xiv Introduction ■■ Approximately 2,000 pediatric physician assistants3 ■■ Approximately 12,000 pediatric nurse practitioners4 ■■ Approximately 12,000 youth-dedicated family nurse practitioners5 The AAP6 recommends that primary care pediatricians achieve competence in initiating care for children and adolescents with ADHD, anxiety, depression, and substance use and abuse. This raises several important considerations. ■■ Pediatric residency training in psychiatric assessment and psychopharma- cology is limited, and requirements are minimal.7 ■■ Treatment of 3 of these conditions—ADHD, anxiety, and depression— may include medication. ■■ Many pediatric PCCs report having insufficient knowledge, skills, and training to prescribe psychotropic medications to youth with these conditions.8 ■■ The effectiveness of postgraduate pediatric psychopharmacology courses targeted to pediatric PCCs has not been well studied, and the courses can be difficult and costly to access. ■■ Child psychiatry consultation programs in many parts of the country (see Appendix B for the National Network of Child Psychiatry Access Programs) address these gaps by providing real-time clinical guidance to pediatric PCCs9 it is critical that consultants in these programs apply a framework that recognizes realities of the primary care setting. Because of limited time and resources for obtaining new knowledge and skills, pediatric PCCs, and those who train or consult with them, need an approach to pediatric psychopharmacology that is coherent, practical, and flexible to meet their needs. Basic Principles A few basic principles provide the foundation for all recommendations in this book. ■■ Evaluation and diagnosis of ADHD, common anxiety disorders, and depression in children and adolescents can be relatively simple and straightforward. ■■ Whenever possible, psychotropic medications should be prescribed concomitantly with, or following inadequate response to, evidence-based psychotherapies and evidence-informed pragmatic supports.
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