Depression in Preschoolers ?

Q.In the 1960s and 70s, there was a great deal of skepticism that children could experience depression. Then in the 1980's, evidence emerged showing that DSM-defined depression could be identified in children as young as six years old. Childhood depression, according to Egger, can be a chronic and relapsing illness with significant morbidity.

A.A number of clinical and community studies have assessed depressive symptoms in preschool children, says Egger, and yet very few studies have examined the presentation of depressive disorders in very young children. "Our understanding of preschool psychopathology is similar to our understanding of psychiatric disorders in older children circa 1970," she adds. "It is painful for us to acknowledge that very young children suffer psychic pain; we want to hold onto the idea that at least that part of childhood is free of it." Clinical Reality "Parents and young children are suffering and turning to pediatricians, child psychiatrists and psychologists," says Egger. "Despite the gaps in our knowledge, clinicians and parents need a road map for how to evaluate and treat young children with emotional disorders." According to Egger, children are in and out of care at a younger and younger age and many children are at risk of being asked to leave preschool or daycare. There have been a few clinical studies looking at the prevalence of depression in preschoolers and infants. In a 1984 study by Kashani and colleagues, 4 percent of preschoolers were referred to a child development unit with "possible or definite DSMIII depression." A 1997 study by the same author found 2.7 percent of 300 referred preschoolers met criteria for DSM-IV dysthymia. Community studies have yielded a little additional data -- 1.1 percent with DSM-III-R MDD (2.3% with subthreshold) in 104 low income preschoolers (Keenan et al. 1997) -- and there has been only one population based-study (Lavigne et al. 1996) showing rates of anxiety and depression at 0.3-0.7 percent. "There was a recognition that using the straight DSM diagnosis may well result in underdiagnosing the prevalence of this disorder in kids," says Egger. "This leaves us with the question of what depression in preschoolers looks like and whether or not the DSM-IV criteria will have to be modified to be developmentally appropriate for young children."

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