At one time or another, we all have taken our children to a mental health professional for a diagnosis and treatment, which may include therapy and sometimes medication. This newsletter is the first of a series focused on giving families more information about diagnosis and treatment and where to find accurate information on the Web. As families we need to understand as much as possible about diagnosis, treatment methods and potential risks. The Coalition compiled the following information from reliable sources, including the National Institute of Mental Health (NIMH), U.S. National Library of Medicine (Medline) and the American Academy of Child and Adolescent Psychiatry. We hope you find the information helpful and that you share it with other families. We're all in this together!
- Jane A. Walker
Executive Director
Therapy - What Should I Expect?
Psychotherapy is a form of treatment that can help children and families understand and resolve problems, modify behavior and make positive changes in their lives. There are several types of psychotherapy that involve different approaches, techniques and interventions. At times, a combination of different psychotherapy approaches may be helpful. In some cases, a combination of medication with psychotherapy may be more effective.
Different types of psychotherapy: (alphabetical order)
Cognitive Behavior Therapy (CBT) helps improve a child's moods and behavior by examining confused or distorted patterns of thinking. During CBT, the child learns that thoughts cause feelings and moods that can influence behavior. For example, if a child is experiencing unwanted feelings or has problematic behaviors, the therapist works to identify the underlying thinking that is causing them. The therapist then helps the child replace this thinking with thoughts that result in more appropriate feelings and behaviors. Research shows that CBT can be effective in treating depression and anxiety.
Dialectical Behavior Therapy (DBT) can be used to treat older adolescents who have chronic suicidal feelings/thoughts, engage in intentional self-harm or have Borderline Personality Disorder. DBT emphasizes taking responsibility for one's problems and helps the person examine how they deal with conflict and negative feelings. This often involves a combination of group and individual sessions.
Family Therapy focuses on helping the family function in more positive and constructive ways by exploring patterns of communication and providing support and education. Family therapy sessions can include the child or adolescent along with parents, siblings and grandparents. Couples Therapy is a specific type of family therapy that focuses on a couple's communication and interactions (e.g., parents having marital problems).
Group Therapy uses the power of group dynamics and peer interactions to increase understanding and improve social skills. There are many different types of group therapy (e.g., psychodynamic, social skills, substance abuse, multifamily, parent support, etc.).
Interpersonal Therapy (IPT) is a brief treatment specifically developed and tested for depression. The goals of IPT are to improve interpersonal functioning by decreasing the symptoms of depression. IPT has been shown to be effective in adolescents with depression.
Play Therapy involves the use of toys, blocks, dolls, puppets, drawings and games to help the child recognize, identify and verbalize feelings. The psychotherapist observes how the child uses play materials and identifies themes or patterns to understand the child's problems. Through a combination of talk and play, the child has an opportunity to better understand and manage their conflicts, feelings and behavior.
Psychodynamic Psychotherapy emphasizes understanding the issues that motivate and influence a child's behavior, thoughts and feelings. It can help identify a child's typical behavior patterns, defenses and responses to inner conflicts and struggles.
Psychoanalysis is a specialized, more intensive form of psychodynamic psychotherapy that usually involves several sessions per week. Psychodynamic psychotherapies are based on the assumption that a child's behavior and feelings will improve once the inner struggles are brought to light.
Psychotherapy is not a quick fix or an easy answer. It is a complex and rich process that can reduce symptoms, provide insight and improve a child or adolescent's functioning and quality of life. Child and adolescent psychiatrists are trained in different forms of psychotherapy and, if indicated, are able to combine these forms of treatment with medications to alleviate the child or adolescent's emotional and/or behavioral problems.
Source: Facts for Families© No. 86 American Academy of Child and Adolescent Psychiatry (AACAP), www.aacap.org . Reprinted with the permission of the American Academy of Child and Adolescent Psychiatry 2008 © All Rights Reserved.
Medication - What Should I Know?
