Preschool Major Depressive Disorder: Preliminary Validation for Developmentally Modified DSM-IV Criteria

doi:10.1097/00004583-200208000-00011

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 41, Issue 8, August 2002, Pages 928-937

https://doi.org/10.1097/00004583-200208000-00011 Get rights and content

ABSTRACT

Objective

To investigate the validity of developmentally modified DSM-IV criteria for preschool major depressive disorder (MDD).

Method

Subjects between the ages of 3.0 and 5.6 years were ascertained from community and clinical sites for a comprehensive assessment that included an age-appropriate psychiatric interview with the parent about the child. Minor developmental modifications to the formal DSM-IV MDD criteria were tested, including translations of symptoms to describe age-appropriate manifestations and setting aside the duration criterion. Preschool children who met modified criteria were compared with psychiatric and normal control groups.

Results

Validation for the modified criteria was supported by a specific and stable symptom constellation, social impairment, greater family histories of affective disorders, and higher child-reported symptoms of depression on an age-appropriate puppet interview. Preschool children with MDD displayed “typical” symptoms of depression, as well as vegetative signs. Standard DSM-IV criteria failed to capture 76% of children who met these modified criteria.

Conclusions

Evidence that preschool children can manifest typical symptoms of MDD when age-adjusted symptoms states are assessed is provided. Findings also suggest that standard DSM-IV criteria may not be sufficiently sensitive for preschool children, as they failed to capture a substantial proportion of symptomatic children. Minor modifications to DSM-IV criteria are recommended to capture clinically significant preschool MDD.

Section snippets

Subjects

At the time of this analysis, 136 children between the ages of 3.0 and 5.6 years had undergone the baseline assessment in the Early Emotional Development Program at the Washington University School of Medicine, and 76 had reached and undergone the 6-month follow-up assessment. Children were recruited from community pediatrician's offices (n = 101) by means of a checklist filled out by parents and designed to screen for early-onset behavior problems (Preschool Feelings Checklist; Luby et al.,

Diagnostic Characteristics of the Study Sample

Out of the 136 preschool children aged 3.0 to 5.6 studied, 49 met the modified criteria for MDD, which we refer to as preschool diagnostic criteria for MDD (P-DC-MDD). This contrasts to only 12 who met all DSM-IV criteria (assessed for translated symptom manifestations). It is important to note that the children who met all DSM-IV formal criteria for MDD were also assessed for the presence of developmentally “translated” symptom states using the YC-DISC-IV therefore the only difference between

Preschool MDD Characterized by Age-Adjusted “Typical” Symptoms of MDD

Preschool children with developmentally modified criteria for MDD (P-DC-MDD) demonstrated a highly specific symptom constellation that significantly differentiated them from both psychiatric and normal comparison groups. It is notable that preschool children who met P-DC-MDD criteria were characterized by “typical” symptoms of MDD when assessed for age-appropriate developmental manifestations of these symptoms. These children also displayed vegetative signs such as changes in activity and

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: This research was supported by NIMH K08 award to Dr. Luby. The Preschool Feelings Checklist and psychometric data can be obtained upon request from the first author: [email protected].

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ArticlesPreschool Major Depressive Disorder: Preliminary Validation for Developmentally Modified DSM-IV Criteria

ABSTRACT

Objective

Method

Results

Conclusions

Section snippets

Subjects

Diagnostic Characteristics of the Study Sample

Preschool MDD Characterized by Age-Adjusted “Typical” Symptoms of MDD

J Am Acad Child Adolesc Psychiatry

Prev Med

Infant Behav Dev

Psychiatr Clin North Am

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

J Am Acad Child Adolesc Psychiatry

Berkeley Puppet Interview: Administration and Scoring System Manuals

Manual for the Child Behavior Checklist and Revised Child Behavior Profile

Unmasking masked depression in children and adolescents

Am J Psychiatry

Diagnosis and prognosis in schizophrenia

Arch Gen Psychiatry

Face-to-face interactions of depressed mothers and their infants

New Dir Child Dev

Frontal lobe activity and affective behavior of infants of mothers with depressive symptoms

Child Dev

Early intervention in autism: effectiveness and common elements of current approaches

The development of emotional expressions

Psychol Issues Monogr

Relative right frontal EEG activation in 3-to 6-month old infants of “depressed” mothers

Dev Psychol

Vagal tone in infants of depressed mothers

Dev Psychopathol

Pregnancy problems, postpartum depression and early mother–infant interactions

Dev Psychol

Articles
Preschool Major Depressive Disorder: Preliminary Validation for Developmentally Modified DSM-IV Criteria