| A Note to Parents | | | | |
| | | | A: When medication is used, it should not be |
| There has been public concern over reports | | | | the only strategy. There are other services |
| that very young children are being prescribed | | | | that you may want to investigate for your |
| psychotropic medications. The studies to date | | | | child. Family support services, educational |
| are incomplete, and much more needs to be | | | | classes, behavior management techniques, as |
| learned about young children who are treated | | | | well as family therapy and other approaches |
| with medications for all kinds of illnesses. | | | | should be considered. If medication is |
| In the field of mental health, new studies | | | | prescribed, it should be monitored and |
| are needed to tell us what the best | | | | evaluated regularly. |
| treatments are for children with emotional | | | | |
| and behavioral disturbances. | | | | Q: What medications are used for which kinds |
| | | | of childhood mental disorders? |
| Children are in a state of rapid change and | | | | |
| growth during their developmental years. | | | | A: There are several major categories of |
| Diagnosis and treatment of mental disorders | | | | psychotropic medications: stimulants, |
| must be viewed with these changes in mind. | | | | antidepressants, antianxiety agents, |
| While some problems are short-lived and don't | | | | antipsychotics, and mood stabilizers. For |
| need treatment, others are persistent and | | | | medications approved by the FDA for use in |
| very serious, and parents should seek | | | | children, dosages depend on body weight and |
| professional help for their children. | | | | age. The Medications Chart in this booklet |
| | | | shows the most commonly prescribed |
| Not long ago, it was thought that many brain | | | | medications for children with mood or anxiety |
| disorders such as anxiety disorders, | | | | disorders (including OCD). |
| depression, and bipolar disorder began only | | | | |
| after childhood. | | | | Stimulant Medications: There are four |
| | | | stimulant medications that are approved for |
| We now know they can begin in early | | | | use in the treatment of attention deficit |
| childhood. An estimated 1 in 10 children and | | | | hyperactivity disorder (ADHD), the most |
| adolescents in the United States suffers from | | | | common behavioral disorder of childhood. |
| mental illness severe enough to cause some | | | | These medications have all been extensively |
| level of impairment. Fewer than one in five | | | | studied and are specifically labeled for |
| of these ill children receives treatment. | | | | pediatric use. Children with ADHD exhibit |
| Perhaps the most studied, diagnosed, and | | | | such symptoms as short attention span, |
| treated childhood-onset mental disorder is | | | | excessive activity, and impulsivity that |
| attention deficit hyperactivity disorder | | | | cause substantial impairment in functioning. |
| (ADHD), but even with this disorder there is | | | | Stimulant medication should be prescribed |
| a need for further research in very young | | | | only after a careful evaluation to establish |
| children. | | | | the diagnosis of ADHD and to rule out other |
| | | | disorders or conditions. Medication treatment |
| This booklet contains answers to frequently | | | | should be administered and monitored in the |
| asked questions regarding the treatment of | | | | context of the overall needs of the child and |
| children with mental disorders. | | | | family, and consideration should be given to |
| | | | combining it with behavioral therapy. If the |
| Questions and Answers | | | | child is of school age, collaboration with |
| | | | teachers is essential. |
| Q: What should I do if I am concerned about | | | | |
| mental, behavioral, or emotional symptoms in | | | | Antidepressant and Antianxiety Medications: |
| my young child? | | | | These medications follow the stimulant |
| | | | medications in prevalence among children and |
| A: Talk to your child's doctor. Ask questions | | | | adolescents. They are used for depression, a |
| and find out everything you can about the | | | | disorder recognized only in the last 20 years |
| behavior or symptoms that worry you. Every | | | | as a problem for children, and for anxiety |
| child is different and even normal | | | | disorders, including obsessive-compulsive |
| development varies from child to child. | | | | disorder (OCD). The medications most widely |
| Sensory processing, language, and motor | | | | prescribed for these disorders are the |
| skills are developing during early childhood, | | | | selective serotonin reuptake inhibitors (the |
| as well as the ability to relate to parents | | | | SSRIs). |
| and to socialize with caregivers and other | | | | |
| children. If your child is in daycare or | | | | In the human brain, there are many |
| preschool, ask the caretaker or teacher if | | | | "neurotransmitters" that affect the way we |
| your child has been showing any worrisome | | | | think, feel, and act. Three of these |
| changes in behavior, and discuss this with | | | | neurotransmitters that antidepressants |
| your child's doctor. | | | | influence are serotonin, dopamine, and |
| | | | norepinephrine. SSRIs affect mainly serotonin |
| Q: How do I know if my child's problems are | | | | and have been found to be effective in |
| serious? | | | | treating depression and anxiety without as |
| | | | many side effects as some older |
| A: Many everyday stresses cause changes in | | | | antidepressants. |
| behavior. The birth of a sibling may cause a | | | | |
| child to temporarily act much younger. It is | | | | Antipsychotic Medications: These medications |
| important to recognize such behavior changes, | | | | are used to treat children with |
