NRNP 6665 week 3 assignment 1 – Prescribing for Children and Adolescents
Prescribing For Children and Adolescents
Generalized anxiety disorder (GAD) in children and adolescents is characterized by persistent and excessive worry that interferes with daily functioning, academic performance, and social relationships. Youth with this disorder often experience irritability, sleep disturbance, muscle tension, fatigue, and difficulty concentrating. Early identification and treatment help reduce long-term psychological and developmental complications (Fagan & Baldwin, 2023). One Food and Drug Administration-approved medication for pediatric generalized anxiety disorder is duloxetine, a serotonin norepinephrine reuptake inhibitor approved for children and adolescents between seven and seventeen years of age. Duloxetine increases serotonin and norepinephrine activity within the central nervous system, which helps regulate mood and emotional responses. Duloxetine reduces anxiety severity and improves functioning in pediatric patients (Fagan & Baldwin, 2023). Benefits include decreased worry, improved emotional stability, and reduction of somatic anxiety symptoms. Risks include nausea, fatigue, decreased appetite, and the possibility of suicidal thoughts in adolescents, which requires careful monitoring by the PMHNP during treatment.
An additional pharmacological option for pediatric generalized anxiety disorder is buspirone, which is sometimes prescribed off-label in children and adolescents with anxiety symptoms. Buspirone works as a serotonin receptor partial agonist and reduces anxiety without producing sedation or dependence, which may occur with benzodiazepines. Buspirone decreases excessive worry and physical symptoms associated with anxiety disorders in youth (Wang et al., 2023). Benefits of buspirone include minimal risk for misuse and limited cognitive impairment compared with other anxiolytic medications. However, the medication may produce modest therapeutic effects and may require several weeks before symptom improvement becomes noticeable. Potential adverse effects include dizziness, nausea, and headaches. When prescribing buspirone, the PMHNP must evaluate symptom severity, previous treatment response, and medication tolerance in order to determine whether off-label pharmacotherapy is appropriate.
A recommended nonpharmacological intervention for pediatric generalized anxiety disorder is family-focused cognitive behavioral therapy. This intervention involves both the child and caregivers in therapy sessions and focuses on restructuring anxious thought patterns while strengthening coping strategies. Family involvement improves treatment adherence and allows caregivers to support behavioral techniques outside therapy sessions. Cognitive behavioral therapy often includes relaxation exercises, gradual exposure to feared situations, and problem-solving strategies designed to improve emotional regulation. Evidence shows that this therapeutic approach significantly decreases anxiety symptoms and improves functioning among children and adolescents with generalized anxiety disorder (Samar et al., 2023). Unlike medication therapy, cognitive behavioral therapy does not produce pharmacological side effects and helps children develop long-term coping skills that support emotional resilience during stressful situations encountered at school or in social environments.
Risk assessment is an important component of treatment planning for pediatric generalized anxiety disorder. The PMHNP should evaluate symptom duration, severity of anxiety, and the level of impairment in school, family, and peer relationships. Assessment should also include screening for suicidal ideation, trauma exposure, and comorbid psychiatric conditions such as depression or attention deficit hyperactivity disorder. Clinical practice guidelines for pediatric anxiety disorders recommend cognitive behavioral therapy as first-line treatment for mild anxiety symptoms and combination therapy with medication for moderate to severe cases (Viswanathan et al., 2022). These guidelines emphasize shared decision-making with families and continuous monitoring of medication effectiveness and adverse effects. A comprehensive evaluation allows the PMHNP to select evidence-based treatment strategies that improve emotional functioning and reduce anxiety symptoms in children and adolescents.
