When toddlers are sad, we take it for granted they'll bounce back quickly. It may feel like a lifetime, but chances are their screaming fits whither with the help of a lollypop, kind words, or a cuddly pet. But some kids just can't be re-directed, no matter how much we bribe them or trick them into thinking happier thoughts. Their misery really does last hours and that makes them feel awful and their parents and siblings anxious and overwhelmed.

Dr. Joan L. Luby, a professor of psychiatry and Director of the Early Emotional Development Program at Washington University School of Medicine in St. Louis, Mo., believes that these children--who in the past were just tagged as difficult or perhaps ADHD--suffer from clinical depression. And if so, they should be receiving treatment early on to rewire their young brains or at least teach them coping strategies.

This rather new approach goes against traditional notions of mental health that claimed that young children just do not have the cognitive maturity to feel such angst. (Freud, for one, said youngsters were just too young to be depressed.) In essence, what Dr. Luby and others are saying is that, yes, pre-schoolers can suffer from depression and the best way-really the only way-to treat them is to get the parents involved. (She has developed a family-centered 14-week program.) The results of her studies as well as the specific kind of therapy she uses were published last year in The Archives of General Psychiatry as well as the American Journal of Psychiatry.

No one knows whether depression among this young set is caused by some inborn chemical imbalance, a genetic defect, or something gone awry in their home life. But these experts believe that therapy can help families figure out coping strategies. Children and parents can enhance their communication skills and even learn to play with each other better. You cannot dismiss the importance of getting on the floor and being silly with your little ones. Perhaps the therapy will rewire their developing brains to avoid bouts of depression later on. Are we talking a cure? So far, no one is talking about cures, but perhaps, at best, prevention. And again, no one really knows. 

This is all well and good. But like any other advance or new path in medicine, there are side effects to worry about. Dr. Claudia Gold is a pediatrician and advanced scholar advanced scholar at the Berkshire Psychoanalytic Institute. Her concern is that "saddling these young children with a major psychiatric diagnosis," will make us treat them with blinders on, ignoring the full picture. She also worries-rightly so-that labeling such young children as clinically depressed will invite drug companies to market their wares to an even broader clientele. (Check out her piece in last year's Boston Globe). To be sure, Dr. Gold works with children and believes in family therapy but she worries about categorizing pre-schoolers. Will parents who are told their children have depression react to them differently? Will children identify themselves as depressed?

These issues--how we label people with mental illness--are certainly not unique to the young, but perhaps we should worry more about the pre-schoolers than we do about adults, because these little ones are in the process of developing a sense of self. I think these specialists are onto something good-reaching out to help our young children and reaching out to parents to encourage some basic communication skills. But we should, as Dr. Gold writes, proceed with caution.

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