“Neither pediatricians nor psychiatrists have training in
offering psychosocial or psychological approaches to mental
health treatment,” Pelham says. “All they have in their toolkit is
Outside of urban areas, in particular, psychological treatments
can be hard to standardize, says Comer. “If you’re filling a
prescription at a CVS in Los Angeles or a Wal-Mart in Nebraska
or a Duane Reade in New York City, you’re getting the same
medication,” he explains. “But if you’re referring someone for a
well-supported psychological treatment across different providers,
there’s not that same guarantee in consistency across providers.”
Comer calls on psychologists to do a better job at getting
treatments disseminated to front-line practice settings. “The
amazing research that’s happening in clinical trials is not having
any impact because it’s not making its way into front-line
How can psychologists more broadly disseminate evidence-based psychological interventions for preschoolers?
When it comes to ADHD, Visser points to research-based
interventions in a 2011 report by the U.S. Department of Health
and Human Services’ Agency for Healthcare Research and Quality.
It found that formal parenting interventions — known as parent
behavior training, or PBT — are effective for children under age 6,
with no reports of complications or harm. In particular, the report
identifies four programs that have the most empirical support
— Triple P, Parent-Child Interaction Therapy (PCIT), Incredible
Years and the New Forest Parenting Programme.
All of these programs focus on positive parenting strategies,
including positive reinforcement for good behaviors and the
importance of having a consistent discipline style, Visser says.
Pelham says that the manuals for these programs are available
for free or for a very small fee, for psychologists interested in
learning more about the programs and some of the strategies
Gleason also notes that several studies point to the
effectiveness of cognitive-behavioral therapy (CBT) for children
experiencing post-traumatic stress disorder (PTSD) and anxiety
disorders. Research shows not only that children as young
as age 4 can learn the skills of CBT, but that the treatment
can help them better understand their feelings and reduce
symptoms of PTSD and anxiety. For example, a study led by
Michael Scheeringa, MD, a professor of child psychiatry at
Tulane University, found that 12 weeks of trauma-focused CBT
significantly improved symptoms of PTSD in 3- to- 6-year-old
children compared with a control group that was waitlisted 12
weeks for treatment (Journal of Child Psychology and Psychiatry,
2011). The effects were actually stronger at the six-month
follow-up, the authors note, suggesting that the treatment can
continue to be effective even after formal therapy has ended.
Another promising psychosocial intervention for young
children with depression is a parent-child psychotherapy
program called PCIT-ED, developed by Joan Luby, MD of
Washington University School of Medicine. The program
focuses on emotion development, but specifically targets
depression in young children. A 2011 pilot study with 54
depressed 3- to- 7-year-olds who participated in the program
found that it improved the children’s executive functioning
and emotion recognition skills compared with a control group
whose members received psychoeducational training, findings
that suggest it could be an early intervention for depression.
The researchers are continuing to test the program, Luby says.
Psychologists can help improve awareness about the
effectiveness of these treatments among pediatricians and
psychiatrists by continuing to take part in integrated care and
co-location opportunities with primary-care providers, Comer
says. Visser also notes that the CDC is working closely with the
American Academy of Pediatrics to educate physicians about
the fact that for these very young children, behavioral therapy
is the recommended first-line treatment. Comer and Visser
are also encouraging parents who have concerns about their
child’s behavior to seek a psychologist first, who can help them
understand and apply parenting and behavioral strategies.
Pelham suggests that more direct-to-consumer education
around parenting tips for dealing with a child showing
symptoms for ADHD could help reduce the number of young
children receiving unnecessary medication.
“Right now, all that gets advertised is medication,” he says.
Comer also points to electronic communication and
telecommunications technologies for help in overcoming
disparities in care and helping families who may not have
local access to quality providers of behavioral therapy for their
“Telehealth offers a potentially game-changing way to extend
the reach of supported care,” he says. But most important, he
adds, “we need to think harder about how psychological and
mental health care can be better integrated and coordinated
with pediatrics, rather than viewed as a separate health care
• ADHD: Clinical Practice Guideline for the Diagnosis,
Evaluation, and Treatment of Attention-Deficit/
Hyperactivity Disorder in Children and Adolescents:
• APA Div. 53 — Society of Clinical Child and
Adolescent Psychology: https://clinicalchildpsychology.org/.
• Effective Child Therapy: www.effectivechildtherapy.
• Florida International University Center for Children
and Families: http://ccf.fiu.edu/.