Tuesday, June 14, 2011

Diagnosed at 3

Since the hospital I work for accepts children ages 3-17, I get a lot of questions about just how a 3 year old can be diagnosed with depression.  It seems absurd that a 3 year old would have enough awareness of the world around them to be depressed, right? If you think about it, most of the  core symptoms of depression are developmentally broad. Sadness, irritability, absence of joy are all hallmark indicators of a depressed state. When you keep in mind the overall mood state of small children is joyfulness, the clinical picture is batter established. Child psychiatrist Dr. Joan Luby has been involved in studying preschool depression for the last 2 decades. Her research and experience contradicts the notion held by developmental psychologists that very young children do not have the  emotional or cognitive competence to be depressed.  IN fact, according to recent research, preschoolers not only show some of the same symptoms of depression as adults, but  they also show similar brain patterns when scanned using functional MRI. The scans showed an increase in the  right amygdala, just like in adults.
Additionally, the experience of depression in very early childhood seems to leave and enduring mark on the brain which makes these kids more likely to be depressed later in life. If we can  find the markers for depression early in childhood, it would open the door to early intervention which could minimize the emotional and cognitive impact. To further illustrate this point, when researchers asked  depressed adults when they first started feeling depressed, they very often report being depressed most of their lives. What to look for? In terms of mood and temperament, look for a lack of exuberance and joy in situations where most children would get very excited. Feelings of fearfulness and and sadness will stand out.  Most of these kids may have a depressed parent. These items may indicate depressed symptoms  later in childhood.  Parents should pay attention to their kids. If your child is persistently irritable, sad and does not brighten in play activities or when  experiencing fun and exciting things this should be just as concerning as a child who acts up in preschool.   Pre-schoolers get kicked out of their schools for disruptive behaviors, usually involving violence towards other kids, while the very quiet depressed child may not be seen as having a problem.
When considering treatments for a very young child, medications can be helpful, but other interventions should be tried first. Play therapy can be helpful. There is some indication that a guided play therapy involving the parent may be especially helpful.  The use of medications in small children has not been studied long enough to know the long term effects on the developing brain, although at least 7 antidepressants are commonly prescribed for children. If medications are necessary,   they should be prescribed by a board certified child and adolescent psychiatrist who will see the child every week to evaluate for side effects and effectiveness of the medication.

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