Maureen's Medical Moment: Depressed preschoolers


Depression is the most common mental health problem in the U.S. affecting about 17 million people. When you think of depression, you probably don't think about children, especially preschool children. But, researchers are discovering new insights about this disorder in the very young.

Child psychiatrist Joan Luby has been studying depression in preschool children for more than 20 years.

"Children as young as age 3 can get clinical depression<' said Luby.

In a recent imaging study, Luby's group found depressed preschoolers had elevated activity in an area of the brain called the amygdala.

"You can see changes in the structure and volume of several key brain regions that are known to be involved in emotion processing," she said, "We believe that the earlier you can identify the disorder, that you can treat the disorder more effectively."

Researchers believe as many as one in every 33 children may have depression. Children are often withdrawn, highly sensitive and are preoccupied with feelings of guilt. The symptoms often go unnoticed.

"Most people don't pick up on depression in their young children. Mostly parents pick up on what we call disruptive symptoms in children," said Luby.

In very young children, Dr. Luby suggests a strategy called "parent child interaction therapy emotion development" is helpful. It works on strengthening the parent-child relationship.

BACKGROUND: Depression is the most common mental health problem in the United States. Every year it affects 17 million people of all ages, economic background, and races. Researchers used to believe that depression could only happen to adults. Now, researchers believe as many as one in every 33 children may have depression; and in teens, that number could be as high as one in eight. (Source: http://kidshealth.org/parent/emotions/feelings/understanding_depression.html)
TYPES: Types of depression include: adjustment disorder with depressed mood, seasonal affective disorder, major depression, dysthymia, and bipolar disorder or manic depression. All of which can affect children. Major depression is characterized by persistent sad mood, feelings of worthlessness or guilt, and the inability to feel pressure or happiness. A child with major depression feels depressed almost every day. Dysthymia could be diagnosed if sadness or irritability is not as severe, but continues for a year or longer. Kids with dysthymia can feel hopeless, have low self-esteem, and even have problems eating and sleeping. Bipolar disorder is characterized by episodes of low-energy depression and high-energy mania. It may affect as many as one to two percent of kids. Experts believe that kids and teenagers with bipolar disorder can experience problems like ADD, oppositional, behavior disorders, anxiety, and irritability. (Source: http://www.psychologytoday.com/conditions/depressive-disorders-children-and-adolescents and http://kidshealth.org/parent/emotions/feelings/understanding_depression.html)

TREATMENT: Depression can be successfully treated in more than 80 percent of the people who become depressed. Counseling may help the child feel better. The type of counseling depends on the age of the child. For young children, play therapy may be best. Older children and teenagers may benefit from cognitive-behavioral therapy. This type can help them change negative thoughts that make them feel bad. Dr. Luby recommends Parent Child Interaction Therapy- Emotion Development (PCIT-ED), which is a form of play therapy between parents and their children. Parent-child interaction therapy has been used successfully to treat hyperactivity and disruptive disorders. Researchers at Washington University School of Medicine in St. Louis adapted it by adding a focus on emotional development to test whether it could help parents teach their children how to regulate negative emotions, like guilt and sadness. "The original form of parent-child interaction therapy had two components," lead author Shannon N. Lenze, PhD, an instructor in the Department of Psychiatry, was quoted as saying. "One was a child-directed interaction, and the other was parent-directed. The first encourages the parent to use effective praising techniques, to play games the child wants to play, to get down on the child's level and be enthusiastic. The second component teaches the parent about effective discipline using a very specific 'time out' to help the child learn to obey parent commands." The third component, which was developed for the study, involves emotions and helps parents learn to help their child more effectively regulate them.

For More Information, Contact:

Judy Martin
Director of Media Relations
Washington University School of Medicine
(314) 286-0105
martinju@wustl.edu


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