Harvard Mental Health Letter

Treating preschoolers with psychiatric disorders

Experts develop treatment algorithms for nine disorders.

In 2000, in an editorial published in the Journal of the American Medical Association, Harvard psychiatrist Joseph Coyle warned that psychiatrists were prescribing medications to children as a quick fix, rather than offering the type of multidisciplinary therapy that improves outcomes. The same year, the American Academy of Child and Adolescent Psychiatry (AACAP) recommended that guidelines be developed for drug treatment of preschoolers with psychiatric disorders.

As a first step in that direction, a working group of experts from 12 medical schools and institutions, convened by the AACAP, has published treatment algorithms for nine mental health conditions diagnosed in young children.

One of the reasons the algorithms took so long to develop is that treatment decisions, which are always complicated, are especially difficult when it comes to preschoolers. Children mature at different rates, so it's sometimes hard to distinguish normal variations in temperament or development from burgeoning mental health problems. And while any medication involves risks in preschoolers, not treating psychiatric disorders also has consequences — which means that clinicians and parents face a delicate balancing act in deciding upon treatment.

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