Preschool children not only suffer with depression, their symptoms are often unnoticed and thus the condition goes undiagnosed. Recent findings on preschool depression indicate that it is not a temporary condition and that early detection is important.
Child psychiatrist and researcher Joan Luby from Washington University in St. Louis has published a new study in which she highlights depression in preschool children, the importance of early detection, and treatment strategies. Luby has been researching depression in preschool-age children for years. In August 2009, a study for which she was the lead author validated the existence of major depressive disorder in children as young as 3 years and showed that children with major depression at such a young age are nearly four times more likely than their peers to have depression two years later.
In 2003, Luby and her research team reported in the Journal of the American Academy of Child and Adolescent Psychiatry that a key symptom to identify depression in preschoolers is anhedonia, which is the inability to experience pleasure from activities and play. Luby noted they found “that depressed children just don’t derive pleasure from the same things as a typical 3- to 5-year-old child. They’re less joyful when they encounter the pleasures of daily life.”
In that study, Luby explained that because very young children cannot express their emotions in words, puppets and play schemes are used to identify them. They also reported that as in older depressed children and adults, depressed preschoolers tended to have more than one psychiatric disorder, with 42 percent also having attention deficit hyperactivity disorder (ADHD), 62 percent had oppositional defiant disorder (ODD), and 42 percent had both disorders.
In this newest study, Luby noted that depression in preschoolers tends to manifest as an inability to enjoy playtime. Parents tend to not notice preschool depression because the children may not be disruptive or obviously sad, and may function normally at times during the day. Age-appropriate interviews have shown that preschoolers do exhibit typical symptoms of depression, such as appearing less joyful, being prone to guilt, and experiencing changes in sleep habits.
The researchers also point out that because of the potentially long-lasting impact of preschool depression, as Luby demonstrated in an earlier study, early diagnosis and intervention are very important. The brains of young children are easily adaptable (“plastic”), which may explain why developmental interventions are more effective if they are initiated at an early age.
Luby notes that the side effects associated with the use of selective serotonin reuptake inhibitors are a concern, even though there is some evidence that these antidepressants may be effective in school-age children. For younger children, there may be another way.
Among depressed preschool children, a promising treatment based on Parent Child Interaction Therapy (PCIT) is being tested and has been modified to focus on a child’s emotional development (ED). Early changes in emotion skills may be an essential element to risk for depression, and it is possible PCIT-ED may help to correct those changes at a very early stage.
Luby J et al. Current Directions in Psychological Science
Luby JL et al. Journal of the American Academy of Child and Adolescent Psychiatry 2003 Mar 1; 42(3): 340-48
Luby J et al. Archives of General Psychiatry 2009; 66:897-905