Caregivers' Attitudes for Pharmacotherapy in Child Psychiatry: A Regional Survey in Japan

BACKGROUND: Pharmacotherapy plays an essential role in managing neurodevelopmental and psychiatric disorders in children, although most psychotropic medications are prescribed off-label. Caregivers' hesitation toward medication remains an important issue in child psychiatry practice. This study aimed to investigate caregivers' concerns and expectations regarding pharmacotherapy for their children and identify factors associated with their willingness to medicate. METHODS: This cross-sectional study was conducted between August and December 2023 at the Center for Child Health, Behavior, and Department, University Hospital, Japan. Primary caregivers of children aged 2-15 years attending follow-up outpatient visits completed structured questionnaires assessing their concerns, expectations, and perceived treatment purposes. Descriptive statistics and multivariate logistic regression analyses were performed to identify predictors of caregivers' willingness to medicate. RESULTS: A total of 212 caregivers (92.5% mothers) participated. The most frequent diagnosis reported was autism spectrum disorder (47.6%), followed by attention deficit/hyperactivity disorder (25.5%). The leading concerns regarding pharmacotherapy were long-term medication use (56.1%), side effects (43.4%) and dependence (41.0%). Over 90% of caregivers expected child psychiatrists to provide supportive opportunities for both children and caregivers. Logistic regression analysis revealed that concern about long-term medication use was significantly associated with a positive attitude toward pharmacotherapy (p < 0.001). Caregivers' perceived distress regarding their children's problems, measured using a visual analogue scale, significantly decreased from 7.9 ± 2.0 at the initial visit to 5.3 ± 2.2 at present under medical care (paired t-test, p < 0.001). CONCLUSIONS: Long-term pharmacotherapy remains a major concern among caregivers in child psychiatry, indicating the need for clinicians to address it earnestly.