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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Effective Treatments for Mental Disorders in Children and Youth

Christine Schwartz, MA, PhD, RPsych, Charlotte Waddell, MSc, MD, CCFP, FRCPC (Child and Adolescent Psychiatry), Jen Barican, MPH, and Daphne Gray-Grant, BA (Honours)

Reprinted from the "Treatments: What Works?" issue of Visions Journal, 2015 15 (4), pp. 35-37

Mental disorders are the leading health problems that Canadian children and youth face from infancy onwards. In fact, at any given time, an estimated 12.6% of young people ages 4 to 17 years—or nearly 84,000 young people in BC—are experiencing these disorders.1

As well, only 30% of children and youth with mental disorders are estimated to receive needed treatment services, and few prevention programs are offered.1 And without effective prevention or treatment, disorders that emerge in childhood usually persist—leading to lifelong distress and symptoms, as well as impairment, or the reduced ability to participate in life, school and work.

These numbers are troubling. However, the good news is that effective treatments exist for all of the mental disorders affecting young people. Some of the most common disorders even have more than one effective treatment.

Which treatments help young people?

The table (see below)1 presents those treatments that have been found to be effective for young people. Each one has produced significant benefits according to at least two rigorous evaluations using randomized-controlled trial methods in children or youth.

Among the psychosocial (or non-medication) treatments, cognitive-behavioural therapy (CBT) shows particularly strong results. There is evidence that it is effective in treating seven of the 10 disorders listed in the table, including with children as young as six.

For anxiety—the most common group of childhood mental disorders—mental health practitioners have successfully delivered CBT to groups of children and youth in schools and clinics. This is a cost-effective way to serve many more young people. Children and youth have also had success using self-guided CBT for anxiety, for example, with telephone support from practitioners. With this latter mode of delivery, CBT has great potential to help young people who have traditionally been hard to serve, such as those living in remote communities.

Certain medications can also reduce symptoms. For bipolar disorder and schizophrenia, in particular, newer antipsychotic medications are supported by rigorous randomized-controlled trial evaluations in young people. However, for many conditions—including some that are very common such as anxiety, conduct and depressive disorders—medications should be used only after effective psychosocial treatments have been tried and young people have not responded. Whenever psychiatric medications are used, close monitoring is needed, since serious side effects can occur.

More resources are needed

Given that 70% of children and youth with mental disorders do not currently receive effective treatments, it is imperative that we address this tremendous gap in services.1 This gap would not be tolerated for childhood cancer or diabetes and it should not be tolerated for childhood mental disorders. The public resources going toward child and youth mental health therefore need to be dramatically increased—so that every young person with a mental disorder can receive effective interventions.

As well as providing effective treatments for all 84,000 young people estimated to have mental disorders in BC at any given time, we need to prevent disorders where we can. There are effective programs for preventing the four of the most common conditions: anxiety, substance use, conduct and major depressive disorders.2 Taken together, these four disorders affect an estimated 58,000 young people in BC at any given time.2

Successful prevention approaches include parent training and CBT starting in the early years—approaches that many practitioners are familiar with.2 By adding prevention programs into the mix, we can begin to reduce the number of people who needlessly experience the symptoms, distress and impairment associated with childhood mental disorders—problems which then often continue over a lifetime.

 

Table: Effective Treatments for Child and Youth Mental Disorders1

Anxiety Disorders (Affect 3.8% or 25,300 BC children and youth)*

Cognitive-behavioural therapy (CBT), and antidepressant medication (fluoxetine; when CBT has not succeeded)

Attention-Deficit/Hyperactivity Disorder (Affects 2.5% or 16,600 BC children and youth)

Behavioural therapy, CBT, parent training, neurofeedback, and medications (methylphenidate, dextroamphetamine and atomoxetine)

Autism Spectrum Disorders (Affect 0.6% or 4,000 BC children and youth)

Intensive behavioural intervention (IBI), and newer antipsychotic medications (risperidone and aripiprazole; when IBI has not succeeded)

Bipolar Disorder (Affect 0.6% or 2,100 BC youth)

Newer antipsychotic medications (risperidone, aripiprazole and quetiapine)

Conduct Disorder (Affects 2.1% or 14,000 BC children and youth)

Parent training, CBT combined with parent training and family therapy, and newer antipsychotic medications (risperidone and quetiapine; when psychosocial treatments have not succeeded)

Eating Disorders (Affect 0.1% or 300 BC youth)

Family therapy (for anorexia)

Major Depressive Disorder (Affects 1.6% or 10,600 BC children and youth)

CBT, interpersonal psychotherapy (IPT), and antidepressant medications (fluoxetine; when CBT or IPT have not succeeded)

Obsessive-Compulsive Disorder (Affects 0.4% or 2,700 BC children and youth)

CBT (exposure + response prevention), and antidepressants (fluoxetine and sertraline; when CBT has not succeeded)

Schizophrenia (Affects 0.1% or 300 BC youth)

Newer antipsychotic medications (risperidone and olanzapine)

Substance Use Disorders (Affects 2.4% or 8,400 BC youth)

CBT, family therapy, and motivational training

* All numbers are estimates based on high-quality epidemiological surveys1

 

 
About the authors

Christine, Charlotte, Jen and Daphne all work with the Children’s Health Policy Centre in the Faculty of Health Sciences at Simon Fraser University in Vancouver. The centre focuses on improving children’s social and emotional well-being and on the public policies needed to reach this goal. For more information, please see childhealthpolicy.ca

Footnotes:
  1. Waddell, C., Shepherd, C.A., Schwartz, C., & Barican, J. (2014). Child and youth mental disorders: Prevalence and evidence-based interventions. Vancouver, BC: Children’s Health Policy Centre, Simon Fraser University. (Please see childhealthpolicy.ca.)
  2. Waddell, C., Schwartz, C., Barican, J, Andres, C., & Gray-Grant, D. (2015). Improving children’s mental health: Six highly effective psychosocial interventions. Vancouver, BC: Children’s Health Policy Centre, Simon Fraser University. (Please see childhealthpolicy.ca.)

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