When medication is used, it should not be the only strategy. There are other services you may want to investigate for your child. Family support services, educational classes, behavior management techniques, family therapy and other approaches should be considered. If medication is prescribed, it should be monitored and evaluated regularly.
There are several major categories of psychotropic medications—stimulants, antidepressants, anti-anxiety agents, antipsychotics and mood stabilizers. For medications approved by the FDA for use in children, dosages depend on body weight and age. The medications chart below shows the most commonly prescribed medications for children with mood or anxiety disorders (including OCD).
Stimulant Medications - There are four stimulant medications that are approved for use in the treatment of attention deficit hyperactivity disorder (ADHD), the most common behavioral disorder of childhood. These medications have been extensively studied and are specifically labeled for pediatric use. Children with ADHD exhibit such symptoms as short attention span, excessive activity and impulsivity that cause substantial impairment in functioning. Stimulant medication should be prescribed only after a careful evaluation to establish the diagnosis of ADHD and to rule out other disorders or conditions. Medication treatment should be administered and monitored in the context of the overall needs of the child and family, and consideration should be given to combining it with behavioral therapy. If the child is of school age, collaboration with teachers is essential.
Antidepressant and Antianxiety Medications - These medications follow the stimulant medications in prevalence among children and adolescents. They are used for depression, a disorder recognized only in the last 20 years as a problem for children, and for anxiety disorders, including obsessive-compulsive disorder (OCD). The medications most widely prescribed for these disorders are the selective serotonin reuptake inhibitors (the SSRIs).
In the human brain, there are many "neurotransmitters" that affect the way we think, feel and act. Three of these neurotransmitters that antidepressants influence are serotonin, dopamine and norepinephrine. SSRIs affect mainly serotonin and have been found to be effective in treating depression and anxiety without as many side effects as some older antidepressants.
Antipsychotic Medications - These medications are used to treat children with schizophrenia, bipolar disorder, autism, Tourette's syndrome and severe conduct disorders. Some of the older antipsychotic medications have specific indications and dose guidelines for children. Some of the newer “atypical” antipsychotics, which have fewer side effects, also are being used for children. Such use requires close monitoring for side effects.
Mood-Stabilizing Medications - These medications are used to treat bipolar disorder (manic-depressive illness). However, because there is very limited data on the safety and efficacy of most mood stabilizers in youth, treatment of children and adolescents is based mainly on experience with adults. The most typically used mood stabilizers are lithium and valproate (Depakote®), which often are very effective for controlling mania and preventing recurrences of manic and depressive episodes in adults. Research on the effectiveness of these and other medications in children and adolescents with bipolar disorder is ongoing. In addition, studies are investigating various forms of psychotherapy, including cognitive-behavioral therapy, to complement medication treatment for this illness in young people.
Effective treatment depends on appropriate diagnosis of bipolar disorder in children and adolescents. There is some evidence that using antidepressant medication to treat depression in a person who has bipolar disorder may induce manic symptoms if it is taken without a mood stabilizer. In addition, using stimulant medications to treat co-occurring ADHD or ADHD-like symptoms in a child with bipolar disorder may worsen manic symptoms. While it can be hard to determine which young patients will become manic, there is a greater likelihood among children and adolescents who have a family history of bipolar disorder. If manic symptoms develop or markedly worsen during antidepressant or stimulant use, a physician should be consulted immediately, and diagnosis and treatment for bipolar disorder should be considered.
