A Note to Parents

There has been public concern over reports that very young children are being prescribed psychotropic medications. The studies to date are incomplete, and much more needs to be learned about young children who are treated with medications for all kinds of illnesses. In the field of mental health, new studies are needed to tell us what the best treatments are for children with emotional and behavioral disturbances.

Children are in a state of rapid change and growth during their developmental years. Diagnosis and treatment of mental disorders must be viewed with these changes in mind. While some problems are short-lived and don't need treatment, others are persistent and very serious, and parents should seek professional help for their children.

Not long ago, it was thought that many brain disorders such as anxiety disorders, depression, and bipolar disorder began only after childhood. We now know they can begin in early childhood. An estimated 1 in 10 children and adolescents in the United States suffers from mental illness severe enough to cause some level of impairment. Fewer than one in five of these ill children receives treatment. Perhaps the most studied, diagnosed, and treated childhood-onset mental disorder is attention deficit hyperactivity disorder (ADHD), but even with this disorder there is a need for further research in very young children.

This booklet contains answers to frequently asked questions regarding the treatment of children with mental disorders.

Questions and Answers

Q: What should I do if I am concerned about mental, behavioral, or emotional symptoms in my young child?

A: Talk to your child's doctor. Ask questions and find out everything you can about the behavior or symptoms that worry you. Every child is different and even normal development varies from child to child. Sensory processing, language, and motor skills are developing during early childhood, as well as the ability to relate to parents and to socialize with caregivers and other children. If your child is in daycare or preschool, ask the caretaker or teacher if your child has been showing any worrisome changes in behavior, and discuss this with your child's doctor.

Q: How do I know if my child's problems are serious?

A: Many everyday stresses cause changes in behavior. The birth of a sibling may cause a child to temporarily act much younger. It is important to recognize such behavior changes, but also to differentiate them from signs of more serious problems. Problems deserve attention when they are severe, persistent, and impact on daily activities. Seek help for your child if you observe problems such as changes in appetite or sleep, social withdrawal, or fearfulness; behavior that seems to slip back to an earlier phase such as bed-wetting; signs of distress such as sadness or tearfulness; self-destructive behavior such as head banging; or a tendency to have frequent injuries. In addition, it is essential to review the development of your child, any important medical problem he/she might have had, family history of mental disorders, as well as physical and psychological traumas or situations that may cause stress.

Q: Whom should I consult to help my child?

A: First, consult your child's doctor. Ask for a complete health examination of your child. Describe the behaviors that worry you. Ask whether your child needs further evaluation by a specialist in child behavioral problems. Such specialists may include psychiatrists, psychologists, social workers, and behavioral therapists. Educators may also be needed to help your child.

Q: How are mental disorders diagnosed in young children?

A: Similar to adults, disorders are diagnosed by observing signs and symptoms. A skilled professional will consider these signs and symptoms in the context of the child's developmental level, social and physical environment, and reports from parents and other caretakers or teachers, and an assessment will be made according to criteria established by experts. Very young children often cannot express their thoughts and feelings, which makes diagnosis a challenging task. The signs of a mental disorder in a young child may be quite different from those of an older child or an adult.

Q: Won't my child get better with time?

A: Sometimes yes, but in other cases children need professional help. Problems that are severe, persistent, and impact on daily activities should be brought to the attention of the child's doctor. Great care should be taken to help a child who is suffering, because mental, behavioral, or emotional disorders can affect the way the child grows up.

Q: Which mental disorders are seen in children?

A: Mental disorders with possible onset in childhood include: anxiety disorders; attention deficit and disruptive behavior disorders; autism and other pervasive developmental disorders; eating disorders (e.g., anorexia nervosa); mood disorders (e.g., major depression, bipolar disorder); schizophrenia; and tic disorders. Under some circumstances, bed-wetting and soiling may be symptoms of a mental disorder.

References

Burns BJ, Costello EJ, Angold A, Tweed D, Stangl D, Farmer EM, Erkanli A. Data Watch: children's mental health service use across service sectors. Health Affairs, 1995; 14(3): 147-59.

Coyle JT. Psychotropic drug use in very young children [editorial]. Journal of the American Medical Association, 2000; 283(8): 1059-60.

Physician's Desk Reference (PDR). Montvale, NJ: Medical Economics Company, 1999.

Shaffer D, Fisher P, Dulcan MK, Davies M, Piacentini J, Schwab-Stone ME, Lahey BB, Bourdon K, Jensen PS, Bird HR, Canino G, Regier DA. The NIMH diagnostic interview schedule for children version 2.3 (DISC 2.3): description, acceptability, prevalence, rates, and performance in the MECA study. Journal of the Academy of Child and Adolescent Psychiatry, 1996; 35(7): 865-77.

Zito JM, Safer DJ, dosReis S, Gardner JF, Botes M, Lynch F. Trends in the prescribing of psychotropic medications to preschoolers. Journal of the American Medical Association, 2000; 283(8): 1025-30.

NIH-04-4702 Reprinted April 2004