References
Fagan, H. A., & Baldwin, D. S. (2023). Pharmacological treatment of generalised anxiety disorder: current practice and future directions. Expert Review of Neurotherapeutics, 23(6), 535–548. https://doi.org/10.1080/14737175.2023.2211767
Samar, B. Ş., Akkuş, K., & Kütük, B. (2023). Effectiveness of cognitive–behavioral family therapy: A systematic review of randomized controlled Trials. Psikiyatride Güncel Yaklaşımlar, 15(1), 175–188. https://doi.org/10.18863/pgy.1115301
Viswanathan, M., Wallace, I. F., Cook Middleton, J., Kennedy, S. M., McKeeman, J., Hudson, K., … & Kahwati, L. (2022). Screening for anxiety in children and adolescents: Evidence report and systematic review for the US Preventive Services Task Force. Jama, 328(14), 1445-1455. https://doi.org/10.1001/jama.2022.16303
Wang, S., Li, Q., Lu, J., Ran, H., Che, Y., Fang, D., & Xiao, Y. (2023). Treatment rates for mental disorders among children and adolescents: A systematic review and meta-analysis. JAMA Network Open, 6(10), e2338174. https://doi.org/10.1001/jamanetworkopen.2023.38174
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nrnp 6665 week 3 assignment 1 – Prescribing for Children and Adolescents
Off-label prescribing is when a physician gives you a drug that the U.S. Food and Drug Administration (FDA) has approved to treat a condition different than your condition. This practice is legal and common. In fact, one in five prescriptions written today are for off-label use.
—Agency for Healthcare Research and Quality
Psychotropic drugs are commonly used for children and adolescents to treat mental health disorders, yet many of these drugs are not FDA approved for use in these populations. Thus, their use is considered “off-label,” and it is often up to the best judgment of the prescribing clinician. As a PMHNP, you will need to apply the best available information and research on pharmacological treatments for children in order to safely and effectively treat child and adolescent patients. Sometimes this will come in the form of formal studies and approvals for drugs in children. Other times you may need to extrapolate from research or treatment guidelines on drugs in adults. Each individual patient case will need to be considered independently and each treatment considered from a risk assessment standpoint. What psychotherapeutic approach might be indicated as an initial treatment? What are the potential side effects of a particular drug?
For this Assignment, you consider these questions and others as you explore FDA-approved (“on label”) pharmacological treatments, non-FDA-approved (“off-label”) pharmacological treatments, and nonpharmacological treatments for disorders in children and adolescents.
Reference:
Agency for Healthcare Research and Quality. (2015). Off-label drugs: What you need to know. https://www.ahrq.gov/patients-consumers/patient-involvement/off-label-drug-usage.htmlLinks to an external site.
Resources
Learning Resources
- Hilt, R. J., & Nussbaum, A. M. (2025). DSM-5-TR pocket guide for child and adolescent mental health . American Psychiatric Association Publishing.
- Chapter 7, “Reaching a DSM-5-TR Pediatric Diagnosis When You Have 45 Minutes or More” (pp. 185 – 186)
- Chapter 10, “Organizing a Comprehensive Pediatric Mental Status Examination With a Psychiatric Glossary” (pp. 213 – 217)
- Chapter 11, “Using DSM-5-TR Assessment Measures to Aid Diagnosis” (pp. 221 – 248)
- Chapter 15, “Initiating Psychosocial Interventions” (pp. 285 – 294)
- Chapter 16, “Starting Psychotherapy” (pp. 295 – 302)
- Chapter 17, “Initiating Medications and Monitoring for Adverse Effects” (pp. 303 – 330)
- Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.
- Chapter 43, “Pharmacological, Medically-Led and Related Treatments”
- Walden University. (n.d.). Developing SMART goals Links to an external site.. https://academicguides.waldenu.edu/ld.php?content_id=51901492Links to an external site.
- Zakhari, R. (2020). The psychiatric-mental health nurse practitioner certification review manual . Springer.
- Chapter 5, “Psychopharmacology”
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
To Prepare
- Your Instructor will assign a specific disorder for you to research for this Assignment.
- Use the Walden library to research evidence-based treatments for your assigned disorder in children and adolescents. You will need to recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating this disorder in children and adolescents.
The Assignment (1–2 pages)
- Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents.
- Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug?
- Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration.
- Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Attach the PDFs of your sources.
By Day 7 of Week 3
Submit your Assignment.
NRNP_6665_Week3_Assignment1_Rubric
| NRNP_6665_Week3_Assignment1_Rubric | ||
| Criteria | Ratings | Pts |
| This criterion is linked to a Learning OutcomeIn 1–2 pages, address the following: • Recommend one FDA-approved drug, one off-label drug, and one nonpharmacological intervention for treating your assigned disorder in children and adolescents. | 25 to >22.0 ptsExcellentThe response accurately and concisely explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents.