| Type of Medication |
Brand Name |
Generic Name |
Approved Age |
| Stimulant Medications |
Adderall |
amphetamine |
3 and older |
| |
Concerta |
methylphenidate |
6 and older |
| |
Cylert* |
pemoline |
6 and older |
| |
Dexedrine |
dextroamphetamine |
3 and older |
| |
Dextrostat |
dextroamphetamine |
3 and older |
| |
Ritalin |
methylphenidate |
6 and older |
Antidepressant and Anti-
anxiety Medications |
Anafranil |
clomipramine |
10 and older (for OCD) |
| |
BuSpar |
buspirone |
18 and older |
| |
Effexor |
venlafaxine |
18 and older |
| |
Luvox (SSRI) |
fluvoxamine |
8 and older (for OCD) |
| |
Paxil (SSRI) |
paroxetine |
18 and older |
| |
Prozac (SSRI) |
fluoxetine |
18 and older |
| |
Serzone (SSRI) |
nefazodone |
18 and older |
| |
Sinequan |
doxepin |
12 and older |
| |
Tofranil |
imipramine |
6 and older (for bed-wetting) |
| |
Wellbutrin |
bupropion |
18 and older |
| |
Zoloft (SSRI) |
sertraline |
6 and older (for OCD) |
| Antipsychotic Medications |
Clozaril (atypical) |
clozapine |
18 and older |
| |
Haldol |
haloperidol |
3 and older |
| |
Risperdal (atypical) |
risperidone |
5 to 16 years (for irritability associated with autistic disorder); 18 and older (for schizophrenia and bipolar mania) |
| |
Seroquel (atypical) |
quetiapine |
18 and older |
| |
(Generic Only) |
thioridazine |
2 and older |
| |
Zyprexa (atypical) |
olanzapine |
18 and older |
| |
Orap |
pimozide |
12 and older (for Tourette’s syndrome).
Data for age 2 and older indicate similar safety profile. |
| Mood-Stabilizing Medications |
Cibalith-S |
lithium citrate |
12 and older |
| |
Depakote |
divalproex sodium |
2 and older (for seizures) |
| |
Eskalith |
lithium carbonate |
12 and older |
| |
Lithobid |
lithium carbonate |
12 and older |
| |
Tegretol |
carbamazepine |
any age (for seizures) |
*Because of its potential for serious side effects affecting the liver, Cylert should not ordinarily be considered
Source: National Institute of Mental Health, Bethesda , Md.: National Institute of Mental Health, National Institutes of Health , U.S. Department of Health and Human Services; (NIH Publication. No 00-4702).
Additional Web Resources
Families for Depression Awareness helps families recognize and cope with depressive disorders to get people well and prevent suicides. Its website includes wellness guides, brochures and links to support groups.
National Alliance on Mental Illness (NAMI) features a Child and Adolescent Action Center on its website, which you can visit by clicking here . The Action Center includes discussion groups, news and information, including sections on juvenile justice and education.
Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services has a National Mental Health Information Center on its website that includes a section on Child and Adolescent Mental Health . Program summaries, information on systems of care and links to other resources are available. Specific information on teen mental health problems also is available.
American Academy of Child and Adolescent Psychiatry provides information on developmental, behavioral and mental disorders affecting children and adolescents.
American Association for Marriage and Family Therapy offers facts on therapy, links to books and articles and help in locating a local therapist.
Child & Adolescent Bipolar Foundation provides message boards, chat rooms, online support groups, a searchable database and research data for families.
National Mental Health and Education Center provides information in English and Spanish for teaches and parents.
National Resource Center on ADHD: A Program of CHADD serves as a national clearinghouse for information and resources on attention-deficit hyperactivity disorder. Information is available in English and Spanish.
United Parents for Families in Crisis provides support, assistance, education and resources for families of children with emotional, behavioral and mental disorders.
Upcoming Events
Respite Care Training and Train the Trainer Workshops, May 30–31 and June 7, 9:30 a.m.–4:30 p.m. each day. Free; limited registration. Contact the Carroll County Respite Connection at 410.549.5707 or e-mail mona@caringcommunities.org for more information.
Respite Care Training and Train the Trainer Workshops, June 13–14 and June 21, 9:30 a.m.–4:30 p.m. each day. Free; limited registration. Contact the Carroll County Respite Connection at 410.549.5707 or e-mail mona@caringcommunities.org for more information.
Maryland Youth Leadership Forum, July 28–Aug. 1, Bowie State University. Rising high school juniors and seniors with disabilities are eligible to apply for this weekend of activities and events to teach self-advocacy skills. For more information, contact DaRue Doakes at 240-898-2185 and visit www.md-ylf.org to access the application form.
