Treatment of Children with Mental Disorders
Treatment of Children with Mental Disorders
A Note to Parents
There has been recent 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 6 to 9
million children and adolescents in the United States suffer from a serious
behavioral or emotional disturbance. 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.
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 the 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, and 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: Are there situations in which it is advisable to
use psychotropic medications in young children?
A: Psychotropic medications may be prescribed for
young children with mental, behavioral, or emotional symptoms when the
potential benefits of treatment outweigh the risks. Some problems are so severe
and persistent that they would have serious negative consequences for the child
if untreated, and psychosocial interventions may not always be effective by
themselves. The safety and efficacy of most psychotropic medications have not
yet been studied in young children. As a parent, you will want to ask many
questions and evaluate with your doctor the risks of starting and continuing
your child on these medication. Learn everything you can about the medications
prescribed for your child, including potential side effects, Learn which side
effects are tolerable and which ones are threatening. In addition, learn and
keep in mind the goals of a particular treatment (e.g., change in specific
behaviors). Combining multiple psychotropic medications should be avoided in
very young children unless absolutely necessary.
Q: Does medication affect young children
differently from older children or adults?
A: Yes. Young children’s bodies handle medication
differently than older individuals and this has implication for dosage. The
brains of young children are in a state of very rapid development, and animal
studies have shown that the developing neurotransmitter systems can be very
sensitive to medications. A great deal of research is still needed to determine
the effects and benefits of medications in children of all ages. Yet it is
important to remember that serious untreated mental disorders themselves
negatively impact brain development.
Q: If my preschool child receives a diagnosis of a
mental disorder, does this mean that medications have to be used?
A: No. Psychotropic medications are not generally the
first option for a preschool child with a mental disorder. The first goal is to
understand the factors that may be contributing to the condition. The child’s
own physical and emotional state is key, but many other factors such as
parental stress or a changing family environment may influence the child’s
symptoms. Certain psychosocial treatments may be as effective as
medication.
Q: How should medication be included in an overall
treatment plan?
A: When medication is used, it should not be the only
strategy. There are other services that you may want ro investigate for your
child. Family support services, educational classes, behavior management
techniques, as well as family therapy and other approaches should be
considered. If medication is prescribed, it should be monitored and evaluated
regularly.
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.
Q: Can events such as a death in the family,
illness in a parent, onset of poverty, or divorce cause symptoms?
A: Yes. When a tragedy occurs or some extreme stress
hits, every member of a family is affected, even the youngest ones. This should
also be considered when evaluating mental, emotional, or behavioral symptoms in
a child.
Q: What difference does it make if a medication is
specifically approved for use in children or not?
A: Approval of a medication by the U.S. Food and Drug
Administration (FDA) means that adequate data have been provided to the FDA by
the drug manufacturer to show safety and efficacy for a particular therapy in a
particular population. Based on the data, a label indication for the drug is
established that includes proper dosage, potential side effects, and approved
age. Doctors prescribe medications, as they feel appropriate, even if those
uses are not included in the labeling. Although in some cases there is
extensive clinical experience in using medications for children or adolescents,
in many cases there is not. Everyone agrees that more studies in children are
needed if we are to know the appropriate dosages, how a drug works in children,
and what effects there are on learning and development.
Q: What does “off-label” use of a medication mean?
A: Many medications that are on the market have not
been officially approved by the FDA for use in children. Treatment of children
with these medications is called “off-label use.” For some medications, the
off-label use is supported by data from well-conducted studies in children. For
instance, some anti-depressant medications have been shown to be effective in
children and adolescents with depression. For other medications, there are no
controlled studies in children, but only isolated clinical reports. In
particular, the use of psychotropic medications in preschoolers has not been
adequately studied and must be considered very carefully by balancing severity
of symptoms, degree of impairment, and potential benefits and risks of
treatment.
Q: Why haven’t many medications been tested in
children?
A: In the past, medications were not studied in
children because of ethical concerns about involving children in clinical
trials. However, this created a new problem: lack of knowledge about the best
treatments for children. In clinical settings where children are suffering from
mental or behavioral disorders, medications are being prescribed at
increasingly early ages. The FDA has been urging that products be appropriately
studied in children and has offered incentives to drug manufacturers to carry
out such testing. The NIH and the FDA are examining the issue of medication
research in children and are developing new research approaches.
Q: Does the FDA approve medications for different
age groups among children?
A: Yes. However, this is based on the data provided to
the FDA by the drug manufacturer and policies in effect at the time of
approval. For example, Ritalin is approved for children age 6 and older,
whereas Dexedrine is approved for children as young as 3. When Ritalin was
tested for efficacy by its manufacturer, only children age 6 and above were
involved; therefore, age 6 was approved as the lower age limit for Ritalin.
Q: What medications are used for which kinds of childhood
mental disorder?
A: There are several major categories of psychotropic
medications: stimulants, antidepressants, antianxiety agents, antipsychotics,
and mood stabilizers. For medications approved by FDA for use in children,
dosages depend on body weight and age.
· Stimulant
Medications: 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. These medication have all been extensively
studied and are specifically labeled for pediatric use. Children with ADHD
exhibit such symptoms as short attention span, excessive activity, and
impulsivity that cause substantial impairment in functioning. Stimulant
medication should be prescribed only after a careful evaluation to establish
the diagnosis of ADHD and to rule out other disorders or conditions. Medication
treatment should be administered and monitored in the context of the overall
needs of the child and family, and consideration should be given to combining
it with behavioral therapy. If the child is of school age, collaboration with
teachers is essential.
· Antidepressant
and Antianxiety Medications: These medications follow the stimulant
medications in prevalence among children and adolescents. They are used for
depression, a disorder recognized only in the last twenty years as a problem
for children, and for anxiety disorder, including obsessive-compulsive disorder
(OCD). The medications most widely prescribed for these disorders are the
selective serotonin reuptake inhibitors (SSRIs). In the human brain, there are
many “neurotransmitters” that affect the way we think, feel, and act. Three of
these neurotransmitters that antidepressants influence are serotonin, dopamine,
and norepinephrine. SSRIs affect mainly serotonin and have been found to be
effective in treating depression and anxiety without as many side effects as
some older antidepressants.
· Antipsychotic
Medications: These medications are used to treat children with schizophrenia,
bipolar disorder, autism, Tourette’s syndrome, and severe conduct
disorders. Some of the older
antipsychotic medications have specific indications and dose guidelines for
children. Some of the newer “atypical”
antipsychotics, which have fewer side effects, are also being used for
children. Such use requires close
monitoring for side effects.
· Mood
Stabilizing Medications: These medications are used to treat bipolar
disorder. However, because there is very
limited data on the safety and efficacy of most mood stabilizers in youth,
treatment of children and adolescents is based mainly on experience with
adults. The most typically used mood stabilizers are lithium and valproate
(Depakote), which are often very effective for controlling mania and preventing
recurrences of manic and depressive episodes in adults. Research on the
effectiveness of these and other medications in children and adolescents with
bipolar disorder is ongoing. In addition, studies are investigating various
forms of psychotherapy, including cognitive-behavioral therapy, to complement
medication treatment for this illness in young people.
Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat co-occurring ADHD or ADHD- like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.
For more information about Mental Illnesses -
Contact:
The Alliance for the Mentally Ill
NAMI of Greater Chicago
1536 West Chicago Ave, Chicago, IL 60622
Phone: 312-563-0445