22 to >19.0 ptsGoodThe response accurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 19 to >17.0 ptsFairThe response somewhat vaguely or inaccurately explains one FDA-approved drug, one off-label drug, and one nonpharmacological intervention that would be appropriate for treating the assigned disorder in children and adolescents. 17 to >0 ptsPoorThe response vaguely or inaccurately explains interventions that would be appropriate for treating the assigned disorder in children and adolescents. Interventions may not represent the three types of interventions required, or response may be missing. |
25 pts |
| This criterion is linked to a Learning Outcome• Explain the risk assessment you would use to inform your treatment decision making. What are the risks and benefits of the FDA-approved medicine? What are the risks and benefits of the off-label drug? | 25 to >22.0 ptsExcellentThe response accurately and concisely explains the risk assessment you would use to inform your treatment decision making. A concise and accurate explanation of the risks and benefits of each pharmacological intervention is provided.
22 to >19.0 ptsGoodThe response accurately explains the risk assessment you would use to inform your treatment decision making. An adequate explanation of the risks and benefits of each pharmacological intervention is provided. 19 to >17.0 ptsFairThe response somewhat vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The explanation of the risks and benefits of each pharmacological intervention is somewhat vague or inaccurate. 17 to >0 ptsPoorThe response vaguely or inaccurately explains the risk assessment you would use to inform your treatment decision making. The risks and benefits of each pharmacological intervention is vague or inaccurate. Or, the response is missing. |
25 pts |
| This criterion is linked to a Learning Outcome• Explain whether clinical practice guidelines exist for this disorder and, if so, use them to justify your recommendations. If not, explain what information you would need to take into consideration. | 25 to >22.0 ptsExcellentThe response accurately and concisely uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations.
22 to >19.0 ptsGoodThe response accurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 19 to >17.0 ptsFairThe response somewhat vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. 17 to >0 ptsPoorThe response vaguely or inaccurately uses either clinical guidelines (if available) or other information from the literature to justify intervention recommendations. Or, the response is missing. |
25 pts |
| This criterion is linked to a Learning Outcome• Support your reasoning with at least three scholarly resources, one each on the FDA-approved drug, the off-label, and a non-medication intervention for the disorder. Be sure they are current (no more than 5 years old). Attach the PDFs of your sources. | 10 to >8.0 ptsExcellentThe response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. The resources reflect the latest clinical guidelines and provide strong justification for decision making.
8 to >7.0 ptsGoodThe response provides at least three current, evidence-based resources from the literature to support the intervention recommendations. 7 to >6.0 ptsFairThree evidence-based resources are provided to support the intervention recommendations, but they may only provide vague or weak justification. 6 to >0 ptsPoorTwo or fewer resources are provided to support the intervention recommendations. The resources may not be current or evidence based. |
10 pts |
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. | 5 to >4.0 ptsExcellentParagraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 to >3.5 ptsGoodParagraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3.5 to >3.0 ptsFairParagraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 3 to >0 ptsPoorParagraphs and sentences follow writing standards for flow, continuity, and clarity <60% of the time. No purpose statement, introduction, or conclusion were provided. |
5 pts |
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation | 5 to >4.0 ptsExcellentUses correct grammar, spelling, and punctuation with no errors
4 to >3.5 ptsGoodContains one or two grammar, spelling, and punctuation errors 3.5 to >3.0 ptsFairContains several (three or four) grammar, spelling, and punctuation errors 3 to >0 ptsPoorContains many (five or more) grammar, spelling, and punctuation errors that interfere with the reader’s understanding |
5 pts |
| This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/narrative in-text citations, and reference list. | 5 to >4.0 ptsExcellentUses correct APA format with no errors
4 to >3.5 ptsGoodContains one or two APA format errors 3.5 to >3.0 ptsFairContains several (three or four) APA format errors 3 to >0 ptsPoorContains many (five or more) APA format errors |
5 pts |
Total Points: 100