Skip to Main Content
Skip Nav Destination

Data support family-focused interventions for young children with behavioral issues :

November 21, 2016

More than 10% of young children have clinically significant mental health problems, but most receive no interventions for their disorder. Although often not recognized, young children experience mental health problems at similar rates as older children.

Pediatricians can help close this gap in the health care delivery system by calling for improved access to care, more research identifying alternative models, adequate payment for providers and improved education on evidence-based interventions.

Those are among the recommendations in the new AAP policy statement and technical report Addressing Early Childhood Emotional and Behavioral Problems. The policy is available at and the technical report at; both will be published in the December issue of Pediatrics. The statements are from the AAP Council on Early Childhood, Committee on Psychosocial Aspects of Child and Family Health, and the Section on Developmental and Behavioral Pediatrics.

Early intervention and evidence-based family-focused therapies are key to helping young children with emotional and behavioral problems.Early intervention and evidence-based family-focused therapies are key to helping young children with emotional and behavioral problems.

The policy summarizes empirically supported approaches to mental health care for young children, describes barriers to interventions and proposes recommendations to enhance care.

“Early intervention is proven to be clinically effective as well as cost-effective, yet too many young children have inadequate access to these services,” said Mary Margaret Gleason, M.D., FAAP, a lead author of both reports. “The gap in services leaves families and their primary care pediatricians without the tools that we know can help.”

Evidence-based family-focused therapies are key, according to the reports.

Effective interventions support the attachment relationship and include infant-parent psychotherapy or Video-feedback Intervention to promote Positive Parenting or promote healthy coping strategies as in cognitive behavioral therapy. For preschoolers, parent management training models, such as parent-child interaction therapy, the Incredible Years series and Triple P (Positive Parenting Program), are effective in decreasing disruptive behaviors, according to the policy (see resources).

These programs are based on similar behavioral principles, prompting parents to reinforce positive behaviors, ignore low-level provocative behaviors and provide clear, consistent, safe responses to unacceptable behaviors.

Familiarity with the principles of evidence-based treatments “allows a primary care pediatrician to guide a parent effectively toward treatment likely to work,” Dr. Gleason said.

“We hope the policy statement and technical report will be helpful for pediatric providers to recognize the substantial gap between the evidence supporting family-focused therapies — with hundreds of randomized controlled trials — and medication treatments in this age group, with two rigorous randomized controlled trials.

“Because young children’s brains are developing extraordinarily rapidly, there is potential for lasting effects of family-focused interventions to shape the foundation of a child’s development. …We already know that these treatments can have long-lasting effects,” said Dr. Gleason. Conversely, the effect of psychopharmacologic treatments on a child’s rapidly developing brain remain mostly unknown, and these treatments have not been shown to have lasting positive effects for children, she noted.

Due to the extreme shortage of child mental health providers, Dr. Gleason said it is particularly important to advocate for innovative approaches to delivering the best possible care. Models that offer pediatricians support through consultation may be one way to begin to fill the gap, she said, adding: “Early childhood wellness is a team effort.”


  • Pediatricians can advocate for legislative and research approaches that will increase access to evidence-based treatments for young children with emotional, behavioral and relationship problems.
  • Pediatricians should collaborate with local agencies to identify services that can assist children and explore opportunities for innovative service delivery models such as consultation or co-location.
  • Primary care and developmental-behavioral pediatricians, along with early childhood mental health providers, child and adolescent psychiatrists, and developmental specialists, can create educational materials for trainees and providers to enhance care for young children.
  • Adequate payment is essential for early childhood preventive services.
  • Graduate medical education and continuing medical education should include training opportunities to ensure that pediatric providers are competent to identify young children with emotional, behavioral and relationship problems as well as risk and protective factors. They should be aware that common problems can be treated with evidence-based treatments; recognize limitations in the data supporting use of medications in very young children; are prepared to identify and address parental factors that influence early child development; and can collaborate and refer across disciplines and specialties.

The policy is endorsed by the American Academy of Child and Adolescent Psychiatry and Zero to Three.

Close Modal

or Create an Account

Close Modal
Close Modal