“My child hasn’t shown improvement since starting this medication overa month ago! Can we still expect itto work?” We’ve all been asked this difficult question, often by desperate parents—especially those of children taking antipsychotics. Now a recent study provides initial data to answer it.

To determine if early nonresponseto second generation antipsychoticswas predictive of “ultimate,” or long- term, non-response, data were collected from the SATIETY (Second-Generation Antipsychotic Treatment Indications, Effectiveness and Tolerability in Youth) cohort study. Subjects were selectedby chart review, and those includedin the analysis were ages four to 19and prescribed antipsychotics forthe diagnoses of psychotic spectrum disorder. Naturalistic treatment was pursued, with the outpatient clinician choosing a medication course as clinically indicated in these primarily antipsychotic- naïve subjects (77.2%).

Assessment was conducted withthe Children’s Global AssessmentScale (CGAS) and the Clinical Global Impression-Severity (CGI-S) at baseline, with the CGI-Improvement (CGI-I) added monthly in follow-up. Subjects were additionally monitored for side effects, particularly EPS, akathisia, and weight change. Treatment adherence was confirmed by monthly antipsychotic blood and plasma levels.

Seventy-nine children were included in the final analysis. Of note, Early Response (ER) was defined as scores of ≤3 (at least minimally improved), and Early Nonresponse (ENR) as ≥4 (worse or no change) on the CGI-I at four weeks. Ultimate Response (UR) (ie, long- term response) was defined by a score of 1 or 2 (much or very much improved), and Ultimate Nonresponse (ie, long- term nonresponse) was ≥3 (minimally improved or worse) on the GCI-I at eight to 12 weeks.