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Psychiatry and Preschool Children

Treating mental illness in young children (preschoolers: defined by the CDC as ages 3-5) is a unique challenge and in some cases can involve the use of psychiatric medication. This is an area where a child psychiatrist is best suited, but even with specialized training, following current literature and evidence is very important. The Preschool Psychopharmacology Working Group set out to assist clinicians in this task by reviewing and presenting the literature on the subject, led by Dr. Mary Margaret Gleason, publishing their findings in the authoritative and respected official journal of the American Academy of Child Adolescent Psychiatry, in 2007. This blog is intended to be understood by individuals without any clinical training.

Interestingly, the authors felt that their guidelines were not going to increase prescription to preschoolers, but in fact reduce medication use in this group of patients.

Their research revealed preschoolers are often not referred for treatment when they have mental health issues, and the main treatment offered is psychotherapy. When medication is used in preschoolers, the majority of the prescriptions are for stimulants (medications that are FDA approved to treat Attention Deficit Hyperactivity Disorder). The authors note that preschool assessments often require multiple appointments before arriving at a treatment plan.

Many people may wonder what can be diagnosed in such a young child? The research of the working group found that disorders such as major depression, post traumatic stress, disruptive behavior disorders, autism and ADHD can be reliably diagnosed based on the evidence of research. Several anxiety disorder diagnoses in preschoolers and other disorders are not research tested at time of the article, however this does not suggest they do not exist, only that they have not been proven by research to date.

It is known that psychiatric medication can change the central nervous system development of the young in animal studies, but the research is limited to understand how this translates to a human preschooler. This is part of the risk and benefit analysis that the doctor and parent must consider at the time of evaluation.

The authors made a clear statement that psychosocial (therapy/aides/tutors) should be tried first in preschoolers, then consider psychiatric medication. Medication also should not be prescribed to children with mild symptoms.

The authors outlined several universal guidelines which are consistent with my own personal clinical views, among which included: avoid medication when psychotherapy is also likely to be effective, psychotherapy should be tried first before the consideration of medication, medication should be tapered off at intervals when improvement has been observed to reassess whether it is necessary, and avoid using medications to treat side effects of a psychiatric medication (reduce the dose or remove the offending medication).

The authors go on to review major mental illness disorders and provide algorithms (step by step approaches) based on available research, to guide clinicians.  I invite interested parties to read more about the algorithms in the referenced article.

Reference:

Psychopharmacological Treatment for Very Young Children: Contexts and Guidelines

MARY MARGARET GLEASON, M.D., et al

1. AM. ACAD. CHILD ADOLESC. PSYCHIATRY, 46:12, DECEMBER 2007

© Neevon Esmaili 2016

Neevon Esmaili, MD
Child Adolescent, & Adult Psychiatrist
Dual Board Certified

The information on this blog is not intended to be used to diagnose or treat a medical or psychiatric illness. It is for informational purposes only. Diagnosis and treatment of medical and psychiatric illness can only be done by a licensed clinical professional, and mentalfitnessclinic-staging.omnibeatwp.com recommends consulting with a qualified healthcare provider for any questions or issues you may have. This blog cannot be used as a substitute for consultation with a qualified medical professional.

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