Toddlers and mental health treatment 

For parents of young children facing mental health concerns or diagnoses, some of the most important questions they have are about treatment. Since mental illness isn’t usually diagnosed in children younger than school-age unless they’re showing symptoms that significantly get in the way of their mental, physical, or emotional growth and development, finding the right treatment can feel urgent. Because older children and adults are often treated with medication, it can be natural to expect that medication might be a part of a young child’s treatment plan, but in many cases, healthcare providers choose to begin treatment for very young children with psychosocial or behavioral therapy.

Why delay prescribing medication?

One of the biggest reasons to delay prescribing medication, especially psychotropic medication, which impacts mental state, is that there hasn’t been very much research done on the effect psychotropic drugs might have on very young children’s developing brains. The American Psychological Association’s Working Group on Psychological Medications for Children and Adolescents cautions that any medication that’s prescribed has been approved for use by the FDA, but that’s approval for general use, and doesn’t necessarily mean anything about whether they’ve been approved to treat preschool-aged children.

Another compelling reason that it’s appropriate to wait to prescribe medication to most young children until school age is that, age aside, most of the conditions that can affect young children, including ADHD, Oppositional Defiant Disorder, Obsessive Compulsive Disorder and Anxiety Disorder, have been found to respond well to behavioral or cognitive therapies. In fact, for most disorders that can affect young children, cognitive or behavioral therapies are recommended by the APA as a “first line of defense.” It’s only after therapies other than medication have been tried and have been given the chance to work that the APA recommends trying a combination of cognitive or behavioral therapies and medication.

The most important thing, the APA stresses, is for the treatment plan to match up with the diagnosis. It’s not common for very young children to be diagnosed with mental health disorders. To choose one of the more common examples, some researchers believe that ADHD can be diagnosed as young as 3 with careful evaluation, but others others believe it’s too difficult to separate out symptoms of ADHD from normal behavioral developments in children that young, especially given the criteria that are currently being used. However, in one study of school-aged children with ADHD, published in the Journal of Development and Behavioral Pediatrics, parents reported that, in two-thirds of the children, symptoms started showing up in children age 4 or younger.

The most commonly prescribed medication for ADHD treatment, Methylphenidate hydrochloride (Ritalin), hasn’t been approved for the treatment of children younger than 6. The most thorough study of the effects of ADHD medication and preschoolers, which followed 303 preschoolers, found that medication did reduce symptoms in the children taking medication. At the same time, though, they also experienced side effects like weight-loss, insomnia, anxiety, loss of appetite, and emotional outbursts, and children in the study grew half an inch less and 3 pounds less than they were expected to based on a projection from national averages. In fact, these side-effects were enough of a concern that 11% of the preschoolers in the study dropped out of it before it was over.

If you have questions about treatment for mental health disorders in children, it’s important to speak with their pediatrician or other healthcare provider.

  • Brendan L. Smith. “ADHD Among Preschoolers.” Monitor on Psychology. 24(7). Web. 2011.
  • “APA Reports Critical Gaps in Evidence for Current Treatment of Children’s Behavioral and Mental Health Problems.” APA. American Psychological Association, Sepetmber 10 2006. Web.
  • “Common ADHD Medications and Treatments for Children.” HealthyChildren. American Academy of Pediatrics, January 8 2015. Web.
  • “Hearing Voices and Seeing Things.” AACAP. American Academy of Child and Adolescent Psychology, No. 102. May 2012. Web.
  • “Psychiatric Medication for Children and Adolescents: Part II – Types of Medication.” AACAP. American Academy of Child and Adolescent Psychology, No. 29. May 2012. Web.
  • “Talking to your child’s pediatrician about behavioral problems & medication.” APA. American Psychological Association, 2016. Web.
  • “What Parents Should Know About The Treatment of Behavioral and Emotional Disorders in Preschool Children.” APA. American Psychological Association, 2016. Web.
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