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Preschool: The New Depression Era

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By Dan Gordon '85

Published Oct 1, 2008 8:00 AM


It's hard to even accept the idea that a toddler could suffer from a mood disorder, let alone know how to recognize and treat it. Yet as many as 3 percent of all U.S. kids are clinically depressed. Here are some signs to look for — and they may not be what you expect.

If your young son or daughter were increasingly agitated, frequently feigned illness or began to worry obsessively, you probably wouldn't attribute the behavior to depression. A UCLA expert in child psychiatry says you might be overlooking the obvious — and missing an opportunity to seek much-needed professional help.

Although most commonly associated with adolescents and adults, depression and other mood disorders are diagnosed in children barely out of diapers. Studies have found that nearly 1 percent of preschool-age children, and approximately 3 percent of children overall, are clinically depressed. But many more remain under the radar.

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Illustration by Isabelle Arsenault

"We don't have good research to show the frequency of mood disorders in kids, but it is almost certainly underestimated and is more common than people realize," says Bhavik Shah, a UCLA child psychiatrist who serves as medical director of the UCLA Program for the Enhancement of Achievement, Behavior and Cognition (UCLA ABC), which offers short-term therapy and instruction for children ages 3-12 with mood, anxiety and other disorders.

The under-diagnosis is partly because symptoms for children don't fall as neatly into the well-defined disorder categories as they do for teens and adults. For example, there is little agreement among experts on what bipolar disorder looks like in children and how to differentiate it from depression, attention deficit hyperactive disorder, or simply a difficult home or school environment.

Depressed children are often mistakenly seen as bipolar because they exhibit agitation and irritability rather than the crying and anxious restlessness more commonly associated with depression. "One thing we know about children is that as their brains develop, these illnesses become more classic," says Shah. "Our understanding of what these symptoms look like in children is still in its infancy."

It's no wonder, then, that it's hard for parents to interpret what they're seeing in their young child. "While it's easy to recognize externalizing, 'acting-out' kinds of behaviors, it's very difficult for parents to recognize depression in their own children," says Mary J. O'Connor, a developmental psychologist and UCLA ABC program director. "They might see them as irritable, negative or merely sad."

Depressed children differ from depressed adolescents and adults in another significant way: They are unlikely to be helped by pills. Indeed, notes Shah, there is little scientific evidence that young children benefit from antidepressants more than they do from a placebo. Too often, Shah says, kids are being put on drugs that are unlikely to help them before any effort is made at adopting simple cognitive-behavioral strategies that are often sufficient: addressing school difficulties, teaching social skills to improve peer interactions, and building self-esteem through increased parental attention and positive reinforcement, to name a few. "Often, parents have trouble acknowledging that their child might benefit from mental health services, but it's important for them to realize that there is treatment available that is highly effective," says Shah.

UCLA ABC tailors a wide range of services to each child's needs, relying on a multidisciplinary team that includes a child psychiatrist, child psychologist, educational consultant, social worker, occupational therapist, recreation therapist, speech and language pathologist, and nurse specialists. "It takes so many people to address the needs of a child that it just isn't done very widely," says Shah. "Unfortunately, what happens too often is that we don't intervene until the child becomes suicidal or so aggressive that inpatient therapy is needed, and then it's more about putting out fires than actually treating."

Anyone suffering from depression or other mood-disorder symptoms should seek early treatment, but for children in these circumstances, the imperative to address the problem is particularly great. When a mental health condition surfaces early in life, it often means that it will be more serious by adulthood unless steps are taken to nip it in the bud. "For almost any psychological disorder, early interventions do more for improving long-term prognosis than anything else," says O'Connor.

How to determine if your preschooler should be evaluated for depression? Shah and O'Connor say the following symptoms should set off alarm bells, particularly if they don't seem to be precipitated by any specific school- or home-related event.

Agitation and anxiety. For young children, a mood disorder doesn't necessarily manifest as melancholy; rather, the child may become easily agitated or appear increasingly anxious, worrying excessively.

Declining school performance and attendance. An unexplained dip in academic marks or worsening classroom attendance and behavior should always be cause for concern.

Child Support

Find out more about the UCLA Program for the Enhancement of Achievement, Behavior and Cognition, including day treatment programs and other support for kids 3 to 12 years old. Visit at www.mednet.ucla.edu or call (310) 825-0210.

Physical ailments. A depressed child may experience increased aches and pains, real or imagined. As with depressed adults, fatigue also is a common symptom.

Changes in eating and sleeping. Increased or depressed appetite, sleeplessness or a sudden tendency to stay in bed could signal an underlying mood issue.

Withdrawal from friends. It may not be a rift so much as merely declining interest in getting together with friends, or less engagement when around them.

Loss of enjoyment. The psychological term anhedonia, characterized by an inability to experience pleasure from life's enjoyable moments, often applies to children with mood disorders.

Hopelessness. Depressed children may feel like nothing is going to get better. They stop thinking about the future. For example, not knowing what they want to be when they grow up because they think they're not going to. Even among children as young as age 5, O'Connor says, any talk of suicide should be taken very seriously.

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