Children as young as 3 can be clinically depressed, and often that depression recurs as kids get older and go to school. It also can reappear during adolescence and throughout life.
But it is possible to effectively treat depression in these children. New research demonstrates that an interactive therapy involving parents and their depressed children can reduce rates of depression and lower the severity of children’s symptoms.
“By identifying depression as early as possible and then helping children try to change the way they process their emotions, we believe it may be possible to change the trajectory of depression and perhaps reduce or prevent recurrent bouts of the disorder later in life,” says psychiatrist Joan Luby, MD, principal investigator of the Washington University School of Medicine study and director of the university’s Early Emotional Development Program.
Luby’s team adapted a treatment known as Parent-Child Interaction Therapy (PCIT) that was developed in the 1970s to correct disruptive behavior in preschoolers. The adaptation involved adding a series of sessions focused on emotions. “We consider depression to be an impairment of the ability to experience and regulate emotions,” says Luby.
The 18-week, 20-session therapy program begins with a truncated version of the traditional PCIT program, then focuses more on enhancing emotional development. “For example, we coach parents to manage a child’s emotional responses to stressful situations,” Luby notes.
One activity designed for the study places a child in a room with a package; the child is asked to wait to open it. The parent, in the room with the child, wears an earpiece and is coached by a therapist observing through a one-way mirror. The goal is to give children tools to keep their emotions under control and train parents to help their children reinforce those tools.
Luby’s team studied 229 parent-child pairs. Children in the study were 3 to 7 years old and had been diagnosed with depression. Half received the adapted therapy, called PCIT-ED.
Compared with children who were placed on a wait list before starting the therapy, those who received the intervention right away had lower rates of depression after 18 weeks and less impairment overall. If depression continued after the treatment, it tended to be less severe than that seen in the kids who had not yet received therapy.
Luby says children in the study will be followed to see how long the effects of the therapy last. Her team is analyzing data gathered three months after treatment ended to see whether improvements were maintained or whether any depression symptoms had returned by that point. The researchers hope to follow the children into adolescence to see whether intervention in early childhood provides sustained benefits.
Interestingly, the researchers also found that symptoms of clinical depression improved in the parents who worked with their children during the study. “Even without targeting the parent directly, if a parent has been depressed, his or her depression improves,” Luby says. “It previously had been demonstrated that if you treat a parent’s depression, a child’s depression improves, but this is powerful new data suggesting that the reverse also is true.”
And, Luby adds, the therapy program can be delivered by master’s degree-level clinicians. “This is a therapy that could be widely disseminated,” she says. “Since it only takes 18 weeks and doesn’t require a child psychologist or psychiatrist, we think it would be highly feasible to deliver in community clinics from a practical standpoint and in terms of cost.”