Few Young Children Get Behavioral Interventions They Need

Marcia Frellick

November 21, 2016

Evidence-based, family-focused therapy has proven benefits for emotional, behavioral, and relationship problems among young children, but few get the interventions, according to a new policy statement issued by the American Academy of Pediatrics (AAP), published online November 21 in Pediatrics.

The statement notes that these problems, including attachment disorders, disruptive behavior, attention-deficit/hyperactivity disorder (ADHD), mood disorders, and disorders tied to sleeping and feeding affect 7% to 10% of preschoolers, which is almost the same prevalence as for older children.

"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," Michael Yogman, MD, a coauthor of the statement and chair of the Committee on Psychosocial Aspects of Child and Family Health, writes in a press release.

Untreated, behavioral disorders can have long-lasting effects including brain function abnormalities and persistent emotional problems. But many families do not have access to treatment for the disorders because of their location, a shortage of providers, or insurance barriers.

"It is time to invest wisely in this domain," Dr Yogman says.

Examples of effective interventions include infant–parent psychotherapy, video feedback for positive parenting, attachment biobehavioral catch-up, parent–child interaction therapy, and programs such as the Incredible Years series, the New Forest Program, and Helping the Noncompliant Child. An accompanying technical report, also published online November 21 in Pediatrics, reviews the data supporting treatments for young children.

In addition, increasing numbers of children are being treated with psychotropic medications, rather than with these programs, although evidence of the drugs' efficacy in children younger than 6 years is limited, and studies have only addressed ADHD, according to the AAP's Council on Early Childhood, Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics.

Pediatricians, as leaders of the medical home, play a critical role in promoting the use of such programs, committee members write, and in knowing the limitations of pharmacotherapy.

Making sure that parents have the support they need (eg, treatment for depression) is often an important clinical intervention for children. The authors note that parental support may reduce children's symptoms.

Pediatricians and other care providers can also reduce the risk for emotional and behavioral problems by reducing a child's exposure to toxic stress and systematically screening for risk factors for emerging problems.

"Existing policy statements address universal approaches, early identification, and strategies for children at risk," the authors note.

Call for Physician Action

The AAP also urges pediatricians to advocate for more research into identifying care delivery approaches and more funding for that research, adequate pay for pediatric providers who serve these children, and more education for providers about evidence-based interventions.

The statement also urges pediatricians to work with community agencies, especially those in child care, to consult on mental health and prevent preschool expulsion, and to advocate for better training in early childhood mental health.

On the legislative front, pediatricians are urged to push for funding for programs that can get the word out about evidence-based treatments, especially in areas with limited resources, for addressing the early childhood mental health workforce shortage with incentives for training in these specialties and decreasing third-party payer barriers.

"Many health care systems do not pay for, or underpay for, necessary components of early childhood care such as care conferences, school observations, discussions with additional caregivers, same-day services, care coordination, and appointments that do not include face-to-face treatment of the child," the statement authors point out.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online November 21, 2016. Policy statement full text, Technical report full text

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