Depression in Preschoolers Treated With a Novel Therapy

Researchers have shown that a therapy-based treatment for disruptive behavioral disorders can be adapted and used as an effective treatment option for early childhood depression. Children as young as in preschool can be diagnosed with clinical depression; psychotherapeutic intervention is greatly needed for them even while on prescribed antidepressants. The study, funded by the National Institute of Mental Health (NIMH), appears online June 20 in the American Journal of Psychiatry.

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Parent-Child Interaction Therapy (PCIT)

Parent-Child Interaction Therapy (PCIT) is a psychotherapeutic model that has been shown to be effective to treat disruptive behavioral disorders in young children. In standard PCIT treatment, parents successfully interact with their children with techniques they are taught. The techniques are then practiced in controlled situations while being coached by a clinician.

This standard intervention therapy has been adapted for use in childhood depression. The researchers added a new emotional development (ED) module to the treatment. This extra material uses the basic techniques of PCIT to train parents to be more effective to help enhance their children's emotional competence and emotion regulation abilities; the parents have to be better emotion coaches for their children while teaching them how to regulate emotions.

"This study builds on programmatic research that has identified factors associated with the development and course of depression among very young children and in turn, represent targets for intervening," said Joel Sherrill, Ph.D., deputy director of the NIMH Division of Services and Intervention Research. "Using a modular approach that builds upon the well-established PCIT platform may ultimately help facilitate dissemination of the ED intervention."

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Study design

Children ages 3-6 who met criteria for early childhood depression and their parents were randomly assigned to two groups in the study:

PCIT-ED treatment group - Children in this group completed standard PCIT modules for a maximum of 12 treatment sessions, followed by an emotional development module lasting eight sessions.

Waitlist group - Children in this group were monitored but received no active intervention since there are currently no empirically tested treatments that are widely used to treat early childhood depression. These children and their parents were offered PCIT-ED treatment after completion of the study.

Children and parents were assessed before and after treatment or the waiting period (depending on group assignment)

Children were assessed for psychiatric symptoms, emotional self-regulation abilities, level of impairment and functioning, and tendency to experience guilt.

Parents were assessed for depression severity, coping styles, strategies they used in response to their child's negative emotions, and stress within the parent-child relationship.

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Study results

At the completion of treatment, compared to children in the waitlist group, children in the PCIT-ED group were

• Less likely to meet criteria for depression
• More likely to have achieved remission
• More likely to score lower on depression severity
• Having improved functioning
• Presenting fewer comorbid disorders
• Having greater emotional regulation skills and greater "guilt reparation" (saying "sorry" spontaneously after having done something wrong, and having appropriate empathy with others)

Parents in the PCIT-ED group also benefited compared to parents in the waitlist group.

• Decreased symptoms of depression
• Lower levels of parenting stress
• Employed more parenting techniques that focused on emotion reflection and processing
• Overwhelmingly reported positive impressions of the therapeutic program

"The study provides very promising evidence that an early and brief psychotherapeutic intervention that focuses on the parent-child relationship and on enhancing emotion development may be a powerful and low-risk approach to the treatment of depression," said lead study author Joan Luby, M.D., of Washington University School of Medicine in St. Louis. "It will be very important to determine if gains made in this early treatment are sustained over time and whether early intervention can change the course of the disorder."

Depression in Preschoolers

Depression that is commonly associated with adults and teens can affect children in their preschool ages too. However, the study of depression arising prior to the age of 6 is relatively new.

Most common symptoms that parents see in their young children and that prompts them to bring the children for mental health evaluation are

• Disruptive behavior
• Irritability
• Social withdrawal
• Loss of interest in activities that the child finds typically enjoyable (anhedonia)
• Excessive guilt
• Sadness and grouchiness
• Crying and play themes involving death
• Absence of significant developmental delay

Note, however, that clinically, irritability is considered a symptom only when it presents along with social withdrawal and anhedonia and/or excessive guilt.

Also, important to note is that the symptoms are not evident in a preschool setting that the child attends for short blocks of time making the condition difficult to diagnose.

The laboratory of Joan L. Ruby has been working on a novel, parent-child psychotherapy for the treatment of preschool depression. This is called the Parent Child Interaction Therapy–Emotion Development (PCIT-ED) and utilizes and expands a well-validated manualized treatment (PCIT) that has proven efficacy for preschool disruptive disorders.

References:

1. Luby JL. Early Childhood Depression. The American journal of psychiatry. (2009);166(9):974-979. doi:10.1176/appi.ajp.2009.08111709.

Source-Medindia