Child and Adolescent Psychiatry

Preschool Problems 185

Treatment

When preschool children have one of the psychiatric syndromes covered
elsewhere in this book, treatment generally follows the standard lines
discussed in the relevant chapter. Liaison with the education authority is
particularly important for children with chronic disorders such as autism,
since it is often helpful for the education authority to know in advance
about children with emotional, behavioural and learning problems that
are likely to require special educational provision. Early warning may also
allow the child to be placed in an appropriate playgroup or nursery school,
which will often help not only the child but also the worn-out parents.
If the assessment identifies one or more problem areas rather than a
specific diagnosis, management strategies need to be considered for each
problem. In some instances, parents may not feel that any treatment is
necessary once they have been reassured that a problem is common and
likely to be short-lived (and told how and when to get back in touch in
the event that the problem does persist). When treatment is indicated,
behavioural approaches are often particularly valuable. For example, if
temper tantrums or night wakening are being reinforced by parental
attention, the solution may be to pay less attention to the problem. The
behavioural programme needs to be tailored to the characteristics of the
parents as well as those of the child. For example, if parents do not have
nerves of steel, they may find it hard to ‘extinguish’ night wakening by
completely ignoring their child’s calls or cries in the middle of the night.
A more ‘softly, softly’ approach may suit such parents better, for example,
paying progressively less attention each successive night. It is important to
remember that a behavioural programme that the parents cannot carry
through to completion is worse than nothing, since it demoralises the
parents and trains the child to hold out against any subsequent attempt
to tackle the problem behaviour.

Subject review

Gardner F, Shaw DS. (2008) Behavioral problems in infancy and preschool
children (0–5).In: Rutter Met al.(eds)Rutter’s Child and Adolescent
Psychiatry, 5th edn. Wiley-Blackwell, Chichester, pp. 882–893.

Further reading

Egger HL, Angold A. (2006) Common emotional and behavioral disorders
in preschool children: Presentation, nosology, and epidemiology.Journal
of Child Psychology and Psychiatry 47 , 313–337.
Richman Net al. (1982)Preschool to School: A Behavioural Study. Academic
Press, London.