From the Editor-in-Chief's Desk

This issue of the journal contains many significant articles, including an encouraging update on the medium-term effects of interventions described in the Treatment of Severe Childhood Aggression (TOSCA) study (Findling et al.), a welcome investigation of antipsychotic polypharmacy in the treatment of behavioral symptoms in autism (Wink et al.), and a survey of caregiver opinions of electroconvulsive therapy for schizophrenia spectrum disorders (Flamarique et al.).

As always, these and other articles in these pages provide a sound research base for medical interventions for child and adolescent psychopathology. As we all know, however, even the best evidence-supported treatments often fail to live up to their potential when faced with real-world variables: treatment adherence, care coordination, and patient motivation. For this reason, I am pleased that in this issue we also present a literature review on common factors in pediatric psychiatry that makes beneficial reading for treating clinicians, public policy professionals, and study designers.

De Nadai et al. describe a system ripe for change that would “benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers” if we can implement existing or modified protocols aimed at improving “common factors” such as medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. The authors provide what amounts to an annotated bibliography of research into the role of common factors in treatment success. They also ask a persuasive question: In treating behavioral health disorders with pharmacological interventions, have we minimized the impact and interaction of behavioral processes?

De Nadai et al. may follow the contours of older arguments skeptical of the primacy of psychotropic medication, but with an appreciation of best outcomes and the literature to support revising clinical approaches. “Current models of pediatric psychopharmacology posit medications as the impetus for clinical improvement, and other factors are frequently seen as auxiliary issues,” the authors write. “Instead, common factors may be core mechanisms of symptom relief, as they provide necessary conditions for successful pharmacotherapy, work in tandem with medication to improve clinical outcomes, and also have independent therapeutic benefits.”

I urge you to study this and other enlightening articles in this issue and to continue asking new questions about how to better serve our unique patient population.