Ethical considerations in psychopharmacological research involving children and adolescents

Rationale. Increased community utilization of psychotropic medications among children has brought attention to pediatric psychopharmacology research and associated ethical issues. Objectives. To discuss ethical aspects of child participation in psychopharmacology protocols. Methods. Selective review of relevant scientific and regulatory literature. Results. Efficacy and safety of psychotropics in children cannot be entirely inferred from adult data and direct participation of children in research is necessary. Child research must follow special regulations that are in addition to those common to all human research. For research with prospect of direct benefit, a critical factor is whether the risk/benefit ratio is favorable to the participating child. For research without such a prospect, the concepts of minimal risk and minor increase over minimal risk apply. However, the interpretation and application of these principles to specific protocols vary across settings and among ethics committees. Thus far, little empirical investigation has been conducted on children and parents' motivation for research participation, effectiveness of the informed consent and assent procedures, possibility of persistent consequences of exposure to experimental treatments and placebo, and validation of the concepts of minimal risk and minor increase over minimal risk.<LF>Conclusions. Research on human subject issues relevant to child participation is a promising approach to improving ethical methods and procedures of pediatric psychopharmacology.