| but also to differentiate them from signs of | | | | schizophrenia, bipolar disorder, autism, |
| more serious problems. Problems deserve | | | | Tourette's syndrome, and severe conduct |
| attention when they are severe, persistent, | | | | disorders. Some of the older antipsychotic |
| and impact on daily activities. Seek help for | | | | medications have specific indications and |
| your child if you observe problems such as | | | | dose guidelines for children. Some of the |
| changes in appetite or sleep, social | | | | newer "atypical" antipsychotics, which have |
| withdrawal, or fearfulness; behavior that | | | | fewer side effects, are also being used for |
| seems to slip back to an earlier phase such | | | | children. Such use requires close monitoring |
| as bed-wetting; signs of distress such as | | | | for side effects. |
| sadness or tearfulness; self-destructive | | | | |
| behavior such as head banging; or a tendency | | | | Mood Stabilizing Medications: These |
| to have frequent injuries. In addition, it is | | | | medications are used to treat bipolar |
| essential to review the development of your | | | | disorder (manic-depressive illness). However, |
| child, any important medical problem he/she | | | | because there is very limited data on the |
| might have had, family history of mental | | | | safety and efficacy of most mood stabilizers |
| disorders, as well as physical and | | | | in youth, treatment of children and |
| psychological traumas or situations that may | | | | adolescents is based mainly on experience |
| cause stress. | | | | with adults. The most typically used mood |
| | | | stabilizers are lithium and valproate |
| Q: Whom should I consult to help my child? | | | | (DepakoteÂ(R)), which are often very |
| | | | effective for controlling mania and |
| A: First, consult your child's doctor. Ask | | | | preventing recurrences of manic and |
| for a complete health examination of your | | | | depressive episodes in adults. Research on |
| child. Describe the behaviors that worry you. | | | | the effectiveness of these and other |
| Ask whether your child needs further | | | | medications in children and adolescents with |
| evaluation by a specialist in child | | | | bipolar disorder is ongoing. In addition, |
| behavioral problems. Such specialists may | | | | studies are investigating various forms of |
| include psychiatrists, psychologists, social | | | | psychotherapy, including cognitive-behavioral |
| workers, and behavioral therapists. Educators | | | | therapy, to complement medication treatment |
| may also be needed to help your child. | | | | for this illness in young people. |
| | | | |
| Q: How are mental disorders diagnosed in | | | | Effective treatment depends on appropriate |
| young children? | | | | diagnosis of bipolar disorder in children and |
| | | | adolescents. There is some evidence that |
| A: Similar to adults, disorders are diagnosed | | | | using antidepressant medication to treat |
| by observing signs and symptoms. A skilled | | | | depression in a person who has bipolar |
| professional will consider these signs and | | | | disorder may induce manic symptoms if it is |
| symptoms in the context of the child's | | | | taken without a mood stabilizer. In addition, |
| developmental level, social and physical | | | | using stimulant medications to treat |
| environment, and reports from parents and | | | | co-occurring ADHD or ADHD-like symptoms in a |
| other caretakers or teachers, and an | | | | child with bipolar disorder may worsen manic |
| assessment will be made according to criteria | | | | symptoms. While it can be hard to determine |
| established by experts. Very young children | | | | which young patients will become manic, there |
| often cannot express their thoughts and | | | | is a greater likelihood among children and |
| feelings, which makes diagnosis a challenging | | | | adolescents who have a family history of |
| task. The signs of a mental disorder in a | | | | bipolar disorder. If manic symptoms develop |
| young child may be quite different from those | | | | or markedly worsen during antidepressant or |
| of an older child or an adult. | | | | stimulant use, a physician should be |
| | | | consulted immediately, and diagnosis and |
| Q: Won't my child get better with time? | | | | treatment for bipolar disorder should be |
| | | | considered. |
| A: Sometimes yes, but in other cases children | | | | |
| need professional help. Problems that are | | | | Q: What difference does it make if a |
| severe, persistent, and impact on daily | | | | medication is specifically approved for use |
| activities should be brought to the attention | | | | in children or not? |
| of the child's doctor. Great care should be | | | | |
| taken to help a child who is suffering, | | | | A: Approval of a medication by the FDA means |
| because mental, behavioral, or emotional | | | | that adequate data have been provided to the |
| disorders can affect the way the child grows | | | | FDA by the drug manufacturer to show safety |
| up. | | | | and efficacy for a particular therapy in a |
| | | | particular population. Based on the data, a |
| Q: Which mental disorders are seen in | | | | label indication for the drug is established |
| children? | | | | that includes proper dosage, potential side |
| | | | effects, and approved age. Doctors prescribe |
| A: Mental disorders with possible onset in | | | | medications as they feel appropriate even if |
| childhood include: anxiety disorders; | | | | those uses are not included in the labeling. |
| attention deficit and disruptive behavior | | | | Although in some cases there is extensive |
| disorders; autism and other pervasive | | | | clinical experience in using medications for |
| developmental disorders; eating disorders | | | | children or adolescents, in many cases there |
