The American Academy of Pediatrics (AAP) has released its first-ever guidance on nonpharmacologic management of mental health disorders in children.
The policy statement provides an overview of the challenges pediatricians face in offering interventions to children in an area where resources are so often limited.
Mary Margaret Gleason, MD, FAAP, is a pediatrician and child and adolescent psychologist, as well as the director for Tulane Infant Mental Health Services at Tulane University in New Orleans, Louisiana. As lead author of the guidance, she says this is the first policy statement focusing on nonpharmacologic interventions for emotional and behavioral problems in children and reflects a growing awareness that children can face mental health problems that impact their growth and development. The policy statement also addresses the issue of access.
“The evidence-based treatments have substantially more data supporting them than medications, but only 1 in 2 children with attention-deficit/hyperactivity disorder (ADHD) receives behavioral therapy, in part because there are insufficient numbers of therapists providing the treatment and also, perhaps, because these treatments have not been a focus of pediatric residency training and many pediatricians are not as comfortable with these treatments as with medications,” Gleason says.
There is growing evidence that demonstrates the efficacy of family-focused therapies in improving emotional, behavioral, and relationship problems, according to the statement, but access to these therapies can be a challenge. In many areas of the country, there is limited access to pediatric mental healthcare providers and pediatricians become the primary provider. However, many pediatricians have only rudimentary training in mental health care and can be overwhelmed at the prospect of providing therapeutic interventions outside of medication.
The problem is significant, with an estimated 7% to 10% of children facing emotional or behavioral problems, according to the statement—and they have a big impact.
“Emotional, behavioral, and relationship problems, including disorders of attachment, disruptive behavior disorders, ADHD, anxiety and mood disorders, and disorders of self-regulation of sleep and feeding in children aged younger than 6 years, interfere with development across multiple domains, including social interactions, parent-child relationships, physical safety, ability to participate in child care, and school readiness. Importantly, if untreated, these problems can persist and have long-lasting effects, including measurable abnormalities in brain functioning and persistent emotional and behavioral problems. In short, early emotional, behavioral, and relationship problems in preschool-aged children interfere with their current well-being, jeopardize the foundations of emotional and behavioral health, and have the potential for long-term consequences.”
Existing policy statements have addressed universal approaches to pediatric mental health care, but this is the first to focus on clinical interventions. There has been little research on the use of mental health medications in young children, and although nonpharmacologic interventions are backed by evidence-based research, most children with behavioral or emotional problems receive no interventions at all.
The first step to increasing access to these interventions is to familiarize pediatricians with the approaches and provide them the tools to make them available to their patients.
For infants and toddlers, the policy statement recommends dyadic interventions that promote attachment security and emotional regulation. These interventions can include infant-parent psychotherapy, video feedback to promote positive parenting, and attachment biobehavioral catch-up.
“These interventions often use real-time infant-parent interactions to support positive interactions, enhance parents’ capacity to reflect on their parenting patterns, and promote sensitivity and an understanding of the infant’s needs,” the policy states.