Preschool
children with depression exhibit typical
symptoms
Depression
in children has been thought to be characterised
more by indirect symptoms such as stomach ache
than sadness or lack of enjoyment. A study
investigated the clinical features of depression
in preschool children from 3 to 5 years old.
A sample of 174 children aged 3.0 to 5.6 years
from community and clinical sites were given a
comprehensive assessment including an
age-appropriate psychiatric interview for
parents. Typical and masked symptoms of
depression were evaluated. Three groups were
studies; depressed children who met all criteria
for major depressive disorder (MDD) except
duration (which may be less than two weeks in
preschoolers), children with a non-affective
psychiatric disorder who met DSM-IV criteria for
attention-deficit/hyperactivity disorder
(ADHD)and/or oppositional defiant disorder (ODD)
and a third group with no pychiatric disorder.
An age-appropriate puppet interview was used for
the child to identify the puppet that best
expresses his or her own emotion. Observation of
other play schemes which induce emotions from
joy to frustration were also used.
Depressed preschool children exhibited typical
symptoms and vegetative signs of depression more
often than non-affective or masked symptoms.
Anhedonia was a specific symptom for depression,
while sadness and irritability strongly related
to MDD. In general symptoms of depression such
as anhedonia, sadness, irritability, low energy,
low self-esteem, tearfulness, and play themes
involving death were more common in MDD than in
ADHD or ODD children. Comorbidity was high in
these preschool children, 42% had depression and
ADHD, 62% depression and ODD, 41% depression and
both ADHD and ODD, and 29% depression and
anxiety disorders.
These findings emphasise the importance of
looking for typical MDD symptoms and
vegetative signs when assessing preschool
children for depression. At that age the child
development is very rapid and being depressed
for a long period of time may be an impairment
in the normal development. J
Am Acad Child Adolesc Psychiatry 42: 340-348,
2003