Depression in Young Children Is Treatable

Over the last decade, research has demonstrated that children as young as 3 years old can develop clinically serious depression. Often, depression is associated with other childhood psychiatric disorders. Young children with depression also have increased risks of clinically significant depression as adolescents and adults.

Although depressive disorders can be diagnosed in very young children, there is little empirical data to support specific therapies for this age group. In an article recently published in the American Journal of Psychiatry, Joan Luby and colleagues reported that a specific type of therapy targeting parent-child interactions is very effective at decreasing depressive symptoms in kids.

Young children have brains that are still developing and are more capable of forming new neural connections in response to external stimuli – a process termed neuroplasticity – than adults. Thus, early interventions may have better chances for success in young children. For example, when a child has a lazy eye, patching the good eye can force the weaker eye to get stronger, provided that this treatment is implemented when the child is young. As a child reaches early adolescence, the brain is less plastic and patching is no longer effective.

The Luby group modified a therapy called Parent-Child Interactive Therapy (PCIT) by adding a module targeting emotional development (ED). PCIT has been shown to help children with disruptive behaviors. The emotional development arm was added to see if this intervention would benefit depressed kids. During the ED module, parents were coached “to use a skill set that validates and tolerates the child’s emotions and assists the child in regulating intense emotions.” In the process, parents learned to help their children examine the reasons for their negative emotions and figure out ways to deal with them more productively.

The investigators studied a group of 229 depressed children between the ages of 3 and 7 years old. All children had to have a stable caregiver to be enrolled in the study. None was taking antidepressant medications or was engaged in concurrent psychotherapy. Children who were considered to be too severely depressed to be randomized to the control group were excluded from the study and referred for immediate treatment. Depression in kids is often accompanied by behavioral symptoms that may fulfill criteria for other childhood disorders. This was true for the children in this study. In addition to depression, approximately 45 percent had an anxiety disorder, about 35 percent had ADHD, and about 50 percent had oppositional defiant disorder.

The 229 child-parent pairs were divided into two groups. One group received the therapy right away while the other was waitlisted for treatment. The waitlisted children served as controls for the group receiving active therapy. (The children on the waitlist who were symptomatic at the end of the waiting period were offered PCIT-ED treatment.) The therapy was administered in 20 sessions over 18 weeks. Masters-level providers can be trained to give this therapy, therefore this treatment approach could be provided at a reasonable cost.

The results were dramatic. Over 75 percent of children in the treatment group no longer fulfilled criteria for depression compared to 25 percent of waitlisted controls. Over 73 percent were considered to be in remission (meaning few or no residual symptoms) compared with 23 percent in the control group. In addition to improvement in depressive symptoms, psychosocial function improved in these children. Parents who participated in the treatment arm of the study reported decreased symptoms of depression and lower levels of stress in themselves. Both the children and parents felt that the treatment was beneficial.

The outcomes reported in this study were measured at the end of the 18-week treatment. The authors state that it will be important to determine the long-term course of these children who respond to early treatment. Hopefully, early treatment will lead to diminished risk of depression or other psychiatric disorders when the children are adolescents or adults. This would be a great outcome and would highlight the importance of early intervention, perhaps pointing the way to effective long-term prevention strategies. Time and further studies will tell.

This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.