Depression in Preschoolers

Learn about depression in preschool aged children ...

depression in preschoolers

Some wonder why depression is so prevalent today, questioning how and why even young children could experience a disorder that seems highly correlated with the stresses of daily adult living.

It was only 20 to 30 years ago that most scientists and mental health experts thought that school-aged children could not possibly suffer with depression. But a number of research studies on the topic haves reversed this viewpoint.

Researchers are now focusing on depression in the youngest of all developmental stages, preschool-aged children, or those under 5-years-old (see Childhood Developmental Psychology). This research has caused controversy, however.

Some in the mental health field believe that labeling such a young child with a serious disorder only leads to a negative self-image, and possibly a self-fulfilling prophesy for future problems. Others worry about the possibility that many will turn exclusively to treating children with medications rather than finding workable behavioral strategies.

Yet as some decry this diagnosis for preschool-aged children, others actively investigate its emergence, and how early detection could positively affect a child’s future. Admitting the need for more viable behavioral treatments, other researchers are working on designing evidence-based practices for treating early childhood depression without resorting to pharmaceuticals.

These researchers cite the high degree of brain neuroplasticity in the earliest stages of development, meaning that a young brain changes rapidly and easily that treating depression at this stage could prevent depression from “setting in” or becoming permanent. After all, early detection for all mental disorders is the password to a more manageable, healthy future – for anyone at whatever life stage.

What does preschool depression look like?

Preschool children display sadness in the form of irritability, and this irritability often surfaces in temper tantrums and angry outbursts. Skeptics say that all young children experience irritability, and bouts of exaggerated crying and temper tantrums are quite normal for kids before the age of 5.

Signs and Symptoms of Possible Early Childhood Depression*

  • Excessive sadness, tearfulness, whining and/or crying
  • Hopelessness
  • An inability to enjoy activities
  • Persistent boredom
  • Children who prefer to be alone
  • Excessive guilt
  • Extreme sensitivity to rejection or failure
  • Pervasive irritability, anger, or hostility

*Information summarized from the American Academy of Child & Adolescent Psychiatry

Yet the common refrain “he or she will grow out it” heard from peers and other family members leaves many parents confused when they sense there is a deeper problem, something more pervasive happening to their preschool-aged child.

An ongoing study funded by the National Institutes of Mental Health and conducted by researchers at Washington University School of Medicine (WUSM) attempts to pinpoint and understand psychiatric disorders in preschoolers, and one aspect of the study focuses specifically on preschool-aged depression.

The research studied the temper tantrums of 270 children between the ages of 3 and 5. Those children identified with having a major depressive disorder (MDD) either exclusively, or MDD along with a disruptive disorder such as ADHD (see ADHD), showed more extreme aggressive behavior toward a caregiver, parent, or object such as a toy. (see Types of Depression.) They also displayed self-injurious behaviors, such as head banging, and skin scratching.

And their tantrums lasted much longer, and occurred much more frequently as compared to a group of healthy children. For example, some of the children studied for depression had five tantrums daily, day after day – sometimes five days out of the week. And these tantrums averaged more than 25 minutes in duration.

Children considered healthy or without depression had far fewer tantrums that lasted on average only 10 or 12 minutes. And they showed far less violent behaviors, toward themselves and toward others. In fact, healthy children might strike out once or twice at a caregiver, but they are able to restrain themselves, and bring themselves back to a state of calm. And they never showed self-injurious behaviors.

Joan Luby, a principal investigator on the study, and professor of child psychiatry at WUSM, and who received her first grant from NIMH to study preschool depression in 1998, has been following - for several years - a group of individuals diagnosed with depression during their preschool years.

Her findings show that young children report similar depressive symptoms as adults, but exhibit the symptoms differently. Children, for instance, who are depressed can’t find pleasure in any fun activities – similar to adults. But their displeasure keeps them from enjoying toys or games, rather than losing interest in sex, for example. And they can’t have fun doing anything, from playing, to watching television, to going on vacation. They are miserable most of the time regardless of activity.

In addition to temper tantrums, their signs of restlessness and irritability turn into constant whining and crying, not occasionally when they can’t have that extra cookie or piece of candy, but when they are at the playground, taking a walk, riding in the car – even at birthday parties. And instead of having suicidal thoughts like adults, they exhibit behaviors and preoccupations focused on violence or even death.

Luby found that the preschoolers who came into her study and were diagnosed as depressed were four times as likely to be depressed two years later compared to a control group of healthy children.

Other studies confirm Luby’s findings as well. It’s now believed that preschool and school-aged children diagnosed as depressed stay depressed into adolescence.

In the article “Can Preschoolers Be Depressed” for the New York Times Magazine, Duke University Child Psychiatrist and Epidemiologist Helen Egger stated that based on her epidemiological studies, 1 to 3 percent of children between 2 and 5 have depression. Along with other researchers, she estimates that about 84,000 of America’s 6 million preschoolers could be clinically depressed.

Intervention, Eggers told the Times, has the potential to prevent depression from turning into a lifelong disorder that causes more extreme consequences – and quite possibly lifelong therapy - in an individual’s adult years.

Intervention methods

The empirical findings of researchers such as Egger and Luby about depression in younger children have only been published over the last decade, making this area of psychological science one of the newest and also open to further exploration. Coupled with that is the need for research into effective treatments and interventions once a young child receives a diagnosis of depression.

Writing in The American Journal of Psychiatry in September 2009, Luby states: “Given the relatively recent scientific validation and related acceptance of preschool depression, no systematic treatment studies have yet become available.”

She writes further that adapting psychotherapeutic strategies used for depressed school-aged children for preschoolers remains problematic. Completed studies on cognitive behavioral therapies used for school-aged children are split on their overall efficacy. Some show promise when used on small trials of school-aged children, but other meta-analyses of these therapies suggest a smaller effect. (Meta-analysis is not a clinical trial but a detailed study of other studies that have been completed over a number of years.)

Additionally, studies done on interpersonal therapy, the other widely used psychotherapeutic treatment for adult depression, have only been done concerning adolescents and depression, Luby writes.

Based on the current lack of evidence for effective therapies, Luby concludes that using novel approaches adapted from psychotherapies used for other early childhood disorders might be the best approach, detailing one such therapy called Parent Child Interaction Therapy-Emotion Development (PCIT-ED).

PCIT-ED is a dyadic therapy, meaning that its approach centers on developing a treatment plan that includes the child and the child’s caregiver. This method was originally designed to treat violent or aggressive behaviors in very young children. A trained therapist works in both a clinical setting and the home environment, teaching parents how to help their children recognize and control emotions, stress, restlessness, and guilt.

As a behavioral approach, parents are taught how to reinforce more appropriate responses and behaviors, and more adaptive functioning within the child’s particular home and sociocultural environment.

If you desire to work as a mental health counselor with preschool-aged children suffering with mental health disorders such as depression, contact schools offering degrees in mental health counseling.

Or, if working as a researcher studying depression is a career goal, consider getting an advanced degree in psychology.

In most cases, at least a master’s degree is required for both counseling and research positions, and many positions require a PhD in Psychology.