Child and Adolescent Psychiatric Clinics of North America
Preschool Depression
Section snippets
Investigations of preschool psychopathology: unique developmental considerations
The study of psychopathology in the preschool period is complicated by several factors. A key consideration is that the preschool period is a time characterized by multiple developmental challenges for young children. For example, during this time many children have their first experience in a formal school program and with a group of same-age peers. Although a growing sense of autonomy develops during the preschool years, children remain inextricably reliant on caregivers. The rapid cognitive
Early findings
Following Spitz's [21] compelling descriptions of depressed affect in institutionalized infants, there was little investigation of mood disorders in young children for several decades. Kashani and colleagues [7], [8], [9], [10], [11], [12], [22], [23], [24] provided the first series of studies that showed evidence of depression in preschool children in clinical and community samples. Several preschoolers who met standard DSM-III criteria for major depressive disorder (MDD) were identified. The
Diagnostic systems
Since Kashani and colleagues first published evidence that depression could occur in preschool-aged children, increasing attention has been given to the need for well-defined and developmentally appropriate diagnostic criteria for young children in general. Because the DSM system was designed primarily for adult populations, DSM criteria generally lack sensitivity to developmental variation in symptom manifestations, especially as they pertain to young children. With the exception of the
Evidence supporting the validity of preschool depression
In their first controlled study of preschool-aged children drawn from clinical and community settings, Luby and colleagues [13] investigated the basic validity of developmentally translated DSM-IV depressive symptoms (Box 1) using a version of the Diagnostic Interview Schedule for Children, Version IV young child (DISC-IVYC) [28], which was modified to allow for assessment of developmentally sensitive symptom manifestations. Because preschoolers have limited, if any, experience in formal
Prevalence
Because the availability of evidence clarifying the nosology of preschool depression is a recent development, methods used to investigate the presence of depressive disorders in population based studies of preschool children have varied and are potentially inaccurate. Correspondingly, there is variation in the reported rate of prevalence of the disorder among community samples. In a two-stage study in which 3860 community children were screened and 510 received an extensive evaluation, Lavigne
Comorbidity
High rates of comorbidity are well known in older depressed children [54] and have been found in depressed preschoolers [14]. Notably, patterns of comorbidity in these young children differ from patterns found in older children and adolescents, in whom anxiety disorders are most frequently comorbid with major depression [54]. Among a group of preschoolers identified as depressed, 42% had comorbid attention deficit hyperactivity disorder, 62% had comorbid oppositional defiant disorder, and 41%
Differential diagnosis
Just as in older children and adults, the accurate clinical diagnosis of MDD requires consideration of other disorders that have similar presenting features. In particular, posttraumatic stress disorder and adjustment disorder with depressive features should be considered in the differential diagnosis for a child who presents with depressive symptoms, such as loss of interest, psychomotor retardation, and difficulty concentrating. The key differentiating feature between these disorders and
Accessing appropriate informants
One of the difficulties of identifying and assessing internalizing disorders is the covert nature of many relevant symptoms. Unlike disruptive behavior disorders, in which diagnostic criteria include robust observable behaviors, a diagnosis of depression requires determination of internal states that are more difficult for parents to assess accurately. Further complicating the issue is the potential for inaccuracy and bias known to be inherent in parent report. For example, parents who
Treatment
To date, no studies have been conducted regarding the safety or efficacy of medication treatment of preschool mood disorders. Use of antidepressants in this age group is necessarily “off label” and empirically unsupported. Similarly, no empirically supported psychotherapy treatment of preschool MDD currently is available. Luby and colleagues (unpublished data) developed a treatment protocol focusing on targeting the parent/child dyad with the goal of teaching parents to serve as more effective
Summary
Significant strides have been made in the past 5 years in the characterization and validation of the nosology of preschool depression, perhaps related, in part, to greater developmental sensitivity of the measures used to assess depressive symptoms. Evidence is available to support the validity of this disorder, including a stable and specific symptom constellation, associated impairment, biologic markers, and greater family history of similar disorders. Because the area of study is relatively
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Suicidal thoughts and behaviors in psychiatrically referred young children
2016, Psychiatry ResearchCitation Excerpt :Despite increased awareness of the prevalence and nature of mental health problems in early childhood, there has been limited empirical attention to very serious and high-risk behaviors that may be associated with severe, early forms of psychopathology. In particular, there have been few empirical studies of suicidal thoughts and behaviors in this age group, despite consensus that depression and other mood disorders may emerge very early in development (Luby et al., 2009; Stalets and Luby, 2006; Youngstrom et al., 2008). To date, most research on youth suicide has focused on adolescents and children older than 10–12 years (Sarkar et al., 2010), with few studies including children as young as five years and only a handful of studies focusing on preschoolers.
The interaction of social risk factors and HPA axis dysregulation in predicting emotional symptoms of five- and six-year-old children
2012, Journal of Psychiatric ResearchCitation Excerpt :In recent studies, children with abnormal functioning of the neuroendocrine and autonomic stress-response systems have proven more vulnerable for developing anxiety and depressive symptoms following exposure to deleterious peer and family experiences (Badanes et al., 2011; Obradovic et al., 2011; Rudolph et al., 2011). In preschoolers, these risk factors and mechanisms remain understudied (Luby, 2009; Luby et al., 2003b; Stalets and Luby, 2006). Complicating matters, symptoms of anxiety and depression – while already somewhat distinct in the preschool period – are nevertheless intimately related at this age, with the former often found to predate the latter (Snyder et al., 2009).
Internalizing Disorders in Early Childhood: A Review of Depressive and Anxiety Disorders
2009, Child and Adolescent Psychiatric Clinics of North AmericaCitation Excerpt :Since the investigation of preschool-onset mood disorders is relatively new, there is little information regarding the stability and course of preschool depression into later childhood and adolescence. The population prevalence of preschool depression also remains somewhat ambiguous due to lack of clinical variability in diagnosing the disorder.80 However, a recent epidemiologic study conducted by Egger and colleagues81 reported a prevalence rate of 1.4% for MDD, 0.7% for depression not otherwise specified, and 0.6% for dysthymia, based on parent report of symptoms.
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Funding for the study of preschool depression was provided by National Institute of Mental Health grant K08-MH3250-5148 and R01-MH64769-01.