The American Academy of Pediatrics recommends increasing access to proven parent-child techniques for helping children; evidence sparse on medication's effects
Family-focused therapy has been proven to help reduce a very young child's symptoms of emotional, behavioral and relationship problems and offer long-term positive effects, but most children receive no evidence-based interventions for these problems, according to a new policy statement issued by the American Academy of Pediatrics (AAP).
The policy statement, "Addressing Early Childhood Emotional and Behavioral Problems," to be published in the December 2016 Pediatrics (online Nov. 21), provides a summary of evidence-based interventions in early childhood and recommends ways that pediatricians can advocate for better access to services.
The statement has been endorsed by Zero to Three and the American Academy of Child and Adolescent Psychiatry. An accompanying technical report with the same title reviews the data supporting treatments for young children.
"At least 7 to 10 percent of preschoolers experience these kinds of problems, which cause substantial suffering, interfere with child and family functioning, and can be associated with long-term developmental difficulties," said Mary Margaret Gleason, MD, FAAP, lead author of the report, on behalf of the Council on Early Childhood.
"While there is little research on the use of medications with the youngest children, we know that many children can benefit from therapy that includes parents, often as agents of change," Dr. Gleason said.
The problems exhibited by up to 10 percent of young children include reactive attachment disorder; disruptive behavior disorders; attention-deficit/hyperactivity disorder (ADHD); anxiety and mood disorders; and difficulty in sleep and feeding, according to the report. Some of these concerns may not fulfill criteria for a formal diagnostic code but need treatment to be paid for by insurers.
Early adversity, such as parental postpartum depression, substance abuse, poverty, abuse and neglect may jeopardize lifelong well-being, according to the policy statement.
Pediatricians can help by screening children for risk factors. While prevention is an important component, this report deals with those already suffering. The cost effectiveness of prevention and early treatment may be an important way to control long-term health care costs.
Many family-focused interventions have been proven to have substantially more lasting effects than medications have been, yet increasing numbers of younger children are being prescribed psychotropic medications, according to the policy statement. The evidence base is limited to studies on medication for (ADHD), and the clinical practice has far outpaced the evidence for safety or efficacy, especially for children in foster care, according to the report. Behavioral treatments are the best first line of treatments for these children.
"We have found parent training programs that work in treating ADHD and behavior problems," said Edward Goldson, MD, FAAP, a co-author of the report, on behalf of the AAP Section on Developmental and Behavioral Pediatrics. "All of them share common principles, such as teaching parents to reward their children's positive behavior and ignore bad behavior. They need to be consistent, more than anything."
Many families do not have access to such treatments, though, because of where they live, a shortage of trained early childhood mental health providers, or insurance barriers.
"Behavioral concerns in early childhood are one of the most common concerns at pediatric office visits, and we now have evidenced-based treatments that are likely to show long-term improvements in children's behavior, development, school performance and health," according to Michael Yogman MD, FAAP, one of the co-authors of the statement and chair of the Committee on Psychosocial Aspects of Child and Family Health.
"It is time to invest wisely in this domain."
The policy statement recommends that pediatricians advocate for increased funding of research on evidence-based treatments, pediatric training and support for integrated behavioral health in pediatric settings. Pediatricians may also collaborate with community agencies, especially those in child care, to provide mental health consultation and prevent preschool expulsion, and advocate for a trained workforce in early childhood mental health.