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Alternative National Guidelines for Treating Attention and Depression Problems in Children: Comparison of Treatment Approaches and Prescribing Rates in the United Kingdom and United States

Murphy, J. Michael EdD; McCarthy, Alyssa E. BA; Baer, Lee PhD; Zima, Bonnie T. MD, MPH; Jellinek, Michael S. MD

doi: 10.1097/HRP.0000000000000026

The use of psychotropic medications for children and adolescents with attention and depression problems continues to generate both attention in the news media and controversy within the field. Given that the United Kingdom has recently issued guidelines for its national health service that differ substantially from those in the United States, the time is ripe to reexamine the evidence. The purpose of this article is to describe the UK’s new “stepped care” guidelines for treating attention and depression problems in children and to compare them to the US guidelines issued by the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry. Our findings are that, despite many similarities, the UK guidelines are generally more conservative in their recommendations for medication use, especially for children experiencing only moderate impairment. Our article also compares prescription and diagnosis rates in the UK and the US, and reports evidence for lower rates of prescribing in the UK, despite some evidence that the rates of problems may not differ substantially. We conclude by noting that the existence of an alternative standard provides validation for clinicians or families who prefer to take a more conservative approach to medication use. The two different approaches to care also provide a valuable opportunity for research to determine whether the approaches result in different treatment outcomes.

From the Departments of Psychiatry (Drs. Murphy, Baer, and Jellinek) and Pediatrics (Dr. Jellinek), Harvard Medical School; Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Drs. Murphy, Baer, and Jellinek, and Ms. McCarthy); Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles (Dr. Zima).

Original manuscript received 19 July 2013, accepted for publication subject to revision 28 October 2013; revised manuscript received 20 November 2013.

Supported, in part, by a grant from the Foundation for Excellence in Mental Health Care (Drs. Murphy and Baer, and Ms. McCarthy).

Correspondence: Michael Murphy, EdD, Massachusetts General Hospital, Child Psychiatry Service, Yawkey 6a, Boston, MA 02114. Email:

© 2014 President and Fellows of Harvard College
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