, and following principles for the discontinuation of medication. J. Am. Acad. Child Adolesc. Psychiatry, 2009;48(9):961Y973. Key Words: practice parameter, psychopharmacology, multiple medications, treatment. During the past 15 to 20 years, there has been a marked increase in our understanding of childhood psychiatric disorders and a developing evidence base for both psycho- pharmacological and psychosocial treatments. Children are commonly affected by psychiatric disorders, and without treatment, they can experience short- and long-term distress Accepted April 23, 2009. This parameter was developed by John Walkup, M.D., principal author, and the Work Group on Quality Issues: William Bernet, M.D., Oscar Bukstein, M.D., M.P.H., and Heather Walter, M.D., M.P.H., Co-Chairs, and Valerie Arnold, M.D., R. Scott Benson, M.D., Joseph Beitchman, M.D., Allan Chrisman, M.D., Tiffany R. Farchione, M.D., John Hamilton, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Jon McClellan, M.D., Ulrich Schoettle, M.D., Jon Shaw, M.D., Matthew Siegel, M.D., and Saundra Stock, M.D. American Academy of Child and Adolescent Psychiatry (AACAP) Staff: Kristin Kroeger Ptakowski and Jennifer Medicus. AACAP practice parameters are developed by the AACAP Work Group on Quality Issues (WGQI) in accordance with American Medical Association policy. Parameter development is an iterative process between the primary author(s), the WGQI, topic experts, and representatives from multiple constituent groups, including the AACAP membership, relevant AACAP components, the AACAP Assembly of Regional Organizations, and the AACAP Council. Details of the parameter development process can be accessed on the AACAP Web site. Responsibility for parameter content and review rests with the author(s), the WGQI, the WGQI Consensus Group, and the AACAP Council. The AACAP develops both patient-oriented and clinician-oriented practice parameters. Patient-oriented parameters provide recommendations to guide clini- cians toward best treatment practices. Recommendations are based on empirical evidence (when available) and clinical consensus (when not) and are graded according to the strength of the empirical and clinical support. Clinician-oriented parameters provide clinicians with the information (stated as principles) needed to develop practice-based skills. Although empirical evidence may be available to support certain principles, principles are primarily based on expert opinion derived from clinical experience. This parameter is a clinician-oriented parameter. The primary intended audience for the AACAP practice parameters is child and adolescent psychiatrists; however, the information contained therein may also be useful for other mental health clinicians. The author acknowledges the following experts for their contributions to this parameter: Daniel S. Pine, M.D., Laurence L. Greenhill, M.D., Christopher Kratochvil, M.D., Aradhana Bela Sood, M.D., Mark Riddle, M.D., Timothy Wilens, M.D., and Charles H. Zeanah, Jr., M.D. This parameter was reviewed at the Member Forum at the AACAP Annual Meeting in October 2005. From September 2006 to December 2007, this parameter was reviewed by a Consensus Group convened by the WGQI. Consensus Group members and their constituent groups were as follows: WGQI (Oscar Bukstein, M.D., Chair, Allan Chrisman, M.D., and Saundra Stock, M.D., Members); Topic Experts (Daniel S. Pine, M.D., and Timothy Wilens, M.D.); AACAP Assembly of Regional Organizations (Susan Daily, M.D.); and AACAP Council (Aradhana Bela Sood, M.D., and Charles Zeanah, Jr., M.D.). Disclosures of potential conflicts of interest for authors and WGQI chairs are provided at the end of the parameter. Disclosures of potential conflicts of interest for all other individuals named above are provided on the AACAP Web site on the Practice Information page. This practice parameter was approved by the AACAP Council on March 18, 2009. This practice parameter is available on the Internet (www.aacap.org). Reprint requests to the AACAP Communications Department, 3615 Wisconsin Avenue, NW, Washington, DC 20016. 0890-8567/09/4809-0961Ó2009 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/CHI.0b013e3181ae0a08 AACAPOFFICIALACTION WWW.JAACAP.COM 961 J. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 48:9, SEPTEMBER 2009