The second edition of Pediatric Psychopharmacology: Principles and Practice is an ambitious textbook that covers much broader territory than its title suggests. Not only is it a comprehensive source of information on the current state of knowledge in pediatric psychopharmacology, but it also addresses many related topics such as genetics, brain structure and function, the neurobiology of the major childhood psychiatric disorders, the general assessment of these disorders, nonpharmacological treatment modalities, and clinical trials methodology and design.
Two of the editors remain from the first edition, and little has changed in the book’s overall structure. It is still divided into the same four Sections: I. Biological Bases of Pediatric Psychopharmacology; II. Somatic Interventions; III. Assessment and Treatment; and IV. Epidemiological, Research, and Methodological Considerations. Almost all the chapter titles remain virtually unchanged as well. This is not necessarily a bad thing, as the first edition was already a thorough and well organized reference. Nonetheless, it highlights that the second edition mainly updates the information in the first, rather than providing a dramatically new perspective on the field. Particular attention is given to landmark treatment studies (e.g., the MTA, PATS, TADS, TORDIA, POTS, CAMS, and TEOSS trials), many of which were published since the book’s first edition. Current controversies are also addressed, such as concerns about suicidality with SSRIs and the risk of sudden death with ADHD medications. Chapter 53, entitled “Conflict of Interest,” is one of the second edition’s few new chapters, and the editors and chapter authors are to be commended for explicitly addressing this important issue in a thoughtful manner. Moreover, disclosures of financial interests are now provided for all authors at the end of the book.
Both the first and second editions of Pediatric Psychopharmacology are dedicated to the late Donald J. Cohen, MD, a pioneer and leader in child psychiatry. In the preface to the first edition (reproduced in the second), the editors assert that “Donald’s vision was woven into the fabric of the entire volume…much as he would, we advocate for thoughtfulness and restraint in the prescription of psychotropic drugs, for the judicious use of diagnostic labels, and for the conceptualization of childhood psychiatric disorders within a developmental framework” (page xiv). These are critically important attitudes for all clinicians who prescribe psychotropic medication to children, and the editors’ deliberate effort to impart them to readers is one of the book’s major strengths. The jewel of Pediatric Psychopharmacology in this regard is the exceptional Chapter 30 (“Thinking About Prescribing: The Psychology of Psychopharmacology”), where the authors remind us of Blackwell’s admonition that “too often a prescription signals the end of an interview rather than the start of an alliance” (page 423), and ask us to consider whether medication “will mean treat or treatment to my patient” (page 425).
It is challenging to weave Dr. Cohen’s sophisticated vision through an edited volume that contains over 50 chapters written by over 100 authors, and there are many passages where it is not so apparent. Indeed, I often found myself wishing for the judicious approach to diagnosis and restrained attitude to treatment that the editors promised. For example, in Chapter 33 (“Assessment and Treatment of Childhood and Adolescent Bipolar Disorder”), the authors describe straightforwardly, without a note of skepticism or concern, the data regarding the use of lithium, anticonvulsants, and atypical antipsychotics in the treatment of pre-school bipolar disorder (page 473). Additional editorial involvement might have ensured that Dr. Cohen’s vision was more present throughout.
The editors could have also required more consistency in format and content and allowed less repetition of information. In Chapter 18 (“Stimulants”), for instance, the section on efficacy precedes the section on adverse effects, whereas in Chapter 20 (“Antidepressants I: Selective Serotonin Reuptake Inhibitors”) they are presented in reverse order. Greater standardization in format would make it easier for the reader to locate the desired information. Atomoxetine is missing from Section II, where the chapters focus on specific drugs, although relevant information is included in Chapter 31 (“Assessment and Treatment of Attention-Deficit Hyperactivity Disorder”). In Section III, several chapters provide useful tables summarizing pharmacotherapy trials for the disorder in question, but other chapters do not provide them. The editors’ decision to organize one set of chapters around medications (Section II) and another around disorders (Section III) has the benefit of offering different perspectives on pharmacological treatment; however, the information in the two places can be redundant instead of providing additional depth of understanding.
Despite these reservations, the second edition of Pediatric Psychopharmacology provides a comprehensive review and update of the evidence base in this complex and rapidly growing field. It also strives to discuss the role of psychopharmacology within a developmental and biopsychosocial context, while highlighting the value of nonpharmacological interventions. To my knowledge, no other textbook matches it on either count.