| (e.g., anorexia nervosa); mood disorders | | | | is not. Everyone agrees that more studies in |
| (e.g., major depression, bipolar disorder); | | | | children are needed if we are to know the |
| schizophrenia; and tic disorders. Under some | | | | appropriate dosages, how a drug works in |
| circumstances, bed-wetting and soiling may be | | | | children, and what effects there are on |
| symptoms of a mental disorder. | | | | learning and development. |
| | | | |
| Q: Are there situations in which it is | | | | Q: What does "off-label" use of a medication |
| advisable to use psychotropic medications in | | | | mean? |
| young children? | | | | |
| | | | A: Many medications that are on the market |
| A: Psychotropic medications may be prescribed | | | | have not been officially approved by the FDA |
| for young children with mental, behavioral, | | | | for use in children. Treatment of children |
| or emotional symptoms when the potential | | | | with these medications is called "off-label" |
| benefits of treatment outweigh the risks. | | | | use. For some medications, the off-label use |
| Some problems are so severe and persistent | | | | is supported by data from well-conducted |
| that they would have serious negative | | | | studies in children. For instance, some |
| consequences for the child if untreated, and | | | | antidepressant medications have been shown to |
| psychosocial interventions may not always be | | | | be effective in children and adolescents with |
| effective by themselves. The safety and | | | | depression. For other medications, there are |
| efficacy of most psychotropic medications | | | | no controlled studies in children, but only |
| have not yet been studied in young children. | | | | isolated clinical reports. In particular, the |
| As a parent, you will want to ask many | | | | use of psychotropic medications in |
| questions and evaluate with your doctor the | | | | preschoolers has not been adequately studied |
| risks of starting and continuing your child | | | | and must be considered very carefully by |
| on these medications. Learn everything you | | | | balancing severity of symptoms, degree of |
| can about the medications prescribed for your | | | | impairment, and potential benefits and risks |
| child, including potential side effects. | | | | of treatment. |
| Learn which side effects are tolerable and | | | | |
| which ones are threatening. In addition, | | | | Q: Why haven't many medications been tested |
| learn and keep in mind the goals of a | | | | in children? |
| particular treatment (e.g., change in | | | | |
| specific behaviors). Combining multiple | | | | A: In the past, medications were not studied |
| psychotropic medications should be avoided in | | | | in children because of ethical concerns about |
| very young children unless absolutely | | | | involving children in clinical trials. |
| necessary. | | | | However, this created a new problem: lack of |
| | | | knowledge about the best treatments for |
| Q: Does medication affect young children | | | | children. In clinical settings where children |
| differently from older children or adults? | | | | are suffering from mental or behavioral |
| | | | disorders, medications are being prescribed |
| A: Yes. Young children's bodies handle | | | | at increasingly early ages. The FDA has been |
| medications differently than older | | | | urging that products be appropriately studied |
| individuals and this has implications for | | | | in children and has offered incentives to |
| dosage. The brains of young children are in a | | | | drug manufacturers to carry out such testing. |
| state of very rapid development, and animal | | | | The NIH and the FDA are examining the issue |
| studies have shown that the developing | | | | of medication research in children and are |
| neurotransmitter systems can be very | | | | developing new research approaches. |
| sensitive to medications. A great deal of | | | | |
| research is still needed to determine the | | | | Q: Does the FDA approve medications for |
| effects and benefits of medications in | | | | different age groups among children? |
| children of all ages. Yet it is important to | | | | |
| remember that serious untreated mental | | | | A: Yes. However, this is based on the data |
| disorders themselves negatively impact brain | | | | provided to the FDA by the drug manufacturer |
| development. | | | | and the policies in effect at the time of |
| | | | approval. For example, RitalinÂ(R) is |
| Q: If my preschool child receives a diagnosis | | | | approved for children age 6 and older, |
| of a mental disorder, does this mean that | | | | whereas DexedrineÂ(R) is approved for |
| medications have to be used? | | | | children as young as 3. When RitalinÂ(R) |
| | | | was tested for efficacy by its manufacturer, |
| A: No. Psychotropic medications are not | | | | only children age 6 and above were involved; |
| generally the first option for a preschool | | | | therefore, age 6 was approved as the lower |
| child with a mental disorder. The first goal | | | | age limit for RitalinÂ(R). |
| is to understand the factors that may be | | | | |
| contributing to the condition. The child's | | | | Q: Can events such as a death in the family, |
| own physical and emotional state is key, but | | | | illness in a parent, onset of poverty, or |
| many other factors such as parental stress or | | | | divorce cause symptoms? |
| a changing family environment may influence | | | | |
| the child's symptoms. Certain psychosocial | | | | A: Yes. When a tragedy occurs or some extreme |
| treatments may be as effective as medication. | | | | stress hits, every member of a family is |
| | | | affected, even the youngest ones. This should |
| Q: How should medication be included in an | | | | also be considered when evaluating mental, |
| overall treatment plan? | | | | emotional, or behavioral symptoms in a child. |