Mental health conditions in children are common, and they are treatable. According to the World Health Organization and the National Institute of Mental Health (NIMH), half of all mental illnesses that occur over a lifetime begin by age 14. Conditions such as ADHD, oppositional defiant disorder (ODD) and autism are usually recognized in childhood, while anxiety disorders, obsessive-compulsive disorder (OCD) and depression can begin in childhood or later. This guide explains the main treatment options, who provides them, how medication fits in and how families can tell which level of care a child needs.
Key points
- NIMH: half of all lifetime mental illnesses begin by age 14.
- Treatment usually means psychotherapy, medication or both, together with support from the family and the school.
- Therapies with the strongest evidence include cognitive behavioral therapy, parent training, interpersonal therapy for teens and applied behavior analysis for autism.
- For preschoolers with ADHD, the American Academy of Pediatrics recommends parent training first.
- In a crisis, call or text 988, the Suicide and Crisis Lifeline.
Treatment starts with a careful evaluation
A good treatment plan depends on an accurate picture of the child. Before treatment begins, a pediatrician, child psychiatrist or psychologist gathers information from parents, teachers and the child, rules out medical causes and checks for other conditions that often occur together. How this works is described in detail in How Is Mental Illness in Children Diagnosed.
The NIMH describes three building blocks of treatment: psychotherapy, medication, and a combination of both. Around them, family involvement and school support make a large difference. Which approach comes first depends on the diagnosis, the child’s age, how severe the symptoms are and what the family prefers.
Who provides treatment
- Pediatricians and family doctors often provide the first evaluation, treat ADHD and mild anxiety or depression, and refer to specialists.
- Child and adolescent psychiatrists are medical doctors who diagnose and treat complex conditions and can prescribe medication.
- Psychologists provide testing and psychotherapy.
- Licensed clinical social workers and professional counselors provide therapy and help families connect with services.
- School psychologists and counselors support children during the school day and help plan accommodations.
Psychotherapy: the main forms
Cognitive behavioral therapy (CBT)
CBT teaches children to notice unhelpful thoughts and replace them with more realistic ones, and to practice new behaviors step by step. For anxiety disorders and OCD, CBT includes gradual exposure: with the therapist’s support, the child faces feared situations in small steps instead of avoiding them. For OCD, this is called exposure and response prevention. Read more about cognitive therapy for children.
Parent training and Parent-Child Interaction Therapy
For young children with ADHD or disruptive behavior, the most effective work often happens with the parents. Parent training in behavior management teaches clear instructions, specific praise, consistent consequences and calm time-outs. Parent-Child Interaction Therapy (PCIT) is a structured form for children aged about 2 to 7 in which a therapist coaches the parent live, often through an earpiece, while parent and child play together.
Interpersonal therapy for adolescents (IPT-A)
IPT-A is a short-term therapy for teen depression. It focuses on relationships and life changes such as conflicts with parents, the loss of a friendship or a move. See interpersonal therapy for children.
Family therapy
Family therapy looks at communication patterns and conflicts that keep problems going. It helps parents and siblings respond in ways that support the child. More on family therapy for children with behavioral disorders.
Behavioral therapy and applied behavior analysis
Behavioral therapy rewards desired behavior in small, achievable steps. Applied behavior analysis (ABA) uses these principles intensively to build communication, social and daily living skills in children with autism. Self-instruction training, in which a child says the steps of a task out loud while doing it, is one technique from this field.
Supportive approaches for younger children
Young children often cannot put feelings into words. Several approaches use play and creativity instead, usually as part of a broader plan rather than on their own:
- Play therapy is used with children aged about 3 to 12. Toys, puppets and storytelling let the child express feelings indirectly; for example, the child describes how a character in a story feels. Blowing bubbles can be used to practice slow, controlled breathing.
- Art therapy lets children draw or paint events and feelings. The therapist talks with the child about the picture and the themes in it.
- Animal-assisted therapy includes sessions with trained dogs or horses. Caring for and riding horses can encourage attention, social contact and responsibility, and a calm dog can make it easier for an anxious child to talk. Research on these methods is more limited than for CBT or parent training.
The role of medication
Medication can be an important part of treatment for some conditions, usually together with therapy. Several medicines are approved by the US Food and Drug Administration (FDA) for specific childhood conditions, for example:
- ADHD: stimulant medicines based on methylphenidate or amphetamine, and non-stimulant options such as atomoxetine, guanfacine extended release and clonidine extended release.
- Depression: fluoxetine from age 8 and escitalopram from age 12.
- OCD: sertraline from age 6, fluoxetine from age 7, fluvoxamine from age 8 and clomipramine from age 10.
- Irritability associated with autism: risperidone and aripiprazole.
The American Academy of Pediatrics (AAP) recommends that children aged 4 to 5 with ADHD start with parent training in behavior management, with medication considered if that is not enough. For school-age children, the AAP recommends FDA-approved medication together with behavioral treatment.
All antidepressants carry an FDA boxed warning about an increased risk of suicidal thoughts and behaviors in children, teens and young adults. This does not mean they should never be used. It means children starting or changing the dose need close monitoring, especially in the first weeks. More on the safety of antidepressants in childhood depression.
Levels of care
Treatment can take place in different settings depending on how severe the problems are:
- Outpatient care: regular appointments, often weekly, with a therapist, pediatrician or psychiatrist. Most children are treated this way.
- School support: an Individualized Education Program (IEP) or a 504 plan can provide accommodations such as extra time, a quiet place to work, counseling or a behavior plan.
- Intensive outpatient programs: several hours of treatment on several days a week while the child lives at home.
- Partial hospitalization: a full day of treatment on most weekdays, with the child going home in the evening.
- Inpatient care: a short hospital stay when a child is in danger or symptoms cannot be managed safely at home.
How families can support treatment
- Attend appointments and practice the skills from therapy at home.
- Keep teachers informed and coordinate with the school counselor.
- Give medication exactly as prescribed and report side effects or changes in mood.
- Keep routines for sleep, meals and physical activity steady.
- Look after your own health. Parent support groups and family counseling help many parents.
If a child talks about suicide, harms themselves or is in danger, call or text 988, the Suicide and Crisis Lifeline, or call 911 in an emergency.
Frequently Asked Questions
How do professionals decide between therapy and medication?
They consider the diagnosis, the child’s age, how severe the symptoms are, earlier treatments and the family’s preferences. For many conditions therapy comes first; for others, such as ADHD in school-age children, a combination is recommended.
How long does treatment take?
It varies. Structured therapies such as CBT or IPT-A often take about 12 to 20 sessions, while conditions such as ADHD or autism usually need longer-term support that changes as the child grows.
Are play therapy and animal-assisted therapy effective?
They can help younger children express feelings and engage in treatment. The research base is smaller than for CBT and parent training, so they are usually used alongside these approaches.
What can the school do?
Schools can provide counseling, accommodations through an IEP or 504 plan and regular feedback to parents and clinicians about how the child is doing in class.
This article is general information and does not replace an evaluation by a pediatrician or a licensed mental health professional.
