Child Parameters

I noted with interest your coverage of the updated practice parameters of the American Academy of Child and Adolescent Psychiatry. It is true that long before the value of practice parameters was widely recognized, the academy was forging ahead with the adoption of parameters on attention deficit/hyperactivity disorder (1991), conduct disorder (1992), and anxiety disorders (1993). While I refer readers to the 1997 Supplement to the Journal of the American Academy of Child and Adolescent Psychiatry for a full accounting of the history of the development of the parameters, I would like to call attention to one aspect of academy policy that is somewhat different from APA’s approach.

Early in the development of the parameters, the academy wrestled with the following question: Should the academy refrain from making recommendations on assessment and treatment until research was scrutinized and replicated? Or should the academy acknowledge that, in the absence of a healthy database, assessment and treatment decisions are made every day by physicians?

The academy, wisely, I believe, chose to act on the realities of the current state of research in child and adolescent psychiatry and opted for the latter.

While the situation has improved through the efforts of dedicated researchers in child and adolescent psychiatry, the academy’s approach to its task has been threefold:

1. to incorporate all available research that was deemed valid and, where research exists but is flawed, to state so clearly in the parameters;



2. to extrapolate, with careful and cautious analysis, from available scientific evidence on adults with psychiatric disorders; and



3. in the absence of any scientific data, to summarize and identify by consensus the best practices of outstanding psychiatrists in the areas covered in the parameters.



Finally, I ask your correction of the following information from the article. The academy’s parameters are available as a set in the 1997 supplement (ordering information: Williams and Wilkins Journal Customer Service, [800] 638-6423). Reprints of individual parameters are available from the academy’s Communications Office by calling (800) 333-7636. Academy members may download the approved parameters in draft form free of charge from the academy’s Web site at http://www.aacap.org.

Lawrence A. Stone, M.D.
President
American Academy of Child and Adolescent Psychiatry