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information. This book aims to do this for practitioners, professionals in health, welfare, and education, and interested laypersons, including parents. This is no easy task, since the levels of technical knowledge vary from that of the special education teacher seeking information about the drugs that many such pupils will be receiving, to that of the modern young child and adolescent psychiatrist whose grasp of the difficult fields of pharmacokinetics (how drugs are absorbed, distributed, and eliminated) and neurotransmitter physiology (via which most psychoactive drugs work) is daunting to the editors, who grew up in the bucolic clinical-empirical era. Inevitably there are sections of the book that will prove too technical for any except the medically qualified, but considerable effort has been applied to make much of the text, especially that discussing the clinical uses and side effects of the drugs, comprehensible to anyone used to getting information by reading. We also take comfort in the fact that many of the major contributions in pediatric psychophar­ macology have been made by nonmedical professionals, notably psychologists, suggesting that an audience beyond the medically qualified is practicable. One other problem confronted us-whether to organize the book by psycho­ pathological symptoms (e.g., hyperactivity) and disorders (e.g., autism) or by drugs.

information. This book aims to do this for practitioners, professionals in health, welfare, and education, and interested laypersons, including parents. This is no easy task, since the levels of technical knowledge vary from that of the special education teacher seeking information about the drugs that many such pupils will be receiving, to that of the modern young child and adolescent psychiatrist whose grasp of the difficult fields of pharmacokinetics (how drugs are absorbed, distributed, and eliminated) and neurotransmitter physiology (via which most psychoactive drugs work) is daunting to the editors, who grew up in the bucolic clinical-empirical era. Inevitably there are sections of the book that will prove too technical for any except the medically qualified, but considerable effort has been applied to make much of the text, especially that discussing the clinical uses and side effects of the drugs, comprehensible to anyone used to getting information by reading. We also take comfort in the fact that many of the major contributions in pediatric psychophar­ macology have been made by nonmedical professionals, notably psychologists, suggesting that an audience beyond the medically qualified is practicable. One other problem confronted us-whether to organize the book by psycho­ pathological symptoms (e.g., hyperactivity) and disorders (e.g., autism) or by drugs.

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I. General Principles.- 1.Introduction: A Guide for Practitioners, Professionals, and Public.- I. Introduction.- A. Preamble.- B. Definitions.- C. The Multidisciplinary Team.- D. Child Psychiatry and Behavioral Pediatrics.- II. Historical Overview.- A. Foundations.- B. Current Trends and Future Directions.- III. Classification of Psychoactive Drugs.- A. Names of Drugs.- B. Look-Alike Drugs.- IV. Drug Evaluation.- V. Determinants of Prescribing.- A. Medical Knowledge.- B. Patient and Parent Factors.- C. Physician Factors.- D. Social Factors.- E. Economic Factors.- F. The Powerful Placebo.- VI. Principles of Drug Use.- A. First Do No Harm (Prima Non Nocere).- B. Know the Disorder and Use Drugs When Indicated.- C. Choose the Best Drug.- D. Understand the Drug and Its Properties.- E. Minimize Drug Use and Dosage.- F. Keep Things Simple.- G. Avoid Polypharmacy.- H. Don't Be a Fiddler.- I. Don't Follow Fads.- J. Take Particular Care with Children.- K. Establish a Therapeutic Alliance.- VII. Conclusion.- References.- 2. Pharmacology.- I. Introduction.- II. Fate of Drugs in the Body.- A. Passage of Drugs across Biological Membranes.- B. Routes of Drug Administration.- C. Distribution.- D. Elimination.- 1 Excretion.- 2 Biotransformation.- 3 Variability in Human Drug Biotransformation.- III. Pharmacokinetics.- A. Apparent Volume of Distribution.- 1 One-Compartment Model.- 2 Two-Compartment Model.- B. Elimination and Clearance.- 1 Flow-Limited Clearance.- 2 Capacity-Limited Clearance.- 3 Dosage, Clearance, and Half-Life.- C. Multiple Dosing and Steady-State Drug Concentrations.- D. Saturation Kinetics.- IV. Time Course of Pharmacological Effect.- A. Nonlinear Concentration-Response Curve.- B. Slow Equilibration with Site of Drug Action.- C. Presence of Active Metabolites.- D. Indirect or Slow Biochemical Response.- V. Pediatric Variations in Pharmacokinetics.- A. Absorption.- B. Distribution.- C. Biotransformation and Excretion.- D. Response.- VI. Mechanisms of Drug Action (Pharmacodynamics).- A. Enzymes.- B. Voltage-Gated Ion Channels.- C. Reuptake Mechanisms.- D. Receptors.- 1 Dose-Response Curve.- 2 Receptor Number and Distribution.- 3 Receptor Subtypes.- 4 Modeling of Drug-Receptor Interactions.- E. Mechanisms of Receptor Action.- 1 Ligand-Gated Ion Channels.- 2 G-Protein-Linked Receptors.- 3 Second and Third Messengers.- F. Speed of Response of Receptors.- G. Summary of Mechanisms of Receptor Activation.- References.- 3. Prevalence of Drug Therapy.- I. Introduction.- A. Research Objectives.- B. Scope of the Review.- II. Hyperactivity (Attention-Deficit Hyperactivity Disorder).- A. Early Studies.- B. Recent Surveys.- C. Special Education.- D. Socioeconomic Status.- E. Treatment Practices.- F. National Estimates of Treatment Prevalence.- III. Mental Retardation.- A. Institutional Settings.- B. Community-Based Facilities.- C. Public Schools.- D. National Estimates of Treatment Prevalence.- IV. Seizure Disorders.- A. Autism.- B. Mental Retardation.- C. Preschool-Aged Children.- V. Autism.- VI. Depression.- VII. Enuresis.- VIII. Tourette Syndrome.- IX. Other Disorders.- X. Summary.- References.- 4. Monitoring and Measuring Drug Effects. I. Physical Effects.- I. Introduction.- II. Baseline Physical Assessment.- A. Past Medical History.- B. Immunizations.- C. Hospitalizations.- D. Trauma.- E. Transfusions.- F. Current Medications.- G. Allergies.- H. Substance Use History.- I. Social History.- J. Family Medical History.- K. Family Psychiatric History.- III. Medical Review of Organ Systems.- A. General Health.- B. Eyes, Ears, Nose, and Throat.- C. Respiratory.- D. Cardiovascular.- E. Gastrointestinal.- E. Urinary Tract.- G. Genital and Reproductive Systems.- H. Musculoskeletal System.- I. Integument (Skin).- J. Endocrine System.- K. Central Nervous System.- IV. Psychiatric Review.- V. Physical and Neurological Exam.- VI. Baseline Biochemical Assessment of Blood and Urine.- VII. Speech and Language Assessment.- VIII. Monitoring Side Effec

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