Can preschoolers be depressed?

[omnirom]

There is a sad story in the news today about a 7 year old boy in Detroit who committed suicide by hanging himself. He was overwhelmed by his parent's separation and from being bullied at school.

This got me thinking, at what age can depression start? Can preschoolers be depressed? Here's a nice NY Times article addressing this question:

http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html?pagewanted=all

I'm curious, for all those who're in C&A, how do you come about with a diagnosis of depression in a preschooler? In general, are such young children able to verbally articulate their emotions in a manner that is clinically significant? I assume that a number of factors are considered, such as a familial history of MDD, parent's accounts of the child's behavior, and direct observation of the child's affect. Are there any cognitive tests that can be done to help with a diagnosis?

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[peppy]

I'm surprised that none of the child folks on here responded to this post.
Sometimes I think it's kind of a shame that the bulk of child psych exposure many of us get in med school/residency is focused on "social problem admissions" rather than these rare but very interesting cases (early onset schizophrenia, early onset depression, etc.).
From what I've heard from the child people at my program, collateral history is given a lot of weight in these kinds of cases, as you'd expect. The focus of treatment tends to be on therapy and behavioral interventions rather than meds with children that young - and if there is concern in the family about how the child is functioning, then I think that would be helpful even if a child doesn't strictly meet the criteria for depression.

 

[billypilgrim37]

I think we avoided it because the question is a bit of a trap, even if the OP didn't mean it to be. The symptoms tend to be much more neurovegetative and somatic rather than existential crises, but they are depression nonetheless. The answer of "yes" will naturally beg lots of other questions about it, and exhaustion would set in by the 5th post of the thread. And whether the OP meant it or not, the inherent subtext of the question expresses doubts about child psychiatry in general, and such questions are just exhausting.

Again, I don't think the OP had evil intention. It's just inherent in the question in an anonymous online forum.

 

[whopper]

I didn't answer it hoping a child psychiatrist would chime in. I wasn't trying to avoid it, nor do I think others.

 

[digitlnoize]

There is a sad story in the news today about a 7 year old boy in Detroit who committed suicide by hanging himself. He was overwhelmed by his parent's separation and from being bullied at school.

This got me thinking, at what age can depression start? Can preschoolers be depressed? Here's a nice NY Times article addressing this question:

http://www.nytimes.com/2010/08/29/magazine/29preschool-t.html?pagewanted=all

I'm curious, for all those who're in C&A, how do you come about with a diagnosis of depression in a preschooler? In general, are such young children able to verbally articulate their emotions in a manner that is clinically significant? I assume that a number of factors are considered, such as a familial history of MDD, parent's accounts of the child's behavior, and direct observation of the child's affect. Are there any cognitive tests that can be done to help with a diagnosis?

Try here: http://www.aafp.org/afp/2007/0101/p73.html

Here: http://hsc.unm.edu/som/psychiatry/c...ccuring Physical&Mental Disorders.Carroll.pdf

And here.

 

[snarfer]

The quick answer is yes and as early as at age 3 according to the st. louis group 2009 study.

 

[Chimed]

Try here: http://www.aafp.org/afp/2007/0101/p73.html

Here: http://hsc.unm.edu/som/psychiatry/c...ccuring Physical&Mental Disorders.Carroll.pdf

And here.

Nice power point. I wasn't able to open the other link and hope I'm not duplicating your reference. Here is a nice article on the subject:
The Clinical Picture of Depression in Preschool Children
by JOAN L. LUBY, AMY K. HEFFELFINGER, CHRISTINE MRAKOTSKY, KATHY M. BROWN, MARTHA J. HESSLER, JEFFREY M. WALLIS, EDWARD L. SPITZNAGEL
Journal of the American Academy of Child & Adolescent Psychiatry (Vol.42, Issue 3)
http://www.jaacap.com/article/S0890-8567(09)60568-2/abstract?source=aemf

I have seen a few pre-school aged kids come in with what I'd consider full MDD, but it's rare. Usually we'll see younger kids with depressive symptoms and they usually get a diagnosis of Depressive DO NOS or adjustment DO with depressed mood. I don't have a lot to add then what was posted above or is in the references. As already stated, we use a lot of collateral information as well as looking at neurovegative symptoms and behaviors.

I think the bigger question that people usually have hidden in the question about diagnosing a young child with depressive symptoms is whether or not they are being placed on medications. For myself, I have never prescribed a child younger then 6 with a depression diagnosis with medications. The younger the patient, the harder I push for therapy, therapy, therapy, therapy.

 

[Chimed]

I
Sometimes I think it's kind of a shame that the bulk of child psych exposure many of us get in med school/residency is focused on "social problem admissions" rather than these rare but very interesting cases (early onset schizophrenia, early onset depression, etc.).

Yeah, that's too bad. For myself, the most rewarding part of child psychiatry is seeing the and treating more neuropsychiatric illnesses. Some of my colleagues really enjoy the complicated social and family issues in child psych, which is great. While I like working with family systems, I prefer more "neuropsychiatric" illnesses to be at the root. I also saw a lot of "social problem admissions" in both medical school and as a current fellow. But luckily I've also been fortunate in both medical school and residency to see enough "real" illness to keep it interesting. If I only saw what you're talking about, I may or may not have still gone into child psych.