My heart fell when I saw this headline yesterday in my Google Alerts:
Psychiatric Medication Treatment Guidelines For Preschoolers Issued
because who would have thought even 10 years ago that we would need such guidelines?
When I first started my professional life, over 30 years ago, I worked in community mental health. I was in charge of designing and directing a therapeutic nursery program in Lewiston, Maine. Those were the days when there were public funds from several sources available for mental health programs. Our program got referrals from parents, physicians, day care centers, Head Start and any other place where children between 3 and 5 were seen. Most of the kids we worked with were on Medicaid and from low income families -- exactly the kind of kids that today are being diagnosed bi-polar and medicated up the wazoo. In the two years I ran that program, none of the kids we saw were prescribed psychiatric meds. Of course, this was in the pre-Prozac dark ages and people still thought Ritalin was not appropriate for very young children. So we worked with the kids in our nursery program and with the parents and surprise! the kids improved. I can't see that kids in similar circumstances have changed so much that the same kind of approach wouldn't work now -- but of course, it requires funding and time and there is no money in it for the usual suspects.
The article reports:
"The number of preschool-age children being treated with stimulants, antidepressants and other psychiatric drugs is on the rise, despite limited research and a lack of clinical practice guidelines. In a first step toward standardizing treatment approaches, child mental health professionals have developed recommendations for specific disorders to help clinicians who are considering medications for children ages 3 to 6. Psychotherapy is recommended as first line of treatment."
In the department of small favors, I am delighted that the report establishes psychotherapy as the first line of treatment. But how many of these kids will receive it, given cutbacks in staffing and treatment?