An Observational Analysis of Behavior in Depressed Preschoolers: Further Validation of Early-Onset Depression

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ABSTRACT

Objective

To investigate whether higher levels of negative and lower levels of positive behaviors could be observed in a sample of depressed preschoolers. Support for the validity of preschool depression is now available; however, objective evidence of negative behaviors among depressed preschoolers is needed.

Method

A structured observational parent-child interaction task was conducted. The behaviors of 152 preschoolers (ages 3.0-5.6) in three study groups (depressed, disruptive, and healthy) were examined with further analyses of depressed subgroups based on severity and comorbidity.

Results

Anhedonically depressed preschoolers emerged as demonstrating less enthusiasm, more avoidance, more noncompliance, and having a more negative overall experience than healthy controls. This more severe and proposed melancholic anhedonic subgroup also displayed less enthusiasm than nonanhedonically depressed preschoolers. Furthermore, the “pure” anhedonic depressed preschoolers without disruptive comorbidity emerged as the only depressed subgroup that was significantly distinguishable from healthy preschoolers.

Conclusions

Findings provide the first objective evidence of more negative and fewer positive behaviors among depressed preschoolers. Notably, the finding that anhedonically depressed preschoolers demonstrated significantly less enthusiasm than those with nonanhedonic depression provides the first objective evidence of the manifestation of anhedonia, a key sign of preschool depression. The implications of the finding that the “pure” anhedonic depressed subgroup without disruptive comorbidity was most distinguishable from comparison groups are explored.

Section snippets

Sample

Preschool subjects (ages 3.0-5.6) were recruited from primary care and specialty mental heath settings for participation in a study of the nosology of depression. One hundred seventy-four preschoolers and their primary caregivers participated in this study and completed a comprehensive emotional and developmental assessment that included parent, child, and dyadic assessments. One hundred fifty-two subjects fell into one of three primary diagnostic groups of interest (and had complete data) for

RESULTS

There were no significant demographic differences found between categorical diagnostic groups and subgroups (Table 1).

DISCUSSION

Findings indicated that both depressed and disruptive (ADHD and/or ODD) preschoolers were significantly less enthusiastic and had a less positive experience with their caregiver as compared with healthy children. However, only the disruptive, and not the depressed, preschoolers were significantly more noncompliant and avoidant when compared with healthy children, suggesting that these two relational impairments are more pronounced in disruptive as opposed to depressive disorders. Consistent

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    Funding for the study of preschool depression was provided by National Institute of Mental Health grants K08-MH01462 and R01 MH64769-01 ; Dr. Luby.

    Disclosure: Dr. Luby has received grant/research support from Janssen, has given occasional talks sponsored by AstraZeneca, and has served as a consultant for Shire Pharmaceutical. The other authors have no financial relationships to disclose.

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