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    Childhood Depression Clues Found in Play

    How Preschoolers Play Can Indicate the State of Their Emotional Health

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    Some say that Luby's study provides the latest pieces to solving the puzzle of diagnosing and treating depression in patients under age 6, on whom antidepressant medications haven't been tested and are rarely administered.

    "This is a very helpful finding because we need to learn more about how to diagnose and treat depression in younger children," says psychiatrist David Fassler, MD, of the University of Vermont College of Medicine and author of Help Me, I'm Sad, a book about childhood depression. "The real message for parents is that depression in children this young is very real. When we identify and diagnose depression in school-aged children and go backwards, we often find there were signs and symptoms at a much earlier age, even in preschool."

    With early diagnosis, childhood depression can be more effectively treated -- which for preschool-aged kids often involves individual and family counseling as well as "play therapy," in which the child is encouraged to draw or act out feelings of despair.

    What causes childhood depression to occur? It may be a family tradition, says Luby. "Most studies indicate that depression runs in families, but it's not clear whether it's primarily caused by genetics or environment."

    But others believe that childhood depression is extremely rare in a typical nurturing and functioning family and can usually be traced to a specific cause.

    "The type of depression that seems to come out of nowhere usually doesn't kick in until about age 8 or 9," says Glen R. Elliott, MD, PhD, director of the Children's Center at Langley Porter Psychiatric Institute at the University of California, San Francisco. "In children this young, there is usually a significant disruption in the child's environment -- a divorce, the death of a parent, moving to a new location, or something like that. If not, we typically look to see if the child has been neglected or abused."

    When preschoolers suffer a family death, divorce, or other situational trauma, they should be expected to display depressive symptoms. But these symptoms usually resolve after several weeks.

    "You may need some help helping your child adjust -- and play can be very useful," Elliott tells WebMD. "Letting kids draw what happened and then thinking about other possible endings may be helpful. For instance, after the earthquakes here in which some children lost their families, that therapy was used and proved to be very beneficial. But if you see a sudden change in a preschooler's behavior or overall involvement in play or other activities that cannot be explained, it may be something to worry about."

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