It is difficult to imagine a depressed third-grader. It is even more difficult to imagine a depressed preschooler. Although childhood depression is a well-recognized and treated disorder, only recently have research studies begun looking at depression in children younger than six years old. In the new Current Directions in Psychological Science, a journal of the Association for Psychological Science, child psychiatrist/researcher Joan Luby from Washington University in St. Louis reports on recent findings examining depression in preschool-age children and the importance of early detection.
Depression in preschool-aged children does not always look the same as does depression in older children and adults — this is one reason that preschool depression has been largely neglected. For example, in depressed adults, anhedonia (the inability to enjoy pleasurable experiences) tends to show up in the form of a decreased libido. In young children however, anhedonia may appear as an inability to enjoy playtime. In addition, preschool depression may go unnoticed by parents because the symptoms may not be disruptive; these children may not seem obviously sad (as do many depressed adults) and may have periods of normal functioning during the day. A key advance for the recognition of preschool depression has been the development of age-appropriate psychiatric interviews. These interviews have shown that preschool-age children do in fact exhibit typical symptoms of depression, including appearing less joyful, being prone to guilt, and changes in sleep patterns.
Research suggests that preschool depression is not just a temporary occurrence but may instead be an early manifestation of the same chronic disorder occurring later on — studies have demonstrated that depressed preschoolers are more likely to have depression in later childhood and adolescence than are healthy preschoolers. Due to the potentially long-lasting effect of preschool depression, early identification and intervention become very important. Young children's brains are very "plastic" — that is, their brains easily adapt and change to new experiences and events. This plasticity may explain why developmental interventions are more effective if started early on and this may also prove true for psychotherapy.
More research is needed for the development of treatments for preschool depression. Luby notes that while one study has shown that SSRI antidepressants may be effective in school aged children, there are concerns about side effects of these medications. A novel treatment for preschool depression is currently undergoing testing and may be promising. This treatment is based on Parent Child Interaction Therapy (PCIT) and has been modified to emphasize the child's emotion development (ED). Early changes in emotion skills may be critical to risk for depression and PCIT-ED may help to correct those changes very early in development.
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