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					Treatment of
Children with
Mental Illness
Frequently asked questions
about the treatment of mental
illness in children


NATIONAL INSTITUTE OF MENTAL HEALTH




           U.S. Department of Health
           and Human Services
           National Institutes of Health
                                                          Introduction


R    esearch shows that half of all lifetime cases of mental illness begin by age 14.1 Scientists are discovering that
     changes in the body leading to mental illness may start much earlier, before any symptoms appear.

Through greater understanding of when and how fast specific areas         This fact sheet addresses common questions about diagnosis and
of children’s brains develop, we are learning more about the early        treatment options for children with mental illnesses. Disorders
stages of a wide range of mental illnesses that appear later in life.     affecting children may include anxiety disorders, attention deficit
Helping young children and their parents manage difficulties early in     hyperactivity disorder (ADHD), autism spectrum disorders, bipolar
life may prevent the development of disorders. Once mental illness        disorder, depression, eating disorders, and schizophrenia.
develops, it becomes a regular part of your child’s behavior and more
difficult to treat. Even though we know how to treat (though not yet
cure) many disorders, many children with mental illnesses are not
getting treatment.



Q.	 What should I do if I am                      Q.	 How do I know if my child’s                Q.	 Can symptoms be caused by a
     concerned about mental,                          problems are serious?                           death in the family, illness in
     behavioral, or emotional                     A.	 Not every problem is serious. In fact,          a parent, family financial prob­
     symptoms in my child?                            many everyday stresses can cause                lems, divorce, or other events?
A.	 Talk to your child’s doctor or health             changes in your child’s behavior. For      A.	 Yes. Every member of a family is
     care provider. Ask questions and learn           example, the birth of a sibling may             affected by tragedy or extreme stress,
     everything you can about the behavior            cause a child to temporarily act much           even the youngest child. It’s normal for
     or symptoms that worry you. If your              younger than he or she is. It is impor­         stress to cause a child to be upset.
     child is in school ask the teacher if your       tant to be able to tell the difference          Remember this if you see mental, emo­
     child has been showing worrisome                 between typical behavior changes and            tional, or behavioral symptoms in your
     changes in behavior. Share this with             those associated with more serious              child. If it takes more than one month
     your child’s doctor or health care pro­          problems. Pay special attention to              for your child to get used to a situation,
     vider. Keep in mind that every child is          behaviors that include:                         or if your child has severe reactions,
     different. Even normal development,              Problems across a variety of settings,          talk to your child’s doctor.
     such as when children develop lan­               such as at school, at home, or with             Check your child’s response to stress.
     guage, motor, and social skills, varies          peers                                           Take note if he or she gets better with
     from child to child. Ask if your child                                                           time or if professional care is needed.
                                                      Changes in appetite or sleep
     needs further evaluation by a specialist                                                         Stressful events are challenging, but
     with experience in child behavioral              Social withdrawal, or fearful behavior          they give you a chance to teach your
     problems. Specialists may include psy­           toward things your child normally is not        child important ways to cope.
     chiatrists, psychologists, social work­          afraid of
     ers, psychiatric nurses, and behavioral                                                     Q.	 How are mental illnesses
                                                      Returning to behaviors more common              diagnosed in young children?
     therapists. Educators may also help
                                                      in younger children, such as bed-
     evaluate your child.                                                                        A.	 Just like adults, children with mental
                                                      wetting, for a long time
     If you take your child to a specialist,                                                          illness are diagnosed after a doctor or
     ask, “Do you have experience treating            Signs of being upset, such as sadness           mental health specialist carefully
     the problems I see in my child?” Don’t           or tearfulness                                  observes signs and symptoms. Some
     be afraid to interview more than one             Signs of self-destructive behavior, such        primary care physicians can diagnose
     specialist to find the right fit. Continue       as head-banging, or a tendency to get           your child themselves, but many will
     to learn everything you can about the            hurt often                                      send you to a specialist who can diag­
     problem or diagnosis. The more you                                                               nose and treat children.
     learn, the better you can work with your         Repeated thoughts of death.
     child’s doctor and make decisions that
     feel right for you, your child, and your
     family.




