Pediatric Psychopharmacology Research at a Crossroads

At a time when pediatric psychopharmacology is receiving more media attention than ever before, the field is at a crossroads and the future is unclear, said Judith L. Rapport, MD, who delivered the Joseph Noshpitz Memorial History Lecture Wednesday, Oct. 27, at the AACAP 57th Annual Meeting in New York, NY.

Rapoport, one of the most influential leaders in the field of child psychiatry, discussed the history of pediatric psychotherapy—a field that is still relatively young—and where research stands now. Rapoport currently serves as chief of the Child Psychiatry Branch, National Institute of Mental Health, in Bethesda, MD, where she has helped author several clinical protocols focusing on biomarkers and treatment for childhood onset psychotic disorders.

Although she has served as author or co-author on more than 350 clinical studies, Rapoport is perhaps best known for the book, “The Boy Who Couldn’t Stop Washing—the Experience and Treatment of Obsessive Compulsive Disorder,” which helped raise awareness about OCD among the public, and helped increase clinicians’ understanding of a complication condition.

In 1978, she led a groundbreaking study examining the cognitive and behavioral effects of dextroamphetamine on both healthy and hyperactive prepubertal boys. The research, which was published in Science, showed that both groups showed a marked decrease in motor activity and reaction time, and improvements in cognitive tests.

These results, said Rapoport, opened the doors for further research of stimulants, leading investigators to wonder what other agents could produce similar effects, and what facets of different syndromes would respond. A large number of clinicians became fascinated with stimulants and began conducting cross-over experiments; a few years later, a double-blind, placebo-controlled trial examined the efficacy of clomipramine in childhood OCD.

“Research was thriving,” she said, when recalling the period starting in the late 1970s that kicked over several decades of intense investigation in the field of pediatric psychopharmacology. “We were like kids in a candy store.”

In recent years, however, research has halted dramatically, said Rapoport, and the pipeline for future treatments is thin. “Most of the drugs used today are ones for which the mechanism was known in the 1950s. We’re not seeing new targets like those in the field of cardiology.” While she can’t pinpoint the exact cause, whether a lack of understanding of the human brain or pressure from the media are to blame, Rapoport does believe that it is critical that research forges ahead to help facilitate earlier screening and treatment of children with mental health disorders.

“We’ve seen the excitement over the discovery of new medications replaced by an increase in concern over the use of medications,” she noted, adding that she believes there is a dire need for newer, more effective antipsychotic medications for the pediatric population.

To access Rapoport’s most recent study, published online ahead of print in the International Journal for Development Neuroscience, click here.