Psychopharmacology of Neurodevelopmental Disorders in Children

Abstract

Recent advances in genetics and psychopharmacology have begun to illuminate the key players that contribute to neurodevelopmental disorders in children such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), Tourette’s syndrome (TS) and rare diseases such as Rett syndrome (RTT). Clinical guidelines and data from clinical trials mainly focus on management of single disorders whilst most patients present with multiple, chronic, co-occurring developmental disorders. Neurodevelopmental disorders often present with a myriad of neuropsychiatric, emotional and behavioural problems and have neurochemical and neuro-circuitry problems underpinning this. Evidence from meta-analyses have indicated the efficacy of different treatments and some studies show benefit in improving co-occurring symptoms in children with ADHD, ASD or TS. It is increasingly being recognized that emotional, behavioural and autonomic dysregulation (EBAD) is central to difficult presentations in children and adolescents with rare diseases, and those with multiple co-occurring disorders. An incremental treatment approach should be adopted starting with non-pharmaceutical intervention followed by implementation of drug treatments. When drug treatments are used, a multimodal treatment strategy to neurodevelopmental disorders in children should be used in order to provide flexible medication regimens where one is able to select and adjust medication that achieves maximum benefit with the least possible side effects so that treatment can be personalized. Cross-lifespan approaches and web-based clinical and research medication-monitoring systems, such as the HealthTracker™, an e-health web-based platform, can assist in the triaging and management of cases across specialist and community clinics. Pharmacological management of neurodevelopmental disorders can present with challenges in Asia, where many of the commonly used medications such as stimulants are more difficult to access. Recent advances in the treatment of ADHD, ASD and TS in children are presented and when applicable discussed in line with experiences from Asia. Innovative strategies working with children and families such as the effective dosing with minimum side effects (EDMS) strategy, and the use of wearable sensor technology to assist in the management of a patient with RTT are described.