John S. Werry
THE USE of psychopharmacotherapy in children dates from the introduction of the stimulants by Charles Bradley in 1937. However, the early years were quiet until newer psychotropic drugs developed in the 1950s gave a new though rather slow impetus to the field. But it was not until the 1970s that pediatric psychopharmacology finally emerged as a fully fledged therapeutic modality and research endeavor in child psychiatry. As with adults, much of the early work was hampered by the lack of double‐ blind and other controls, by diagnostic vagueness and heterogeneity reflected in such terms as "emotionally disturbed" or "behavior disorders," and by the absence of reliable, valid, and quantitative measures of analysis. 41,68 However, there has been conspicuous improvement in the field during the last ten years. 19
Unlike adult psychiatry, which both discovered and initially tested most of the psychotropic drugs currently used in children, pediatric psychopharmacology is still very much an empirical clinical exercise, lacking the attractive theoretical rationale for employing the antipsychotics or the antidepressants that are used in adult psychiatry. This is mostly because the uses to which these drugs are put in children are quite different from those in adults, and also because there is a serious shortage of trained investigators in pediatric psychopharmacology, particularly those with a biomedical background. As with adult psychiatry, there have been no substantive additions to the types of drugs used in children since 1960, partly because of the lack of basic research.
The rise of pediatric psychopharmacology has been accompanied by considerable public interest and concern, which is reflected in congressional and public enquiries, in legislation, and increasingly in advocacy litigation. 62 While much of the criticism has been ill-informed and is part of a sophisticated