Children and adolescents

In adults, the major indications for the use of antipsychotic medication are, for the most part, agreed. They may not in practice be universally applied, but at least on the written page it is possible to obtain some element of consensus on those categories of illness in which their use ought to be recommended.

The position in children and adolescents has been much more open and controversial. Concern has especially focused on the use of anti-psychotics as agents of non-specific behavioural control rather than as drugs active against specific disorders of the mental state. In recent years, however, a number of specific indications have been identified on the basis of clinical research and it is therefore the case that these compounds will continue to be used in the very young.

The literature on extrapyramidal side-effects of antipsychotics in children and adolescents is poor. Studies are few and often methodologically flawed, limiting the conclusions that can be drawn. There is an uncomfortable component of surmise in what is to follow.

However, it is important to acknowledge the problems that recognition of disorders of this type present for those involved in paediatric practice. Patients are less able to articulate, far less understand, symptomatology, which is more likely than in adults to show solely in behavioural terms. As a result, formal examination in children requires much greater levels of expertise and ingenuity than in adults, a particular issue for those whose background and inclination may be towards predominantly psychological mechanisms.