1

    Before diagnosing a mental illness, the     Q.	 Are there treatment options                      CBT can be adapted to fit the needs of
    doctor or specialist tries to rule out          for children?                                    each child. It is especially useful when
    other possible causes for your child’s                                                           treating anxiety disorders.3
    behavior. The doctor will:
                                                A.	 Yes. Once a diagnosis is made, your
                                                    child’s specialist will recommend a spe­         Additionally, therapies for ADHD are
    Take a history of any important medical         cific treatment. It is important to under­       numerous and include behavioral par­
    problems                                        stand the various treatment choices,             ent training and behavioral classroom
    Take a history of the problem – how             which often include psychotherapy or             management. Visit the NIMH Web site
    long you have seen the problem – as             medication. Talk about the options with          for more information about therapies
    well as a history of your child’s               a health care professional who has               for ADHD.
    development                                     experience treating the illness observed         Some children benefit from a combina­
    Take a family history of mental disorders       in your child. Some treatment choices            tion of different psychosocial approaches.
                                                    have been studied experimentally, and            An example is behavioral parent man­
    Ask if the child has experienced physi­         other treatments are a part of health            agement training in combination with
    cal or psychological traumas, such as a         care practice. In addition, not every            CBT for the child. In other cases, a
    natural disaster, or situations that may        community has every type of service or           combination of medication and psycho­
    cause stress, such as a death in the            program.                                         social therapies may be most effective.
    family                                                                                           Psychosocial therapies often take time,
                                                Q.	 What are psychotropic
    Consider reports from parents and               medications?                                     effort, and patience. However, some­
    other caretakers or teachers.                                                                    times children learn new skills that may
                                                A.	 Psychotropic medications are sub­                have positive long-term benefits.
    Very young children often cannot                stances that affect brain chemicals
    express their thoughts and feelings, so         related to mood and behavior. In recent          More information about treatment
    making a diagnosis can be challenging.          years, research has been conducted to            choices can be found in the psycho­
    The signs of a mental illness in a young        understand the benefits and risks of             therapies and medications sections of
    child may be quite different from those         using psychotropics in children. Still,          the NIMH Web site.
    in an older child or adult.                     more needs to be learned about the           Q.	 When is it a good idea to use
    As parents and caregivers know, chil­           effects of psychotropics, especially in          psychotropic medications in
    dren are constantly changing and grow­          children under six years of age. While           young children?
    ing. Diagnosis and treatment must be            researchers are trying to clarify how
    viewed with these changes in mind.
                                                                                                 A.	 When the benefits of treatment out­
                                                    early treatment affects a growing body,
                                                                                                     weigh the risks, psychotropic medica­
    While some problems are short-lived             families and doctors should weigh the
                                                                                                     tions may be prescribed. Some children
    and don’t need treatment, others are            benefits and risks of medication. Each
                                                                                                     need medication to manage severe and
    ongoing and may be very serious. In             child has individual needs, and each
                                                                                                     difficult problems. Without treatment,
    either case, more information will help         child needs to be monitored closely
                                                                                                     these children would suffer serious or
    you understand treatment choices and            while taking medications.
                                                                                                     dangerous consequences. In addition,
    manage the disorder or problem most
                                                Q.	 Are there treatments other than                  psychosocial treatments may not
    effectively.
                                                    medications?                                     always be effective by themselves. In
    While diagnosing mental health prob­                                                             some instances, however, they can be
    lems in young children can be challeng­
                                                A.	 Yes. Psychosocial therapies can be very
                                                    effective alone and in combination with          quite effective when combined with
    ing, it is important. A diagnosis can be                                                         medication.
                                                    medications. Psychosocial therapies
    used to guide treatment and link your
                                                    are also called “talk therapies” or              Ask your doctor questions about the
    child’s care to research on children with
                                                    “behavioral therapy,” and they help              risks of starting and continuing your
    similar problems.
                                                    people with mental illness change                child on these medications. Learn
Q.	 Will my child get better with                   behavior. Therapies that teach parents           everything you can about the medica­
    time?                                           and children coping strategies can also          tions prescribed for your child. Learn
A.	 Some children get better with time. But         be effective.2                                   about possible side effects, some of
    other children need ongoing profes­             Cognitive behavioral therapy (CBT) is a          which may be harmful. Know what a
    sional help. Talk to your child’s doctor        type of psychotherapy that can be used           particular treatment is supposed to do.
    or specialist about problems that are           with children. It has been widely stud­          For example, will it change a specific
    severe, continuous, and affect daily            ied and is an effective treatment for a          behavior? If you do not see these
