St. Louis, MO, USA. 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 journal Current Directions in Psychological Science, child psychiatrist and researcher Joan Luby from the Washington University in St. Louis reports on recent findings examining depression in preschool-age children and the importance of early detection.

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.

• 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.

Interview Puppets. Joan Luby and her colleagues help identify depression in children with nonthreatening interviews and checklists designed to be appropriate to their ages.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.

Luby notes that more research is needed for the development of treatments for preschool depression. One study has shown that antidepressants called Selective serotonin reuptake inhibitors (SSRIs) may be effective in school aged children, but there are concerns about the side effects of these medications, particularly when prescribed for children.

A novel and noninvasive for treatment for depression in preschoolers is currently undergoing testing, Luby says, 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.

CitationPreschool Depression: The Importance of Identification of Depression Early in Development. Joan L. Luby. Current Directions in Psychological Science 2010; 19(2): 91-95. doi:10.1177/0963721410364493

Abstract

The empirical finding that school-aged children could suffer clinical depression refuted the widely held assumption that this age group would be too developmentally immature to experience depressive symptoms. Currently childhood depression is a well-recognized and widely treated clinical disorder. Following more recent developmental findings emphasizing the emotional sophistication of very young children, scientific studies have demonstrated that depression can arise early in life, during the preschool period of development. Preschool depression is characterized by typical symptoms of depression such as anhedonia; changes in sleep, appetite, and activity level; and excessive guilt. Further, longitudinal continuity of preschool depression into school age has been established, suggesting that preschool depression is an early manifestation of the later childhood disorder. Based on the known efficacy of early developmental intervention in a number of domains and disorders related to the greater neuroplasticity of the brain earlier rather than later in childhood, it is important to identify depression at the earliest possible point. Early intervention strategies for preschool depression that focus on enhancing emotional development are currently being tested.

Keywords: preschool, depression, emotion development.

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