Is the Right Research Being Done to Guide the Development of the American Academy of Child and Adolescent Psychiatry's Practice Parameters?

The American Academy of Child and Adolescent Psychiatry (AACAP) developed Practice Parameters (PPs) to provide recommendations regarding the assessment and treatment of children and adolescents with mental health disorders. Each recommendation comes with a rating, based on the level of evidence. In descending order, recommendations are rated as a clinical standard (CS), clinical guideline, or clinical option (CO), as well as recommendations that are “not endorsed” due to ineffectiveness or contraindication. According to the PPs, a recommendation is rated as a CS if it is supported by “rigorous empirical evidence and/or overwhelming clinical consensus,” whereas, the lower quality recommendations, rated as COs, are founded on “emerging empirical evidence (e.g. uncontrolled trials or case series/reports) or clinical opinion, but lack strong evidence and/or strong clinical consensus.” Based on the current definition, clinicians may be perpetuating practices that are based on as little as expert opinion. We are aware that AACAP is in the process of transitioning from PPs to Clinical Practice Guidelines (CPGs), which will embody a systematic approach to reconcile recommendations with national guidelines. In accordance with these higher standards, we believe that our evaluation of the research gaps will elucidate the need to encourage resource allocation in deficient areas.