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Children's Health

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Depression Affects Kids as Young as 3

When Preschoolers Are Depressed, Play Therapy, Not Medication, Is in Order, Researchers Say

Recognizing Depression in Preschoolers continued...

An inability to enjoy the typical play a preschooler enjoys is another warning sign, Luby says.

A general ''lack of joy" about life also warrants investigation, she says. Preschoolers can also have changes in sleep and appetite and their activity level, compared to their playmates.

If symptoms persist over a period of a week or two, it's time to seek help, Luby says.

Among experts, she says, there is a question about whether the two-week duration of symptoms normally considered worrisome for adults -- and a signal that it's clinical depression, not just the temporary blues -- should apply to children.

She tells parents to seek help if their child's symptoms are intense and continue over a week or two, even if the symptoms are not constantly present over that time.

''Children have a natural buoyancy," she says, so the symptoms may come and go more than they might with adults.

Depression in Preschoolers: Seeking Help

Where should worried parents turn for help? "You could go to the pediatrician, but you might have to educate your pediatrician a bit," Luby says, noting that not all are aware that depression can strike as young as age 3.

Parents might also seek help from a mental health provider, she says.

Although antidepressant medication is a mainstay of treating adult depression, it should never be given to preschoolers, she says. "Absolutely not to medication," she tells parents. It's not been tested in young children.

''Psychotherapy is recommended," she says, "in the kids' case, play therapy."

Luby is in the process of testing a modified version of a treatment called Parent-Child Interaction Therapy or PCIT that was originally designed for children with a conduct disorder.

In PCIT, parents of children with conduct disorders are taught to work with the child to improve pro-social behavior and reduce negative behavior. Luby is testing a version that focuses on teaching parents to enhance a child's emotional development. The thought is that early changes in emotional development skills could help with the depression.

She is hoping that early intervention will prove more effective than waiting and that the gains will be sustained in later childhood. She is studying the approach with 300 children, including some with depression, some with other mental health issues, and some healthy comparison children.

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