KIDS
September 23, 2009

Even Toddlers Get The Blues

Depression is not something one sees often in toddlers, but it does exist. It’s useful to intervene early, before depressive patterns become...

Toddlers are cheerful and fearless explorers who run instead of walk and dance instead of standing still. They experiment with new skills, learn the power of words, and enjoy delighting their parents with their humorous antics. Usually. But some toddlers actually experience depression, similar to that seen adults. Clinicians used to think that toddlers didn't have sophisticated enough thinking skills to experience "true" depression, but that perception has been challenged by several studies.

...[P]reschoolers, whose thinking, reacting, and emotional pathways are still developing, may respond very favorably to interventions that prevent emotional problems from becoming deep−seated.

What does a depressed toddler look like? He may be irritable, sad, or tearful. He may be unable to enjoy activities that used to be fun. Her weight may have changed and she may have difficulty sleeping. She may complain of fatigue or act tired. He may feel guilty. He may not seem to be thinking as clearly or learning as readily as he used to. She may be thinking and talking about death.

When doctors evaluate a patient for depression, they use specific questions to elicit the types of symptoms and feelings associated with depression. The same type of questionnaire, with just a few modifications to fit the toddler's daily experience, has been shown to accurately reflect depression in toddlers. For example, difficulties with one's work or professional colleagues can be seen in depressed adults, but for toddlers, whose work is play, questions are focused on playtime behaviors and interaction with peers. When a person is depressed, there are characteristic changes in the stress hormone levels. These same changes have been seen in depressed preschoolers. This finding adds support to the idea that toddler depression is analogous to and as real as adult depression.

Early intervention in patients who are prone to or experiencing psychiatric symptoms can improve long−term outcomes. Environmental and behavioral interventions to increase resilience and decrease the behaviors or thoughts keeping the depression or anxiety going can affect brain chemistry in a positive way. The idea is that preschoolers, whose thinking, reacting, and emotional pathways are still developing, may respond very favorably to interventions that prevent emotional problems from becoming deep−seated. It is this hope, that effective early intervention can prevent long−term problems, which has fueled the desire for the earliest possible accurate diagnosis of psychiatric problems.

A recent study in the August issue of the Archives of General Psychiatry has shown that preschool depression, similar to depression in older children and adults, can have either chronic (longstanding), or recurring symptoms. Preschoolers who were depressed at the beginning of the study were four times more likely to be depressed 12 and/or 24 months later than non−depressed children. Children who are particularly vulnerable to depression may have a genetic predisposition for this condition, or they may show other psychiatric disorders, such as disruptive disorder, during childhood. They may also have experienced stressful life events such as parental separation or divorce, death of a pet, birth of a sibling, change in daycare, death of parent, abuse, removal from home.

A child who is unhappy because she didn't get a cookie, or who didn't sleep well because of bad dreams is not depressed. Concerned parents can help their preschoolers by being aware of their behavior and moods and getting feedback from their preschool teachers or babysitters. They can ask the care providers whether the child seems to enjoy herself during the day, whether he interacts with the other children, whether she is restless or irritable, and how he copes with the sandbox stresses such as learning to share and waiting your turn. Parents should also be aware that events and experiences can impact their child's mood more than they realize. Often toddlers don't talk about the things that are troubling them, and parents may think they are unaware. Gentle comments or questions, (“Gee, Mr. B was a good cat, wasn’t he?” “Grandma would have liked this, wouldn’t she?”) when stressful events are occurring can help bring feelings out. Parents can also seek counseling to help their children cope with unavoidable life stressors. They should bring their concerns about depression or other mood problems to their child's physician and, if appropriate, have the child evaluated by a clinician who specializes in pediatric behavioral/psychiatric issues.

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