Treatment of Children with Mental Disorders
Questions & Answers
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
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
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 1 in 5 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
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
a child to temporarily act much younger. It is important to recognize such
changes, but also to differentiate them from signs of more serious problems.
deserve attention when they are severe, persistent, and impact on daily
help for your child if you observe problems such as changes in appetite or
withdrawal, or fearfulness; behavior that seems to slip back to an earlier phase
bed-wetting; signs of distress such as sadness or tearfulness; self-destructive
such as head banging; or a tendency to have frequent injuries. In addition, it
to review the development of your child, any important medical problem he/she
have had, family history of mental disorders, as well as physical and
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
child. Describe the behaviors that worry you. Ask whether your child needs
by a specialist in child behavioral problems. Such specialists may include
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
developmental level, social and physical environment, and reports from parents
other caretakers or teachers, and an assessment will be made according to
established by experts. Very young children often cannot express their thoughts
feelings, which makes diagnosis a challenging task. The signs of a mental
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
severe, persistent, and impact on daily activities should be brought to the
the child’s doctor. Great care should be taken to help a child who is suffering,
mental, behavioral, or emotional disorders can affect the way the child grows
Q: Which mental disorders are seen in children?
A: Mental disorders with possible onset in childhood include: anxiety disorders;
deficit and disruptive behavior disorders; autism and other pervasive
disorders; eating disorders (e.g., anorexia nervosa); mood disorders (e.g.,
depression, bipolar disorder); schizophrenia; and tic disorders. Under some
bed-wetting and soiling may be symptoms of a mental disorder.
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,
or emotional symptoms when the potential benefits of treatment outweigh the
risks. Some problems are so severe and persistent that they would have serious
consequences for the child if untreated, and psychosocial interventions may not
be effective by themselves. The safety and efficacy of most psychotropic
have not yet been studied in young children. As a parent, you will want to ask
questions and evaluate with your doctor the risks of starting and continuing
on these medications. Learn everything you can about the medications prescribed
your child, including potential side effects. Learn which side effects are
which ones are threatening. In addition, learn and keep in mind the goals of a
treatment (e.g., change in specific behaviors). Combining multiple psychotropic
should be avoided in very young children unless absolutely necessary.
Q: Does medication affect young children differently from older children or
A: Yes. Young children’s bodies handle medications differently than older
and this has implications for dosage. The brains of young children are in a
state of very
rapid development, and animal studies have shown that the developing
systems can be very sensitive to medications. A great deal of research is still
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
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
with a mental disorder. The first goal is to understand the factors that may be
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
the child’s symptoms. Certain psychosocial treatments may be as effective as
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
that you may want to investigate for your child. Family support services,
classes, behavior management techniques, as well as family therapy and other
approaches should be considered. If medication is prescribed, it should be
and evaluated regularly.
Q: What medications are used for which kinds of childhood mental
A: There are several major categories of psychotropic medications: stimulants,
antianxiety agents, antipsychotics, and mood stabilizers. For medications
approved by the FDA for use in children, dosages depend on body weight and age.
Medications Chart in this booklet shows the most commonly prescribed medications
children with mood or anxiety disorders (including OCD).
- Stimulant Medications: There are four
stimulant medications that are approved for
use in the treatment of attention deficit hyperactivity disorder (ADHD), the
behavioral disorder of childhood. These medications have all been extensively
and are specifically labeled for pediatric use. Children with ADHD exhibit such
as short attention span, excessive activity, and impulsivity that cause
impairment in functioning. Stimulant medication should be prescribed only after
evaluation to establish the diagnosis of ADHD and to rule out other disorders or
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
it with behavioral therapy. If the child is of school age, collaboration with
- Antidepressant and Antianxiety Medications: These medications follow the
medications in prevalence among children and adolescents. They are used for
a disorder recognized only in the last twenty years as a problem for children,
for anxiety disorders, including obsessive-compulsive disorder (OCD). The
most widely prescribed for these disorders are the selective serotonin reuptake
In the human brain, there are many “neurotransmitters” that affect the way we
feel, and act. Three of these neurotransmitters that antidepressants influence
dopamine, and norepinephrine. SSRIs affect mainly serotonin and have been
found to be effective in treating depression and anxiety without as many side
as some older antidepressants.
- Antipsychotic Medications: These medications are used to treat children with
bipolar disorder, autism, Tourette’s syndrome, and severe conduct disorders.
Some of the older antipsychotic medications have specific indications and dose
for children. Some of the newer “atypical” antipsychotics, which have fewer side
effects, are also being used for children. Such use requires close monitoring
- Mood Stabilizing Medications: These medications are used to treat bipolar
(manic-depressive illness). However, because there is very limited data on the
efficacy of most mood stabilizers in youth, treatment of children and
based mainly on experience with adults. The most typically used mood stabilizers
lithium and valproate (Depakote®), which are often very effective for
and preventing recurrences of manic and depressive episodes in adults. Research
effectiveness of these and other medications in children and adolescents with
disorder is ongoing. In addition, studies are investigating various forms of
including cognitive-behavioral therapy, to complement medication treatment for
illness in young people.
Effective treatment depends on appropriate diagnosis of bipolar disorder in
adolescents. There is some evidence that using antidepressant medication to
depression in a person who has bipolar disorder may induce manic symptoms if it
taken without a mood stabilizer. In addition, using stimulant medications to
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
manic, there is a greater likelihood among children and adolescents who have a
history of bipolar disorder. If manic symptoms develop or markedly worsen during
or stimulant use, a physician should be consulted immediately, and diagnosis
and treatment for bipolar disorder should be considered.
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 FDA means that adequate data have been
the FDA by the drug manufacturer to show safety and efficacy for a particular
a particular population. Based on the data, a label indication for the drug is
that includes proper dosage, potential side effects, and approved age. Doctors
medications as they feel appropriate even if those uses are not included in the
Although in some cases there is extensive clinical experience in using
children or adolescents, in many cases there is not. Everyone agrees that more
children are needed if we are to know the appropriate dosages, how a drug works
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
FDA for use in children. Treatment of children with these medications is called
use. For some medications, the off-label use is supported by data from
studies in children. For instance, some antidepressant medications have been
shown to be effective in children and adolescents with depression. For other
there are no controlled studies in children, but only isolated clinical reports.
particular, the use of psychotropic medications in preschoolers has not been
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
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
suffering from mental or behavioral disorders, medications are being prescribed
increasingly early ages. The FDA has been urging that products be appropriately
in children and has offered incentives to drug manufacturers to carry out such
The NIH and the FDA are examining the issue of medication research in children
are developing new research approaches.
Q: Does the FDA approve medications for different age groups among
A: Yes. However, this is based on the data provided to the FDA by the drug
and the policies in effect at the time of approval. For example, Ritalin® is
children age 6 and older, whereas Dexedrine® is approved for children as young
When Ritalin® was tested for efficacy by its manufacturer, only children age 6
above were involved; therefore, age 6 was approved as the lower age limit for
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
affected, even the youngest ones. This should also be considered when evaluating
emotional, or behavioral symptoms in a child.
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For More Information on Mental Disorders
in Children, Contact:
Office of Communications and Public Liaison,
Information Resources and Inquiries Branch
6001 Executive Blvd., Room 8184, MSC 9663
Mental Health FAX 4U: 301-443-5158
NIMH home page address: http://www.nimh.nih.gov