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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia

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This Practice Parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Early-onset schizophrenia is diagnosed using the same criteria as in adults and appears to be continuous with the adult form of the disorder. Clinical standards suggest that effective treatment includes antipsychotic medications combined with psychoeducational, psychotherapeutic, and educational interventions. Since this Practice Parameter was last published in 2001, several controlled trials of atypical antipsychotic agents for early-onset schizophrenia have been conducted. However, studies suggest that many youth with early-onset schizophrenia do not respond adequately to available agents and are vulnerable to adverse events, particularly metabolic side effects. Further research is needed to develop more effective and safer treatments.

Key Words

schizophrenia
psychosis

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This Practice Parameter was developed by Jon McClellan, M.D., Saundra Stock, M.D., and the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI): Heather J. Walter, M.D., M.P.H., and Oscar G. Bukstein, M.D, M.P.H., Co-Chairs; and Christopher Bellonci, M.D., R. Scott Benson, M.D., Allan Chrisman, M.D., Tiffany R. Farchione, M.D., John Hamilton, M.D., Helene Keable, M.D., Joan Kinlan, M.D., Nicole Quiterio, M.D., Ulrich Schoettle, M.D., Matthew Siegel, M.D., and Saundra Stock, M.D.

AACAP Practice Parameters are developed by the AACAP CQI in accordance with American Medical Association policy. Parameter development is an iterative process among the primary author(s), the CQI, topic experts, and representatives from multiple constituent groups, including AACAP membership, relevant AACAP committees, the AACAP Assembly of Regional Organizations, and the AACAP Council. Details of Parameter development process can be accessed on the AACAP website. Responsibility for Parameter content and review rests with the author(s), the CQI, the CQI Consensus Group, and the AACAP Council.

AACAP develops patient-oriented and clinician-oriented Practice Parameters. Patient-oriented Parameters provide recommendations to guide clinicians toward best assessment and treatment practices. Recommendations are based on critical appraisal of the empirical evidence (when available) and clinical consensus (when not) and are graded according to the strength of the empirical and clinical support. Clinician-oriented Parameters provide clinicians with the information (stated as principles) needed to develop practice-based skills. Although empirical evidence may be available to support certain principles, principles are based primarily on clinical consensus. This Parameter is a patient-oriented Parameter.

The primary intended audience for AACAP Practice Parameters is child and adolescent psychiatrists; however, the information contained therein may be useful for other mental health clinicians.

The authors acknowledge the following experts for their contributions to this Parameter: Nitin Gogtay, M.D., Robert Findling, M.D., and Benedetto Vitiello, M.D.

Jennifer Medicus served as the AACAP staff liaison for the CQI.

This Practice Parameter was reviewed at the Member Forum at the AACAP Annual Meeting in October 2009.

From December 2011 to June 2012, this Parameter was reviewed by a consensus group convened by the CQI. Consensus group members and their constituent groups were Heather J. Walter, M.D., M.P.H., chair, John Hamilton, M.D., and Matthew Siegel, M.D. (CQI); Nitin Gogtay, M.D. (Topic Expert); Melissa DelBello, M.D. (AACAP Committee on Research); George Realmuto, M.D., and Nilda Gonzalez, M.D. (AACAP Assembly of Regional Organizations); and Mark S. Borer, M.D., and Steven N. Adelsheim, M.D. (AACAP Council).

This Practice Parameter was approved by the AACAP Council on November 20, 2012.

This Practice Parameter supersedes the Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia, published in the Journal of the American Academy of Child and Adolescent Psychiatry, 2001;40(suppl):4S-23S.1

This Practice Parameter is available on the Internet (http://www.aacap.org).

Disclosures: Dr. McClellan receives or has received research support from the National Institute of Health. Dr. Stock has received research funding from Forest, Merck/Schering-Plough, Supernus Pharmaceuticals, Inc., Bristol-Myers Squibb, AstraZeneca LP, and Boehringer-Ingelheim. Dr. Bukstein receives research support from Shire, has served as a consultant with PRIME Continuing Medical Education and EZRA Innovations, and has intellectual property with Routledge Press. Dr. Walter has no financial relationships to disclose. Disclosures of potential conflicts of interest for all other individuals named above are provided on the AACAP website on the Practice Parameters page.

Correspondence to the AACAP Communications Department, 3615 Wisconsin Avenue, N.W., Washington, D.C., 20016.