    activities. Also, don’t delay seeking           number of conditions, such as depres­            changes while your child is taking the
    help. Treatment may produce better              sion, obsessive-compulsive disorder,             medication, talk to his or her doctor.
    results if started early.                       and social anxiety. A person in CBT              Also, discuss the risks of stopping your
                                                    learns to change distorted thinking pat­         child’s medication with your doctor.
                                                    terns and unhealthy behavior. Children
                                                    can receive CBT with or without their
2                                                   parents, as well as in a group setting.
Q.	 Does medication affect young                 Q.	 What medications are used                    Q.	 Why haven’t many medications
    children differently than older                  for which kinds of childhood                     been tested in children?
    children or adults?                              mental disorders?                            A.	 In the past, medications were seldom
A.	 Yes. Young children handle medications A.	 Psychotropic medications include stim­                 studied in children because mental ill­
    differently than older children and              ulants, antidepressants, anti-anxiety            ness was not recognized in childhood.
    adults. The brains of young children             medications, antipsychotics, and mood            Also, there were ethical concerns about
    change and develop rapidly. Studies              stabilizers. Dosages approved by the             involving children in research. This led
    have found that developing brains can            U.S. Food and Drug Administration                to a lack of knowledge about the best
    be very sensitive to medications. There          (FDA) for use in children depend on              treatments for children. In clinical set­
    are also developmental differences in            body weight and age. NIMH’s medica­              tings today, children with mental or
    how children metabolize – how their              tions booklet describes the types of             behavioral disorders are being pre­
    bodies process – medications. There­             psychotropic medications and includes            scribed medications at increasingly
    fore, doctors should carefully consider          a chart that lists the ages for which            early ages. The FDA has been urging
    the dosage or how much medication to             each medication is FDA-approved. See             that medications be appropriately stud­
    give each child. Much more research is           the FDA Web site for the latest informa­         ied in children, and Congress passed
    needed to determine the effects and              tion on medication approvals, warn­              legislation in 1997 offering incentives
    benefits of medications in children of           ings, and patient information guides             to drug manufacturers to carry out
    all ages. But keep in mind that serious          at www.fda.gov.                                  such testing. These activities have
    untreated mental disorders themselves                                                             helped increase research on the effects
    can harm brain development.                  Q.	 What does it mean if a                           of medications in children.
                                                     medication is specifically                       There still are ethical concerns about
    Also, it is important to avoid drug inter­
                                                     approved for use in children?                    testing medications in children. How­
    actions. If your child takes medicine for
    asthma or cold symptoms, talk to your        A.	 When the FDA approves a medication,              ever, strict rules protect participants in
    doctor or pharmacist. Drug interactions          it means the drug manufacturer pro­              research studies. Each study must go
    could cause medications to not work as           vided the agency with information                through many types of review before,
    intended or lead to serious side effects.        showing the medication is safe and               and after it begins.
                                                     effective in a particular group of people.
Q.	 How should medication be                         Based on this information, the drug’s        Q.	 How do I work with my child’s
    included in an overall treatment                 label lists proper dosage, potential side        school?
    plan?                                            effects, and approved age. Medications       A.	 If your child is having problems in
A.	 Medication should be used with other             approved for children follow these               school, or if a teacher raises concerns,
    treatments. It should not be the only            guidelines.                                      you can work with the school to find a
    treatment. Consider other services,              Many psychotropic medications have               solution. You may ask the school to
    such as family therapy, family support           not been studied in children, which              conduct an evaluation to determine
    services, educational classes, and               means they have not been approved by             whether your child qualifies for special
    behavior management techniques. If               the FDA for use in children. But doctors         education services. However, not all
    your child’s doctor prescribes medica­           may prescribe medications as they feel           children diagnosed with a mental
    tion, he or she should evaluate your             appropriate, even if those uses are not          illness qualify for these services.
    child regularly to make sure the medi­           included on the label. This is called            Start by speaking with your child’s
    cation is working. Children need treat­          “off-label” use. Research shows that             teacher, school counselor, school
    ment plans tailored to their individual          off-label use of some medications                nurse, or the school’s parent organiza­
    problems and needs.                              works well in some children. Other               tion. These professionals can help you
                                                     medications need more study in chil­             get an evaluation started. Also, each
                                                     dren. In particular, the use of most psy­        state has a Parent Training and Infor­
                                                     chotropic medications has not been               mation Center and a Protection and
                                                     adequately studied in preschoolers.              Advocacy Agency that can help you
                                                     More studies in children are needed              request the evaluation. The evaluation
                                                     before we can fully know the appropri­           must be conducted by a team of pro­
                                                     ate dosages, how a medication works              fessionals who assess all areas related
                                                     in children, and what effects a medica­          to the suspected disability using a
                                                     tion might have on learning and                  variety of tools and measures.
                                                     development.




