NRNP 6665 PRESCRIBING FOR CHILDREN AND ADOLESCENTS ESSAY

Prescribing for Children and Adolescents

Pediatric Generalized Anxiety Disorder (GAD) manifests with a child or adolescent exhibiting a lot of worry and fear that has no real cause. The child with GAD may worry about things such as future events or family matters and may not realize their worry is severe. The purpose of this paper is to describe an FDA-approved and off-label drug and non-pharmacological measure used to treat pediatric GAD.

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FDA-Approved Drug, Off-Label Drug, and Non-Pharmacological Intervention

Selective serotonin reuptake inhibitors (SSRIs) are the medications of choice for treating GAD in children and adolescents. Fluoxetine is an FDA-approved SSRI for pediatric GAD. Its benefits include having a less prominent adverse effect profile, a long half-life, and a better compliance rate (Patel et al., 2018). However, it is associated with an increased risk of suicidal thinking and behavior in children and adolescents.

Buspirone is used off-label to treat pediatric GAD. It has an anxiolytic effect and has demonstrated superior effectiveness compared with a placebo. It has not been established as a first-line medication for GAD in pediatrics because of a 1-3 week delay in symptom relief, no effect on comorbid depression, and having a relatively short half-life requiring 2-3 times dosing per day (Strawn et al., 2018).

Cognitive behavior therapy (CBT) is a widely used psychotherapy treatment for pediatric GAD. It has been found to decrease GAD symptomatology and is as effective as medication but with less attrition and more durable effects. CBT in pediatric GAD usually includes client self-monitoring of worrying or related symptoms and cognitive restructuring, including assessing and reviewing interpretive and predictive thoughts or worries (Patel et al., 2019).

Risk Assessment to Use to Inform Treatment Decision Making

The risk assessment that will inform treatment decisions will include a drug’s associated efficacy in improving GAD symptomatology and associated side effects. For instance, Buspirone is well tolerated with mild adverse effects like dizziness, blurred vision, and nausea. However, it takes up to 2-3 weeks to attain full efficacy making it less ideal. On the other hand, Buspirone has a long-established efficacy in children with GAD and a good profile, making it ideal for pediatrics.

Clinical Practice Guidelines

The clinical practice guidelines indicate that CBT and SSRIs are safe and effective short-term treatments for anxiety in children and adolescents. Serotonin-norepinephrine reuptake inhibitor (SNRI) has some empirical evidence as an additional treatment option. Thus, the guidelines support prescribing an SSRI like Fluoxetine for pediatric GAD. They also support using CBT as psychotherapy for children and adolescents with anxiety.

Conclusion

Fluoxetine is an SSRI that is FDA-approved to treat GAD in pediatric populations. Its efficacy has been established, and it has a good safety profile. Buspirone is used off-label, but it takes 2-3 weeks to attain full efficacy, which limits its use. CBT is the most preferred psychotherapy treatment for pediatric GAD and is used as first-line therapy.

References

Patel, D. R., Feucht, C., Brown, K., & Ramsay, J. (2018). Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Translational pediatrics, 7(1), 23. doi: 10.21037/tp.2017.08.05

Perrin, S., Bevan, D., Payne, S., & Bolton, D. (2019). GAD-specific cognitive behavioral treatment for children and adolescents: A pilot randomized controlled trial. Cognitive Therapy and Research, pp. 43, 1051–1064. https://doi.org/10.1007/s10608-019-10020-3

Strawn, J. R., Mills, J. A., Cornwall, G. J., Mossman, S. A., Varney, S. T., Keeshin, B. R., & Croarkin, P. E. (2018). Buspirone in Children and Adolescents with Anxiety: A Review and Bayesian Analysis of Abandoned Randomized Controlled Trials. Journal of Child and Adolescent Psychopharmacology, 28(1), 2–9. doi:10.1089/cap.2017.0060

Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020). Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry. doi:10.1016/j.jaac.2020.05.005

• Your Instructor will assign a specific disorder for you to research for this Assignment.
• Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.

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THE ASSIGNMENT (1–2 PAGES)

• Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.

Please utilize your syllabus and/or Rubric so your assignment can be completed appropriately.

Assignment 1 requires me to assign a diagnosis for each student.  Here is the grouping.

Students with Last name first initial of I though S – Please complete your assignment on Generalized Anxiety