Treatment of Young Children with Mental Conditions

A note to parents

There has been recent public concern over reports that increasing numbers of very young children are being prescribed psychotropic medications. Some parents are criticized for giving their children these medications while others are criticized for not doing so. New studies are needed to tell us what the best treatments are for children with emotional and behavioral disturbances.

Although progress has been made in diagnosing the mental illnesses that begin in childhood, children’s brains are in a state of rapid change and growth, and diagnosis and treatment of mental disorders must be viewed with this in mind. While some problems are short lived, others are persistent and very serious, and parents should seek help for their children. Treatment decisions should be weighed for risks and benefits, and each child should be viewed individually.

When to get help

Changes in behavior can be of real concern to parents. It’s important to recognize behavior changes, but also to differentiate them from signs of more serious problems. All children act out at times as part of typical development. Some children, however, experience significant changes that may indicate a more serious problem. In some cases, children need help. Problems deserve attention when they are severe, persistent and impact daily activities. Seek help for your child if you observe persistent problems such as:

• sleep disturbances,
• changes in appetite,
• social withdrawal or fearfulness,
• behavior that slips back to an earlier phase such as bedwetting,
• signs of depression,
• erratic and aggressive behavior,
• a tendency to be easily distracted or forgetful or an inability to sustain attention,
• self-destructive behavior such as head banging
• a tendency to have frequent injuries.

It’s important to address concerns early because mental, behavioral or emotional disorders affect the way your child grows up.

People to talk to if you are concerned

Remember that every child is different and even normal development varies from child to child. If your child is in daycare or preschool, ask the teacher if your child has shown any troubling changes in behavior and discuss this with your doctor. Ask your doctor questions and find out everything you can about the behavior or symptoms that worry you. Be sure to tell your doctor about extreme symptoms such as self-injury, impulsive or aggressive behavior, hyperactivity or social withdrawal.

Ask your doctor whether your child needs further evaluation by a specialist in child behavioral problems. A variety of specialists including psychiatrists, neurologists, psychologists, behavioral therapists, social workers and educators may be needed to help your child. Consistent follow-up is critical to successful treatment.

Learning About Medications

The use of medication is not generally the first option for a preschool child with a psychiatric disorder. When medication is used, it should not be the only strategy. Family support services, educational classes on parenting strategies, behavior management techniques and other approaches should be considered. If medication is prescribed, it should be monitored and evaluated closely and regularly. There are several categories of medications used for emotional and behavioral disorders: stimulants, anti-depressants, anti-anxiety agents, anti-psychotics and mood stabilizers.

Stimulants

There are four stimulant medications that are approved for use in the treatment of attention deficit hyperactivity disorder (ADHD), the most common behavioral disorder of childhood. Children with ADHD exhibit symptoms such as short attention span, excessive activity and impulsivity that cause substantial impairment in functioning. If the child attends school, collaboration with teachers is essential. These medications are labeled for pediatric use.

Anti-Depressant and Anti-Anxiety Medications

These medications are used for depression and for anxiety disorders including obsessive compulsive disorder.

Other medications that are used to treat these disorders in children include Effexor (venlafaxine), Paxil (paroxetine), Prozac (fluoxetine), Serzone (nefazodone) and Wellbutrin (bupropion). They are not labeled for pediatric use.

Anti Psychotics

These medications are used to treat schizophrenia, bipolar disorder, autism, Tourette’s syndrome and conduct disorders.

There are other medications used to treat these disorders in children including Clozaril (clozapine), Risperidal (risperidone), Seroquel (quetiapine) and Zyprexa (olanzapine). These drugs are newer (atypical) antipsychotics and have fewer side effects. These medications are not labeled for pediatric use.

Mood Stabilizers

These medications are used to treat bipolar disorder (manic depressive illness).

Research on the effectiveness of these and other medications in children and adolescents with bipolar disorder are ongoing. In addition, studies are investigating various forms of psychotherapy including cognitive-behavioral therapy, to complement medication treatment for this illness in young people.

Jennifer Bowles

Jennifer is a clinical pharmacologist. She helps doctors of all medical specialties choose medications. Jennifer consults about drug dosage, interactions, and side effects.