3
Q.	 What resources are available                     a child is diagnosed, frustration, blame,        Stress from caregiving can make it hard
    from the school?                                 and anger may have built up within a             to cope with your child’s symptoms.
                                                     family. Parents and children may need            One study shows that if a caregiver
A.	 Once your child has been evaluated,              special help to undo these unhealthy             is under enormous stress, his or her
    there are several options for him or her,        interaction patterns. Mental health pro­         loved one has more difficulty sticking to
    depending on the specific needs. If spe­         fessionals can counsel the child and             the treatment plan.4 It is important to
    cial education services are needed, and          family to help everyone develop new              look after your own physical and mental
    if your child is eligible under the Indi­        skills, attitudes, and ways of relating to       health. You may also find it helpful to
    viduals with Disabilities Education Act          each other.                                      join a local support group.
    (IDEA), the school district must develop
                                                     Parents can also help by taking part
    an “individualized education program”                                                         Q. Where can I go for help?
    specifically for your child within               in parenting skills training. This helps
    30 days.                                         parents learn how to handle difficult        A.	 If you are unsure where to go for help,
                                                     situations and behaviors. Training               ask your family doctor. Others who can
    If your child is not eligible for special        encourages parents to share a pleasant           help are listed below.
    education services, he or she is still           or relaxing activity with their child, to        Mental health specialists, such as psy­
    entitled to “free appropriate public edu­        notice and point out what their child            chiatrists, psychologists, social work­
    cation,” available to all public school          does well, and to praise their child’s           ers, or mental health counselors
    children with disabilities under Section         strengths and abilities. Parents may
    504 of the Rehabilitation Act of 1973.           also learn to arrange family situations          Health maintenance organizations
    Your child is entitled to this regardless        in more positive ways. Also, parents             Community mental health centers
    of the nature or severity of his or her          may benefit from learning stress-
    disability.                                                                                       Hospital psychiatry departments and
                                                     management techniques to help them
    The U.S. Department of Education’s                                                                outpatient clinics
                                                     deal with frustration and respond
    Office for Civil Rights enforces Section         calmly to their child’s behavior.                Mental health programs at universities
    504 in programs and activities that              Sometimes, the whole family may need             or medical schools
    receive Federal education funds. For             counseling. Therapists can help family           State hospital outpatient clinics
    more information about Section 504,              members find better ways to handle
    please see http://www.ed.gov/about/              disruptive behaviors and encourage               Family services, social agencies,
    offices/list/ocr/504faq.html.                    behavior changes. Finally, support               or clergy
    More information about programs for              groups help parents and families con­            Peer support groups
    children with disabilities is available at       nect with others who have similar prob­
    http://www.ed.gov/parents/needs/                 lems and concerns. Groups often meet             Private clinics and facilities
    speced/edpicks.jhtml?src=ln.                     regularly to share frustrations and suc­         Employee assistance programs
                                                     cesses, to exchange information about
Q.	 What special challenges can                      recommended specialists and strate­              Local medical and/or psychiatric
    school present?                                  gies, and to talk with experts.                  societies.
A.	 Each school year brings a new teacher                                                             You can also check the phone book
    and new schoolwork. This change can
                                                 Q.	 How can families of children                     under “mental health,” “health,” “social
    be difficult for some children. Inform           with mental illness get support?                 services,” “hotlines,” or “physicians”
    the teachers that your child has a men­      A.	 Like other serious illnesses, taking care        for phone numbers and addresses. An
    tal illness when he or she starts school         of a child with mental illness is hard on        emergency room doctor can also pro­
    or moves to a new class. Additional              the parents, family, and other caregiv­          vide temporary help and can tell you
    support will help your child adjust to           ers. Caregivers often must tend to the           where and how to get further help.
    the change.                                      medical needs of their loved ones, and           More information on mental health is at
                                                     also deal with how it affects their own          the NIMH Web site at www.nimh.nih.gov.
Q.	 What else can I do to help my                    health. The stress that caregivers are           For the latest information on medica­
    child?                                           under may lead to missed work or lost            tions, see the U.S. Food and Drug
A.	 Children with mental illness need guid­          free time. It can strain relationships           Administration Web site at www.fda.gov.
    ance and understanding from their par­           with people who may not understand
    ents and teachers. This support can              the situation and lead to physical and
    help your child achieve his or her full          mental exhaustion.
    potential and succeed in school. Before




4
Citations
1. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE.         For more information about children
   Prevalence, severity, and comorbidity of 12-month DSM-IV          and mental health
   disorders in the National Comorbidity Survey Replication.         Visit the National Library of Medicine’s MedlinePlus Web
   Arch Gen Psychiatry. 2005 Jun;62(6):617–27.                       site at http://medlineplus.gov
2. Silverman WK, Hinshaw SP. The Second Special Issue on             En Español, http://medlineplus.gov/spanish
   Evidence-Based Psychosocial Treatments for Children and
   Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol.     For information on clinical trials:
   2008 Jan–Mar;37(1).                                               NIMH supported clinical trials
3. Silverman WK, Hinshaw SP. The Second Special Issue on             http://www.nimh.nih.gov/health/trials/index.shtml
   Evidence-Based Psychosocial Treatments for Children and           National Library of Medicine Clinical Trials Database
   Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol.     http://www.clinicaltrials.gov
   2008 Jan–Mar;37(1).
                                                                     Clinical trials at NIMH in Bethesda, MD
4. Perlick DA, Rosenheck RA, Clarkin JF, Maciejewski PK, Sirey J,    http://patientinfo.nimh.nih.gov
   Struening E, Link BG. Impact of family burden and affective
                                                                     Information from NIMH is available in multiple formats.
   response on clinical outcome among patients with bipolar
                                                                     You can browse online, download documents in PDF, and
   disorder. Psychiatr Serv. 2004 Sep;55(9):1029–35.
                                                                     order materials through the mail. Check the NIMH Web
                                                                     site at http://www.nimh.nih.gov for the latest information
Reprints                                                             on this topic and to order publications. If you do not have
                                                                     Internet access please contact the NIMH Information
NIMH publications are in the public domain and may be repro­         Resource Center at the numbers listed below.
duced or copied without the permission from the National Institute
of Mental Health. NIMH encourages you to reproduce them and          National Institute of Mental Health
use them in your efforts to improve public health. Citation of the   Science Writing, Press & Dissemination Branch
National Institute of Mental Health as a source is appreciated.      6001 Executive Boulevard
However, using government materials inappropriately can raise        Room 8184, MSC 9663
legal or ethical concerns, so we ask you to use these guidelines:    Bethesda, MD 20892-9663
                                                                     Phone: 301-443-4513 or
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                                                                     TTY: 301-443-8431 or
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    used in a manner that has the appearance of such information.    Web site: http://www.nimh.nih.gov
    NIMH requests that non-Federal organizations not alter
    publications in a way that will jeopardize the integrity and
    “brand” when using publications.
    Addition of non-Federal Government logos and Web site links
    may not have the appearance of NIMH endorsement of any
                                                                     U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
    specific commercial products or services or medical treat­
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    ments or services.
                                                                     National Institute of Mental Health
If you have questions regarding these guidelines and use of
NIMH publications, please contact the NIMH Information               NIH Publication No. 09-4702
Resource Center at 1-866-615-6464 or e-mail nimhinfo@nih.gov.        Revised 2009




                 U.S. Department of Health
                 and Human Services
                 National Institutes of Health

				
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